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Advice and Insights April 5, 2022

By Debra Wood, RN, contributor

7 Strategies to Improve Maternal and Infant Health

Obstetrician–gynecologists and OB/GYN advanced practitioners have the unique privilege of overseeing women’s health, with duties ranging from primary care and well visits to reproductive assistance, surgery, and helping bring their babies into the world. Yet there are a number of factors that continue to impact maternal health and infant health and need to be addressed.

Recognizing the Problems for Mothers and Babies

Maternal morbidity and mortality in the United States remain higher than in other high-income countries. The problem is especially severe for minority women and those with low socioeconomic status. 

About 700 women die of pregnancy-related complications each year according to the American College of Obstetricians and Gynecologists (ACOG). For each death, there are 70 severe unexpected outcomes. 

The U.S. maternal mortality rate remains twice as high as Canada’s rate and three times as high as the United Kingdom, according to a National Academy of Sciences report. Additionally, the rate of severe maternal morbidity continues to rise. Black women die of preventable complications of pregnancy at up to four times the rate of white women. The reasons include barriers to care, chronic conditions, maternal stress, social determinants of health, systemic racism, and inadequate training for healthcare workers and providers. 

The infant mortality rate in the United States was 5.6 deaths per 1,000 live births in 2019, according to the Centers for Disease Control and Prevention (CDC), with three of the top causes being birth defects, preterm birth, and low birth weight, and maternal complications during pregnancy. Infants are also affected by low breastfeeding rates. Only 58.3 percent of infants were still being breastfed at six months, despite research showing benefits to mothers and babies with exclusive breastfeeding until that time, according to the CDC’s 2020 Breastfeeding Report Care. The data also showed that fewer Black mothers start breastfeeding than Asian, White, or Hispanic moms.

To address some of these issues, federal lawmakers recently passed the Maternal Health Quality Improvement Act as part of the 2022 omnibus spending bill. It will support training programs to prevent bias in healthcare, improve access to obstetric care in rural areas, and facilitate the adoption of evidence-based best practices through the Alliance for Innovation on Maternal Health, a partnership between the U.S. Health Resources and Services Administration and ACOG.  

Many health-related and community organizations are taking steps to improve maternal and child health. The American Public Health Association reports that when it comes to maternal health, “investments in prevention, health care, and education last a lifetime. The following are a few of the most notable efforts currently underway:

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Ways to Improve Maternal & Infant Health

1. Increasing access to care

Access to quality healthcare is a contributing factor to poorer maternal and child health outcomes. Improvements will require more gynecologists, OB/GYN physician associates (PAs), an OB/GYN nurse practitioners. 

“PAs can help improve maternal health,” said Melissa Rodriguez, DMSc, PA-C, president of the Association of PAs in Obstetrics and Gynecology. “All across the country, there are maternity deserts. PAs, as maternal healthcare providers, we can assure everyone has access to a trained provider.”

Gynecologists can then focus on more complex cases. And, she said, PAs are trained to help patients manage comorbidities, such as hypertension and diabetes. About 2,000 PAs are practicing obstetrics.

PAs and OB/GYN nurse practitioners in Florida, where Rodriguez is located, care for women unable to reach a medical campus. 

2. Changing the culture of medicine

ACOG has made a formal commitment to changing the culture of medicine to eliminate racial health disparities and confront implicit and explicit bias. That will require OB/GYNs to examine their own prejudices and address inequality.  

Mass General Brigham in Boston and The New Commonwealth Racial Equity and Social Justice Fund are investing $2.5 million to promote maternal health equity, support practitioners and advocates advancing outcomes, and enhance health equity of Black and Brown communities across the commonwealth by dismantling systemic racism in its hospitals. 

3. Modifying social determinants of health

The March of Dimes and Anthem Blue Cross and Blue Shield Foundation are working to address racial disparities and social determinants of health in Colorado and developed Breaking Through Implicit Bias in Maternal Healthcare training. The educational materials aim to improve patient-provider communication and decision-making. The program also supports services for new mothers and babies, including helping new mothers receive information and services to promote birth spacing, smoking cessation, and mental health. 

4. Boosting breastfeeding support

The National Association of County and City Health Officials (NACCHO) has launched the Reducing Breastfeeding Disparities through Continuity of Care project. With input from more than 100 maternal child professionals, NACCHO developed the Continuity of Care in Breastfeeding Support: A Blueprint for Communities, designed to support local-level organizations to strengthen their community lactation landscapes to ensure that families are supported throughout their infant and toddler feeding journey, also known as the first 1,000 days, reported Harumi Reis-Reilly, MS, CNS, LDN CHES, IBCLC, lead program analyst at NACCHO. 

“Currently, 10 funded communities are implementing Blueprint recommendations to increase breastfeeding rates and improve community health, and over 750 individuals have downloaded this resource to implement in their communities,” Reis-Reilly said. 

The breastfeeding blueprint is one of several NACCHO projects to improve maternal and child health. 

5. Addressing specific complications

The CVS Health Foundation and America’s Essential Hospitals, an association dedicated to high-quality care, including the most vulnerable, awarded $847,000 to SUNY Downstate Health Sciences University in Brooklyn, New York, and 11 other hospitals to help improve Black maternal mortality and morbidity. The program will focus on addressing hemorrhage or hypertension.

6. Providing transport to specialty care

Baylor Scott & White Health in Temple, Texas, has launched a maternal transport team to facilitate transfers of high-risk obstetrics patients from hospitals throughout the region to the Baylor Scott & White Medical Center - Temple, which has received Level IV designation for its maternity care and neonatal intensive care. Access to that higher level of care should help improve outcomes. 

"We have a wide array of specialists available 24/7, including sub-specialist physicians and highly trained obstetrical nurses, ensuring our ability to care for the most complicated obstetrical and postpartum patients,” said Jessica Clay Ehrig, MD, a maternal-fetal medicine specialist at Baylor Scott & White – Temple, in a statement. 

7. Increasing insurance coverage

The American Medical Association (AMA) has adopted a new policy to promote equity and expand insurance for women in groups with higher rates of maternal morbidity and mortality. The AMA will research barriers to optimal care, adopt federal standards, develop a standardized definition of maternal mortality and educate care teams about equitable care. 

Likewise, ACOG supports extending postpartum Medicaid to 12 months. Currently, women lose their coverage 60 days after delivery. The American Rescue Plan Act of 2021 will allow states to increase that to one year. 

Staff Care is seeking talented OB/GYN physicians, nurse practitioners, and physician assistants for temporary opportunities across the U.S.

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