Improving Maternal Outcomes Starts with Knowing Why

According to the CDC, 80% of pregnancy-related deaths can be prevented; that’s a 20% increase from previous years. Know why?

That’s actually the theme for today’s Maternal Health Awareness Day: “Know Why.”

Maternal Health Awareness Day shines a light on the many complex factors contributing to maternal health deaths and amplifies promising initiatives to combat the rising rates of maternal morbidity and mortality.

As a mother of three children, including a five-month old, and senior program manager for AHA’s work on maternal health, this issue hits close to home.

This year’s Maternal Health Awareness Day highlights strategies health care organizations are spearheading to tackle the leading causes of maternal deaths: mental health conditions and cardiac and coronary conditions. Hemorrhage is considered the second underlying cause of pregnancy-related deaths. These conditions not only come to surface during pregnancy but are more detrimental during the postpartum period. Data show 53% of pregnancy-related deaths occur up to one year postpartum.

Prevalence of these conditions differ by race and ethnicity.

After digging deeper, here is what I’ve learned:

• Since COVID-19, many women in the U.S. report needing mental health services, but either don’t have access to available and affordable mental health services or fear/avoid seeking treatment.
• Cardiac and coronary conditions are prominent in non-Hispanic Black individuals, who are already subjected to health care disparities leading to poorer maternal health outcomes. Additionally, mental health conditions was the leading underlying cause of death among Hispanic and non-Hispanic White women; and hemorrhage for non-Hispanic Asian individuals.
• Many women are unaware of warning signs and risk factors for cardiac and coronary conditions.
• Women, who make 80% of household decisions, often dismiss their own need for medical attention.

Being 5 months postpartum, these statistics terrify me. But I am comforted that hospitals and health care organizations are increasingly addressing these challenges by implementing strategies focused on “knowing the patient.” This may include:

• Identifying risk factors for mental and cardiac health conditions. For example, Northshore’s Perinatal Depression Program administers a universal perinatal depression screening to all pregnant and postpartum women, at every appointment. While The Children's Hospital of San Antonio obstetrics simulation program, Practicing for Patients, trains labor and delivery providers with simulation drills to better detect, manage and treat women who experience a postpartum hemorrhage or hypertensive emergency during pregnancy. Additionally, ACOG’s perinatal mental health toolkit offers strategies to help OB-GYNs and other women’s health care professionals address perinatal mental health conditions.
   
• Offering prevention and management measures. The AHA’s Better Health for Mothers and Babies initiative partnered with the federal Million Hearts 2027 effort to highlight ways hospitals are preventing cardiovascular diseases among pregnant and postpartum women. Learn how Hannibal Regional Healthcare and the Missouri Hospital Association partnered to provide blood pressure monitoring kits to at-risk women. Also, hear why Addressing the Burden of Hypertensive Disorders of Pregnancy is necessary for equitable maternal care. In addition to safety bundles on hypertension and cardiac conditions, the Alliance for Innovation on Maternal Health (AIM) will soon release its perinatal mental health bundle, further equipping hospitals with evidence-based education and tools essential for improving maternal outcomes.
   
• Extending postpartum Medicaid coverage. A recent study in Health Affairs showed ACA Medicaid expansion states reduced 60-day postpartum hospitalizations by 17%. The AHA supports the 39 states and Washington, D.C. that to date have expanded Medicaid coverage, and advocates for all to join. AHA was pleased Congress, in the fiscal year 2023 Omnibus Appropriations bill, permanently gave states the option to provide 12 months of Medicaid postpartum coverage to women. Currently 26 states and D.C. have taken up this option and we hope more will do so in the future.
   
• Assessing language and cultural preferences. The Centers for Disease Control and Prevention’s Hear Her campaign recently released resources to better identify and assess the needs of American Indian and Alaska Native People who are pregnant or postpartum. The campaign seeks to encourage partners, friends, family, coworkers and providers—anyone who supports pregnant and postpartum women—to really listen when a pregnant individual tells you something doesn’t feel right. Acting quickly could help save her life.
   
• Recognizing implicit bias. As part of AHA’s maternal health equity efforts, AHA members are using the film, Toxic: A Black Women’s Story, to spark conversation on how structural racism and implicit bias threatens maternal health. Learn about their experiences and best practices for using the film here.
   
• Providing coordinated care, extending into the community, to meet all types of needs. Many say it takes a village to raise a child and having a reliable support system in one’s neighborhood can help one thrive. Hospitals can partner with community-based organizations to implement AIM‘s Community Care for Postpartum Safety and Wellness Bundle. The bundle provides steps to create an ecosystem of clinical, community and social care for women, from birth to one-year postpartum.

Is your organization implementing strategies to improve health care outcomes for pregnant/postpartum women impacted by mental health and cardiac and coronary conditions? Use the hashtag #MaternalHealthAwarenessDay on social media to share your efforts and join the conversation on social media.

To eliminate maternal mortality, we must know why it happens. Let’s work together to learn and make changes, one day at a time.

Aisha Syeda, MPH, is a senior program manager for AHA’s Strategic Initiatives.