Last week, tennis superstar Serena Williams opened up about her post-birth complications that could have ended in tragedy. Despite being a VIP at a top hospital, Williams had to be her own advocate to get her clinicians to take fast action to address a pulmonary embolism that could have killed her. Williams knew she had a clotting disorder, recognized the symptoms, and insisted that doctors and nurses give her what she needed – a CT scan and a heparin drip (while they were focused on side effects of pain medicine and an ultrasound of her legs). How many patients would be educated and strong enough to do the same?
In the United States, the number of maternal deaths has actually doubled over the past 20 years. And, a CDC Foundation analysis found that close to 60 percent of these maternal deaths were preventable. We’ve made great strides elsewhere in health care during this time – for instance, mapping the human genome which has allowed scientists to isolate genes that cause specific diseases and create targeted treatments to address them. But, we’re failing women and their families with a maternal mortality ratio that is higher than nations such as Iran, Syria, Ukraine, and Jamaica (and among only 20 nations in the world to have seen an increase in maternal mortality over the past 20 years – 12 of these nations are in sub-Saharan Africa).
What is the root of the problem and what can we do about it?
Lack of Communication
The research points to a lack of communication about post-birth complications to new mothers. Focus groups in New Jersey and Georgia, two states with high rates of maternal mortality, revealed that postpartum nurses spent most of their time educating moms about how to care for their new babies, not themselves. The information that they did receive about health risks was inconsistent and often incorrect. Many post-birth complications do not happen until after women have been discharged, so the education piece is key. Overlooking signs of common complications like heart attack, blood clots, excessive bleeding, infection and stroke could be deadly. While women are supposed to follow-up with their OB/GYNs six weeks post-delivery, up to 40 percent of new moms never go back for their follow-up appointments, and too many women die or suffer near-death complications in the interim.
One reason that many clinicians avoid the conversation about risks? The author of a study published in the November issue of the American Journal of Maternal/Child Nursing found that some nurses were uncomfortable discussing the possibility that complications could be life-threatening, saying, “’Well you know what, I don’t want to scare the woman. This is supposed to be a happy time. I don’t want to seem like all I want to talk about is death.’ ”
Ignoring the Magnitude of the Problem
The picture of maternal mortality in the U.S. is still fuzzy – for a variety of reasons, the United States has not published an official maternal mortality rate since 2007, leading to a deficit of information both nationally and internationally. Some believe the information that we do have is actually an undercount, because it’s difficult to track hospital readmissions for childbirth-related ailments. More troubling perhaps is that we are not focusing on why new mothers are dying and working to address these issues on a systemic level – hospital and government authorities often do not investigate why the new mother died and complications that are not fatal are even less likely to be examined.
Lack of Knowledge Among Health Care Professionals
The November study of postpartum nurses featured in the American Journal of Maternal/Child Nursing revealed startling statistics:
- Nearly half of the nurses who responded to the survey were unaware that maternal mortality has risen in the U.S. in recent years, and 19 percent thought maternal deaths had actually declined.
- Only 12 percent of the respondents knew that the majority of maternal deaths occur in the days and weeks after delivery.
- Only 24 percent correctly identified heart-related problems as the leading cause of maternal death in the U.S.
- Cardiovascular disease and heart failure — which, according to recent data, account for more than a quarter of maternal deaths in this country — were the area that the nurses felt the least confident in teaching about.
Studies show that educating clinicians about life-threatening obstetric complications works – the California Maternal Quality Care Collaborative created a series of “toolkits” to help doctors and nurses improve their handling of emergencies. Hospitals that adopted the toolkit saw a 21 percent decrease in near deaths from maternal bleeding in the first year; hospitals that didn’t use the protocol had a 1.2 percent reduction. By 2013, maternal deaths in California fell to around 7 per 100,000 births, similar to other developed nations.
But, we’re faced with the challenge of inertia – in California, half of the 250 hospitals that deliver babies still are not using the toolkits. Many hospitals blame a lack of resources. A small hospital that delivers 500 babies a year may see one maternal death every 10 years, but that doesn’t mean it shouldn’t be a priority. Systemically, change takes longer than it should. According to the Institute of Medicine, it takes an average of 17 years for a new medical protocol to be widely adopted.
The Path Forward
Most people will agree that the maternal death rate in the U.S. is unacceptable. As health care marketers and communicators, we can help impact change:
- Talking to women, early and often – Pregnancy and childbirth should be a joyful time, perhaps the only time that you are happy to be in the hospital, but let’s not be afraid to have conversations about potential complications. These conversations should happen before, during, and after pregnancy and not just at discharge.
- Educating clinicians – especially nurses, who are on the front line – Research shows that simply educating nurses with short, targeted information can make a difference in helping patients recognize worrisome symptoms. It’s also obviously important for doctors and nurses to recognize and address distress signals and symptoms – researchers who have analyzed maternal deaths and near deaths have noted that “delay and denial” is generally the problem.
- Addressing systemic change – Merck has taken steps to impact maternal mortality in the U.S. and around the world with Merck for Mothers, a 10-year $500 million initiative focused on improving the health and well-being of mothers during pregnancy and childbirth. Imagine what could happen if more organizations committed to focus on maternal mortality.
If we can map the human genome and discover a vaccine for breast cancer, we should certainly be able to ensure that women in this country are safe in childbirth. This is a clinical challenge, but as communicators, we are empowered to make a difference through awareness and education.
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