Mamas on Bedrest: Research and Practical Efforts Aimed At Improving Maternity Care!

April 12th, 2013

Hello Mamas,

I have to confess, I’m having a moment of Geek. I received an article link from a former Mama on Bedrest and the Geek in me has been jumping up and down as I am reading it. Finally, researchers here in the United States are taking notice of the fact that intra partum maternal mortality rates are atrocious and they are doing something about it!

Now you are probably saying, “What has that got to do with me, a Mama on Bedrest?” Well, it has everything to do with you! It means that physicians, researchers and hospitals around the country are making changes to ensure that if you have a complication during your labor and delivery, you don’t die from it. In my book, that’s a pretty big deal!

Okay, this is not exactly a sexy topic. It’s not, “4 Ways to better prop yourself up on pillows while on bed rest,” or some other topic that is immediately associated with your current situation. It’s not soothing, it’s not comforting. Yet it’s extremely important. It’s the nuts and bolts of maternity care. Its looking at a grave situation-maternal mortality in the United States (which is worse than any other industrialized nation by the way  and 3-4 times worse in African American women!)-and saying, “We’re going to fix this!!” The good thing is that when American physicians and researchers put their minds and energy into improving outcomes, things typically do improve! (Look at how care of preterm infants has vastly improved, assisted reproductive technology allows women to become pregnant in the first place, and all the advances in perinatal care if you want examples!)

So what is the article saying-Exactly?

The article is from the St. Louis Post Dispatch and asked the question, “Why are so many US women dying during childbirth?” The doctors and researchers in this article, all from the St. Louis Missouri area, began looking closely at cases of maternal intra partum death and came up with the following reasons and solutions:

  • Preconception counseling or at least very early prenatal counseling is important-especially in women with pre-existing conditions and/or riskfactors for complications.
  • Pregnancy has become increasingly risky because of  the prevalence of obesity, Type 2 diabetes, hypertension and cardiovascular disease; more older women having children; advancements in fertility treatments resulting in twin births; and the high rate of C-sections. All of these issues must be addressed early and aggressively, from start to finish during pregnancy.
  • Researchers and high-risk pregnancy specialists say an important step is stratifying maternity care, parallel to what has been adopted in the care of high-risk newborns. Higher-level hospitals would have the specialists and infrastructure needed to take care of complex (maternal health) cases, help institute guidelines to improve care, and consult with lower-level hospitals on complex cases. They note that often a mama and her baby are transferred to another hospital to care for a sick, fragile infant, forgetting that the infant is ill because the mama is also in poorer health. Care must start with mama!!
  • Physicians and hospitals must be continually evaluating their outcomes and making adjustments to improve care. Complication protocols must be instituted and everyone must be trained in these protocols. Doctors and staff who fail to comply must be “reined in.”
  • What hospitals can also do, many say, is promote spontaneous, vaginal births — the safest for mothers and babies. One procedure or drug increases the risk for another, often causing a cascade of interventions that ends with a C-section. In the U.S., the C-section rate has skyrocketed to 33 percent of all births. The World Health Organization says it should be closer to 15 percent.
  • Consider using more Midwives and for uncomplicated births. Their low-tech approach has been shown to reduce C-section rates and improve other health outcomes.
  • More research and study needed to understand the causes and treatments of potentially catastrophic maternal conditions. Even if a complication is rare, there should be protocols in place  every part of the health care team should be educated on the condition and the protocol and know what to do in the event of a catastrophic event.
  • Statewide maternal mortality review committees (and a national registry??) made up of key players in prenatal, childbirth and postpartum care are being instituted. Committees regularly review deaths to gain insight on warning signs, prevention and treatments. Such committees exist in Illinois and Missouri and the Illinois committee is the model for several other committees forming around the country. Federal legislation proposed two years ago to beef up state maternal mortality committees stalled, but nationally, there is a bigger effort around improving care than there ever has been before by government, doctors groups and researchers.

The wheels of change are slowly turning and finally there is emphasis on the health of mamas! I’ve said my goal is to put myself out of business. Hopefully with these changes in maternity care, that desire is not long off!

Leave a Reply

Your email address will not be published. Required fields are marked *