Rate of maternal morbidity sounds alarms

Listen to this article

Pennsylvania has seen an alarming rise in severe maternal morbidity rates among patients hospitalized for delivery.

Dr. Margaret Larkins-Pettigrew, senior vice president and chief clinical diversity, equity and inclusion officer for Highmark Health, said Black women die at a rate three times higher than white women and Black babies die twice as frequently as non-Black babies.

“That number should be zero,” she said emphatically.

That said, Larkins-Pettigrew said at issue is those who survive labor and delivery but are left with lifelong health issues, an increasing problem that needs to be addressed.

Those increased health issues increase the overall cost of health care, she said.

The Pennsylvania Health Care Cost Containment Council (PHC4) said severe maternal morbidity includes unexpected outcomes of labor and delivery that result in significant consequences to a woman’s health.

In a report earlier this year, PHC4 said the rate of severe maternal morbidity in Pennsylvania increased 40% from 2016 to 2022 and Black women, women between 40 and 55 years old, women insured by Medicaid, and women from zip codes with poverty rates over 25% were most affected.

Larkins-Pettigrew said morbidity can lead to mortality, but when it doesn’t, it leaves women with lifelong health issues.

“The pregnancy journey starts with prenatal care,” she said. “If a woman has a chronic illness, she needs to get it under control because pregnancy decreases the immune system and produces ‘hyper hormones’.”

Nicole Stallings, president and CEO of the Hospital and Healthsystem Association of Pennsylvania (HAP), said maternal health is a priority.

“The data is concerning,” she said. “We are creating a plan of action to identify programs, policies and partnerships to accelerate and improve health outcomes for moms and babies. It’s an all hands approach.”

Stallings said providers, payors, the government and other organizations are “digging into the data” to find the disparities so changes to policies can be made.

Both Stallings and Larkins-Pettigrew said physicians, while they may not be aware, can create barriers to treatment through unintentional bias.

“If you don’t have a partnership, your voice can’t be heard,” Larkins-Pettigrew said.

She explained that if a physician doesn’t understand the culture of the patient, communication can be hindered, and proper care may not be forthcoming.

“Women shouldn’t be fearful of pregnancy,” Larkins-Pettigrew said. “Even if a woman Is healthy, if she gets preeclampsia, if it’s not taken care of, she could lose the capacity to live a full life.”

Larkins-Pettigrew said, too, if a woman goes into renal failure, she could be subject to dialysis for life.

Another statistic she cited is that 50% of women who get gestational diabetes will develop diabetes later in life.

“The first thing we need to do is acknowledge how we got here and create a path to change,” she said.

To that end, Highmark has established a Women’s Institute that looks at the woman’s journey and offers programs for chronic illness and postpartum clinics that follow patients in their communities.

Highmark has also helped establish First Steps and Beyond, which is designed to decrease Black infant mortality rates, reduce preterm birth rates, increase knowledge about safe sleep recommendations for infants and provide additional support in the fourth trimester, she said.

That program is in conjunction with the Heinz Foundation and PNC.

At the state level, Stallings said HAP is looking at ways to train physicians to look at the whole person and reflect on the race and ethnicities they serve. That entails looking at barriers to care, including prescriptions, transportation and aftercare support.

Joe Haddock, segment president, Eastern Pennsylvania, Highmark Inc., said employers can look at the benefit packages they offer and encourage employees to get screenings.

Haddock said Highmark offers Bright Blue Futures which gives members access to preventative care, including prenatal care. The company is also expanding its telehealth programs to include more counseling for pregnancy issues that can be accessed between office visits.

Capital Blue Cross, in a statement, said it recognizes that unequal access to health care resources has led to poorer health outcomes for socially disadvantaged populations, and that the issue is especially poignant when it comes to maternal health.

“As part of its ongoing and innovative work to address maternal health outcomes, Capital recently began offering its members a trio of apps to guide families through everything from planning conception and pregnancy to balancing life as a working parent,” Capital Blue Cross said. “Maternal mortality and complication rates are significantly worse for certain minority and disadvantaged populations, and these apps may help narrow gaps in care.”

Haddock said Highmark works with employers to offer the best coverage for the lowest costs to employees, which he said can lead to better outcomes throughout pregnancy.

He added that employers need to look at maternity leave policies and make it easier for employees to take the time they need without losing income.

“Offering the proper time off is good for well-being,” he said. “If someone returns to work too early, it can lead to mental health issues.”

Larkins-Pettigrew agreed, citing 20% of deaths postpartum are suicide, often because of a lack of wrap-around care after discharge from the hospital.

“We need intentional commitment for better outcomes. Everyone who touches a woman’s life, including the government, needs to look at political determinants of health because that trickles down to social determinants of health that affect everyone,” she said.

Stallings agreed. HAP is looking at the data and working with the state legislature to form a committee to implement change.

Since 2005, she said, 17 rural hospitals across the state have stopped maternity care due to the inability to attract obstetricians and gynecologists due to the liability climate.

“The issue is showing up in all hospitals,” Stallings said. “We are working to increase the number of Dulas and midwives to help work with patients.”

Larkins-Pettigrew said in addition, community health workers need to be involved in following patients into their home lives to ensure they are getting the services they need to stay healthy and raise healthy children.

“We need to make sure there is a safety net, and we are working toward that goal,” Larkins-Pettigrew said.

Progress is being made, with data showing a decrease in neonatal deaths and more support structures in place.

“We can’t share the data yet because there is so much involved,” she said. “The project is for a five-year period so we will be able to share the data in the next few years.”

That said, Larkins-Pettigrew said Highmark has made significant changes in its culture to make sure people are met where they are by educating its 20,000 employees and the communities it serves.