It's hard to imagine that in a state with as many hospitals as New Jersey has, how can we be one of the worst states for maternal deaths. How does this happen? Costa Rica has better outcomes than New Jersey does. Our NJ mothers are dying at the rate of 37 per 100,000 live births, putting our state between the countries of Georgia and Uzbekistan both having 37 maternal deaths per 100,000 live births and Mexico at 38 deaths per 100,000 live births. The national U.S. average is 20 deaths per 100,000 live births. The highest number of deaths is occurring in African American women who are 5 times more likely to die from complications of childbirth. The disparity between white infant deaths and black infant deaths is concerning. While the death rate has slightly improved, 1 in 1,000 white babies dies while black infant deaths is 9.7 in 1,000 live births.
So why is this happening? How do we improve the health of our moms and save lives?
One of the biggest barriers has been lack of access. As an emergency room nurse in Newark, NJ I witnessed first hand the provider desert that exists in areas of lower socioeconomic areas. Women who found out they were pregnant in the ER would be scheduled for the hospital clinic, which could take up to three months. By the time the patients got into the clinic they could be in their third trimester. Clearly this delay in care can have serious impacts on both the health of the mother and fetus.
Risk factors related to maternal complications associated with maternal death include: obesity, lack of early prenatal care, high blood pressure, diabetes, smoking and drug use.
As New Jersey's maternal death rate was on the rise so was the opiate crisis. Many of the risk factors mentioned above are avoidable or manageable, meaning that deaths are avoidable.
State, county and local agencies need to take a hard look at this crisis. Avoidable maternal complications often result in premature births which can result in long term complications for the baby if it survives. In the U.S. 1 in 10 babies is born premature, before 37 weeks., roughly 10% of all babies born in New Jersey are born prematurely. Nationally preterm births cost $26 billion dollars, 50% of preterm births were insured by state funded Medicaid. Not only is the cost of preterm birth and issue, but loss of household income is directly associated with premature birth, as is the increased cost of education for the child.
While every premature birth, fetal death and maternal death may not be avoided, it is clear that there is relationship between avoidable risk factors and poor outcomes. Access to care and early prenatal care is found to positively impact this crisis.
In addition to the care for the mothers, it is also important to ensure that nurses and providers are adequately trained on recognizing and treating maternal complications. Many postpartum nurses spent time teaching new moms about how to care for their baby, but little if any time was spent on warning signs for the mother's own health. In my own experience in the ICU I have care for moms who were transferred to the ICU that were very sick, yet knew very little about what was happening to them and the course of treatment. In my ICU it is policy that any nurse caring for a maternal fetal patient, meaning a mom who is pregnant or recently delivered, who is admitted with and infection such as sepsis, preeclampsia or heart failure, must have completed specific training. I have been in my ICU for almost 3 years and the class has never been offered to me, yet I have cared for these women. Thankfully there are podcasts and online education that allows me to learn about these serious complications. We are failing the women of New Jersey.
For more information read the propublica article The Last Person You'd Expect to Die