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Stanford University School of Medicine

How California reversed the national trend of rising maternal mortality

In the last 10 years, U.S. mothers have been dying in childbirth at shocking rates: Compared to other developed countries, three times as many U.S. women die during or shortly after pregnancy. Nationally, maternal death rates are still rising.

But, as an excellent new story in Vox explains today, California has successfully fought the trend. As of 2013, California women died during or shortly after pregnancy at a rate of 7.3 deaths per 100,000 live births, which is half the state's 2006 rate and a third of the current national rate.

The difference is largely due to the work of the California Maternal Quality Care Collaborative, a group of experts headquartered at Stanford who have been studying what causes pregnant women and new mothers to die. Early on, the CMQCC identified postpartum hemorrhage and preeclampsia (dangerously high blood pressure) as the leading preventable causes of maternal deaths.

The CMQCC team has also written evidence-based recommendations for treatment, such as their hemorrhage toolkit, and led on-the-ground efforts to prepare California hospitals for obstetric emergencies. The Vox piece gives an example:

One key idea in the hemorrhage toolkit was to make sure hospitals were armed with all the best protocols and necessary tools that might save those moms’ lives in the event of a bleed.

At St. Joseph hospital, [obstetrician and CMQCC founding member David] Lagrew showed me a simple beige, waist-high rolling cart with four drawers and red handles, known as “the hemorrhage cart.” Every hospital delivering babies should have one, the CMQCC toolkit says. The cart is filled with everything to manage a hemorrhage: medicines that slow the flow of blood, instruments that repair a tear or laceration, intrauterine balloons that can provide pressure and control bleeding from a uterus that isn’t contracting well.

“Minutes count, so you can't afford to be thinking, ‘Hey, what med do I need to use next? Where do I find a balloon catheter to stop the bleed?’” Lagrew says.

Although the CMQCC is now working to share their successes with other states, recent political turmoil around health care could send maternal mortality rates higher, the story says:

Senate Republicans are pushing to repeal and replace Obamacare with the Better Care Reconciliation Act. It could make it harder for American women to access reproductive health care and family planning services. It’ll make maternity benefits optional for private health plans, and defund Planned Parenthood — where 2.5 million Americans access family planning and maternity care services.

The Better Care Act would also gut Medicaid, which covers about half of all births in the US. If the GOP plan passes, the nonpartisan Congressional Budget Office expects it will result in more unplanned pregnancies and 22 million people losing their health care within a decade.

For a preview of what this could do to women’s health, look to Texas, which has the highest maternal mortality rate in the developed world. There, 36 moms die per 100,000 births, or five times California’s maternal mortality rate. Texas has also closed down Planned Parenthood clinics and rejected Medicaid expansion — changes the GOP would like to see ripple across the US. The state boasts the largest uninsured population in America.

The whole piece is worth a read.

Previously: New obstetric hemorrhage tool kit released today, Teaching Chinese clinicians about maternal hemorrhage management and Attending to signs of preeclampsia in late-stage pregnancy
Photo by Howard Ignatius

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