Health-care professionals in central Ohio and across the state are adopting tools to prevent the deaths of pregnant women and new moms. And they're doing it amid a rising national rate of maternal deaths that is significantly higher than almost every other developed country.

Delivery room staffers are practicing on mannequins that simulate the birthing process; health-care providers are paying better attention to risk factors; and hospitals are stocking "safety bundles" of items to keep on hand for specific emergencies, such as a hemorrhage or severe high blood pressure.

Maternal mortality, defined as pregnancy-related deaths that occur up to one year after childbirth, is still rare. But rising U.S. rates are troubling to advocates who say the health of moms and babies is indicative of the health of the community at large.

"Childbirth needs to be as safe as possible. Otherwise we're in big trouble," said Dr. Thomas Harmon, vice president of medical affairs at OhioHealth Riverside Methodist Hospital. "Infant mortality and maternal mortality — they're a reflection of our society's priorities around health and wellness."

Nationally, roughly 700 women die of a pregnancy-related issue each year, according to the federal Centers for Disease Control and Prevention. The most recent CDC figures show that the rate of such deaths rose to 17.3 deaths per 100,000 births in 2013, nearly two-and-a-half times the 7.2 deaths per 100,000 births in 1987.

Even higher rates are estimated in a 2016 research study published in the Lancet medical journal. It puts the U.S. rate at 26.4 deaths per 100,000 births in 2015, 17.5 in 2000 and 16.9 in 1990.

Though it's still safe to have a baby, the United States can do better, with as many as half of the deaths preventable, said Harmon, an obstetrician/gynecologist.

The international study shows that the United States fares nearly four times worse than Canada, and significantly lags behind all but one developed country (South Africa). Maternal death rates are 15.8 per 100,000 births in Turkey, 8.8 in England, 6.4 in Japan, 5.8 in Israel and 4.2 in Italy.

Maternal deaths can have an impact on infant-mortality rates, said Dr. Cynthia Shellhaas, a maternal and fetal specialist at Ohio State University's Wexner Medical Center.

"You really can't separate the two. Mom's health is integral to the health of a baby," said Shellhaas, who also serves as a consultant to the Ohio Department of Health. "If Mom is doing poorly, for lot of our mothers, infant mortality comes right along with her death."  

The CDC lists top causes of U.S. maternal deaths as cardiovascular disease, other diseases such as diabetes, infection or sepsis, hemorrhage, and heart muscle diseases — all conditions that can be caused or exacerbated by pregnancy. Blood clots, high blood pressure, problems with blood flow in the brain and complications from anesthesia also are causes.

Health-care providers struggle to explain why the national numbers are increasing.

It could be partly due to better reporting of deaths that occur during or after pregnancy, or a rise in chronic conditions that can be exacerbated by pregnancy. There's also been an increasing number of pregnancies among older women, who are more likely to have such conditions and to give birth by cesarean section. Smoking, substance abuse and mental-health conditions also play a role.

"Pregnant women are frequently thought of as being a healthy population," Shellhaas said. "That’s not the case."
Also affecting maternal mortality are social issues that impact overall health, such as food and housing insecurity, unsafe neighborhoods, lack of child care or no transportation to medical appointments, said Mickey Johnson, vice president of the Mount Carmel Women’s Health Service Line. Women with a lower income might not be able to afford medications or might not be able to miss work to regularly see a doctor.

"We believe that every mother and baby deserve a healthy start," said Johnson, who also sits on the March of Dimes Ohio board.

Women in Ohio fare significantly better than the U.S. average, with 11.5 Ohio deaths per 100,000 births in 2013 and 10.8 in 2014, based on reviews of maternal-associated deaths. Data on subsequent years are unavailable.

The numbers come from an Ohio Department of Health committee that reviews death certificates and records from health-care providers, coroners and law enforcement agencies.

Ohio's lower rates can be attributed, in part, to the formation of the committee in 2010, ahead of many other states, said Sandy Oxley, who oversees the health department's Bureau of Maternal, Child and Family Health.

Among its efforts, the department has paired with Ohio State University to train obstetric nurse educators and managers on ways to create labor simulations for hospital staff. Though many sites might not be able to afford the high-tech mannequins, other simulations use staff as actors who use props that include wearable "pregnant bellies."

The state plans to use upcoming findings on 2015 and 2016 deaths to create new initiatives, including those that address racial and ethnic disparities.

The gap between black and white women is stark, with black women in the United States three to four times more likely than white women to die of pregnancy-related conditions, according to federal statistics. In Ohio, deaths of black women are two to three times more common.

Issues being addressed by state and local groups battling Ohio's high infant-mortality rate likely helps reduce maternal deaths and the racial disparities, officials said.

Addressing chronic health conditions before pregnancy and encouraging women to space their pregnancies, to give their bodies time to recover between births, is key to solving the problem, Oxley said.

Yet maternal deaths are just the tip of the iceberg when it comes to protecting pregnant women and moms, Shellhaas said.

For every maternal death, there are 100 cases of women who have significant pregnancy-associated conditions. Much could be learned by studying these cases as well as the deaths, she and others said.

"It's not just the women who die, but it’s the women who are severely impacted by the complications of their pregnancy," Shellhaas said.

 

jviviano@dispatch.com

@JoAnneViviano