“Countries that have far fewer resources than we do (in the United States) make maternal care a priority. Because we don’t, we suffer the consequences,” said Jacquelyn McMillian-Bohler, who leads educational excellence at Duke University’s School of Nursing.
She said those consequences include premature births and births that could lead to unnecessary interventions and higher mortality rates.
The delivery is much more deadly in the US than in many other high-income countries such as Australia, Japan and Spain. In North Carolina and across the country, black women are most at risk of dying from complications related to pregnancy.
Why that is — and what can be done to improve the odds — was the topic of Wednesday night’s EQUALibrium Live forum hosted by WFAE and the Novant Health Foundation.
“Underneed suffering” is how obstetrician Dr. Novant’s Jaleema Nanton Speaks formulated this statistic from the Centers for Disease Control and Prevention: More than 80% of maternal deaths are diagnosed by the CDC may be preventable.
Black women in the US are two to three times more likely to die of complications due to pregnancy. American Indian women also have a much higher maternal mortality rate.
“If we can reconcile that, I think that’s what maternal health equity looks like,” Speaks said.
The maternal mortality rate for Hispanic women is slightly higher than white women, who have the lowest rate.
Obstacles to good maternal care in North Carolina
There is a shortage of maternal health care providers in North Carolina, said Rebecca Severin, supervisor of the maternal health innovation program at the state department of public health. She said that while the state is on track to expand Medicaid, it has gone nearly 10 years without any challenges.
“There is a problem with access for some people to get the care they need. And then you consider that 80% of North Carolina counties are considered rural,” Severin said.
Eleven hospitals nationwide have closed since 2005, according to UNC-Chapel Hill’s Shep’s Center for Health Services Research. Others have closed maternity wards.
All panelists agreed that racism was a key factor in higher maternal mortality.
McMillian-Bohler said it can creep into medical school. She gave an example of a textbook she reviewed a few years ago that said that a black person can exaggerate pain.
“All these things are taught as truthful things. It’s in the textbook, so it must be. And then we are released into the world to practice. And so you can see how this would affect not just someone who doesn’t share the identity, but all practitioners,” McMillian-Bohler said.
Finding solutions — training, recruiting, speaking up
There are many efforts in North Carolina to improve maternal health care and close gaps. That includes setting objective standards about how to respond to issues like sepsis or bleeding, Speaks said. That is part of the work of a network of providers called the North Carolina Perinatal Quality Collaborative.
“So it’s not for a healthcare provider like myself to, sort of, estimate or guess whether that blood pressure is okay or acceptable, whether there are objective measures and standards of care in place so that we apply them equally and fairly to our patients,” said Speaks. .
Those efforts also include more training for nurses and doctors, recruiting more people of color into maternal health care, and making midwives and doulas more accessible to provide information and support.
Before births moved to hospitals, McMillian-Bohler noted that midwives were the standard of care.
“Having someone who was from your community, who was like you, who shared your experience was something that was possible,” McMillian-Bohler said.
Two young Cherokee women who formed the Selu Mothering Project on the Qualla Boundary are seeing good results, said Lisa Lefler, who directs culture-based Native Health Programs at Western Carolina University.
“They can actually speak in a way that their young native mothers understand. They are able to address some of the other issues for the mothers and help them get good food for their baby,” Lefler said.
Another solution: Speak up and help family and friends understand their options when it comes to pregnancy and childbirth. As McMillian-Bohler said, after all, you know your body best.