Most maternal deaths can be prevented. Here’s how California aims to cut them in half

[September 19, 2024]  By ANA B. IBARRA/CalMatters

After a rise in the rate of maternal deaths, California health officials have a new plan to keep new mothers healthy before and after birth. Their goal: cut pregnancy-related deaths in half by 2026.

Between 2019 and 2021, more than 200 Californians died during pregnancy, at childbirth or within a year of giving birth. That’s about 70 deaths a year, or one mother every five days.

While California has one of the lowest maternal mortality rates in the country, health experts say the number of deaths is unacceptably high. By some estimates, 80% of maternal deaths are preventable.

A new plan from California Surgeon General Dr. Diana E. Ramos calls for an educational campaign targeting patients and health care providers. It focuses on spreading awareness about the factors that contribute to pregnancy-related deaths. Ramos wants patients to become more active participants in their health, and for them to be able to identify potential medical risks even ahead of pregnancy.

For example, the blueprint calls for an accessible, at-home questionnaire to help expecting parents assess their own risk of pregnancy complications. It will allow them to self-screen for risks, such as preeclampsia and preterm births. The vast majority of maternal deaths in California are caused by heart disease, hemorrhage and sepsis or other infections, state data show.

For health care providers, the blueprint suggests universal adoption of a tool known as the Obstetric Morbidity Index. It’s meant to help evaluate maternal risks at any stage of pregnancy and it’s used in other countries.

Ramos launched an educational campaign, Strong Start and Beyond, on Tuesday in San Francisco. She was accompanied by First Partner Jennifer Siebel Newsom and by U.S. Health and Human Services Secretary Xavier Becerra.

The state’s push for improving its maternal mortality rates also comes as California is experiencing a wave of closures of labor and delivery wards. More than 50 have closed in the past decade, creating maternity care deserts around the state. A similar trend is happening nationwide.

California’s new blueprint doesn’t include funding or new programming. It aims to raise awareness about the role that someone’s overall health plays in a pregnancy, Ramos said. She also wants to draw attention to resources already available in communities — including access to doulas, now a covered benefit in the Medi-Cal program — as well as services available through counties, health systems and community groups.

“We have so many resources, but up until now, everyone’s been…doing their own thing, it’s been fragmented,” Ramos told CalMatters. “We’re bringing together all of these efforts, breaking down these silos and really elevating the amazing work that everyone is doing.”

Ramos said her office created the plan with disparities in mind. Black women have the highest maternal mortality rates in the state.

“The significance of the blueprint is that we are moving from identification of the problem to solutions that bring together hospitals, clinics, public health, all centered around the patient,” said Dr. Amanda Williams, an associate professor of obstetrics and gynecology at Stanford’s School of Medicine. She is also a member of the advisory group that helped put the blueprint together.

“Sometimes in medicine, we act like people spend their whole life in the office, clinic or hospital, but it’s not where they truly are,” she added. “And so if we want to make a dent in perinatal morbidity and mortality, we have to work collaboratively and we have to work with the community.”

Chronic illnesses are a leading factor in maternal deaths

Prior to COVID-19, about a quarter of all pregnancy-related deaths were associated with heart disease, according to data from the California Department of Public Health.

Ramos says one way to truly make a difference is to emphasize the importance of managing chronic conditions from before pregnancy to after birth. This includes high blood pressure, cholesterol and obesity, all which are linked to heart disease.

In 2020 and 2021, deaths in pregnancy and within the first year of giving birth shot up in large part because of COVID-19 infections, which are included in the data. During the peak of the pandemic, 31% of maternal deaths in California were linked to infections, mostly COVID.

State data show that 23% of deaths happen on the day of delivery, another 23% take place within the first six days from delivery, and 27% occur seven to 42 days after giving birth. This highlights the importance of postpartum care, Ramos said.

“Oftentimes, as a new mom, you’re exhausted, you’re tired…you ignore your health,” Ramos said. “The message we can get to any new mom is to keep their postpartum visit, because depending upon what their healthcare coverage is, whether you’re Medi-Cal, Kaiser, a PPO, your likelihood of keeping that postpartum visit is going to vary, and it’s often at that postpartum visit when any complications that occur during pregnancy are followed through.”

“The postpartum visit can help save a mom,” she said.

Disparities among Black moms continue

In California, Black mothers are three to four times more likely than other racial or ethnic groups to die from pregnancy-related complications. This disparity has persisted for years.

Experts say the inequity is due to several factors, including chronic stress created by discrimination and racism, unhealthy community conditions and a lack of access to high-quality health care.

Last year, the California Department of Public Health commissioned a report that found:

1. By the time of delivery, about one in five Black mothers were diagnosed with hypertension.

2. About one in four Black patients experience symptoms of depression during pregnancy — higher than other racial and ethnic groups.

3. Black women were more likely than other groups to report being untreated unfairly or disrespectfully while giving birth at a hospital.

4. Older women tend to experience higher rates of preterm births across all racial and ethnic groups. But Black women’s preterm birth rates start to increase at a younger age.

“Nobody is talking about maternal health in California without talking about issues of equity,” said Williams. That’s racial equity, but also financial and geographic.

State data show that mortality rates are also higher for women on government-funded insurance compared to people on private insurance. And when it comes to geography, the San Joaquin Valley has the highest rates of maternal deaths in the state.
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This story was originally published by CalMatters and distributed through a partnership with The Associated Press.

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