Moms in America are compared to mothers in any other developed country. When you start to drill into that grim statistic, though, one thing becomes strikingly clear: It’s largely African American women who are dying.Black moms across the US are three and a half times more likely to die in childbirth than white Americans. (The pregnancy-related mortality is 12 per 100,000 live births for white women, and 40 per 100,000 for black women.)That gap is also growing:Remarkably, though, North Carolina has managed to. In 1999, 39 black women per 100,000 live births died as a result of pregnancy-related complications compared to only 11 white women per 100,000 in the state. By 2013, the gap closed: The rate was 23 per 100,000 births for both white and black moms, bringing with the national maternal mortality rate. Javier Zarracina/VoxAlarmingly, the white maternal mortality rate has risen in North Carolina over the years. Health officials there aren’t sure what’s going on yet, but told me they plan to investigate.
CURRENT STRATEGIES IN HYPERTENSION Co-morbid Conditions and Hypertension Management. Clinicians are being “graded”for level of BP control. 140/90 held as standard. In primary care visit, other factors intervene with “control”. Retrospective cohort of 15,459 patients with uncontrolled HTN with 200 clinicians.
And the trend that’s been linked to opioid abuse, and increases in obesity, diabetes, and cardiovascular disease.Still, the black maternal death rate in North Carolina has halved, and the gap between black and white deaths has closed. You simply don’t see this kind of convergence in the area of maternal mortality anywhere else in the US. Even in California, which has managed to drive down its maternal death rate to only — the lowest in the country — the black-white health gap remains stubbornly persistent. ( seven white women per 100,000 births died and 26 black women per 100,000 births died — in line with the national disparity.)What’s unique about North Carolina, according to doctors, nurses, and researchers there, is a population health management program, called Pregnancy Medical Home, for low-income pregnant women. The program is run through Medicaid, the government health insurance for the poor, and 94 percent of Medicaid doctors participate in the program. And it’s just one of several initiatives in the state to make births safer for moms that seem to be saving more lives.
Why North Carolina may be seeing its racial health gap disappearWhen a woman on Medicaid in North Carolina becomes pregnant, her doctor is incentivized (through Medicaid financial reimbursements) to screen for issues that might make her pregnancy high-risk, looking out for potential obstetric or psychosocial risks as early as possible, such as high blood pressure, diabetes, or depression. If the patient is deemed to be high risk, she’s connected with a “pregnancy care manager,” who helps the mom understand and adhere to steps needed to reduce her health risks.Kate Berrien, the vice president of clinical programs at Community Care of North Carolina, walked me through how this works: Say a mom is identified as being at risk for preeclampsia, pregnancy-induced high blood pressure, which can be deadly for mom and baby. The mom’s doctor might suggest she start on low-dose aspirin, an evidence-based intervention to reduce the risk of preeclampsia.“The doctor would let the pregnancy care manager know that the patient has been started on aspirin,” Berrien explained, “so that the care manager can follow up to make sure the patient is able to obtain the medication and that she understands how and when to take it, as well as why she is on this treatment.”. RelatedIf the mom has diabetes — one of the conditions that puts women at a higher risk of preeclampsia — the doctor might design a special diet for the patient.
The care manager would then make sure the patient can actually follow the doctor’s recommendations (helping her with access to healthy food, offering support to adjust her diet, or frequent check-ins to assess her progress). The care manager might also help the mom access insulin, if necessary.And if the patient isn’t responding to these interventions, and needs to be induced for an early labor to prevent complications to the mother and infant, the health care manager might help her get ready for her stay in the hospital, by finding a caretaker for her other children or making sure her family has access to the food they need while she’s out.“That care manager will visit women at the doctor’s office or at the home,” said Kathryn Menard, director of maternal-fetal medicine at the University of North Carolina. “She or he will help mothers overcome any barriers in adhering to a care plan — like food insecurity, housing issues, access to insulin.” She continued: “I am not familiar with any statewide program like this.”The primary goal of the program is pre-term birth prevention, Berrien added. “By tackling women’s health problems before she goes into labor, we mitigate her risks.”Since the program launched in 2011, the state has also seen a decline in the C-section rate among Medicaid recipients and improvements in the low birth weight rate among babies.“I believe this program really helps with our health care inequities that exist,” said Menard.
“If you can help people navigate through the system and they’ve got peers in their community helping with care management — that makes a difference.”Why the effort isn’t saving more white women’s lives isn’t clear. But African American women are disproportionately represented in the North Carolina Medicaid population and it’s possible that the Pregnancy Medical Home program for the Medicaid population might disproportionately benefit them, Berrien said.
Other explanations for why North Carolina’s black maternal mortality rate dippedThere’s no clear line of causation linking the change in North Carolina’s black maternal mortality rate and their unique Pregnancy Medical Home approach — the program just happened to be the one things that came up again and again when I asked people working in this area about what North Carolina was doing differently. What’s more, Pregnancy Medical Home launched in 2011, after which the black maternal mortality rate continued to decline — but it can’t account for the decline in the mortality rate among black moms before then.And it’s possible there are other contributors to the decrease in death. The Perinatal Quality Collaborative of North Carolina launched in 2009 to improve mom and baby care across the state. They’ve worked in 65 birthing hospitals in North Carolina and conducted nine statewide quality improvement efforts, including reducing early elective deliveries, which can lead to deadly complications for moms and babies, and improving the management of preeclampsia.“Gestational hypertension and preeclampsia are severe problems in the African American maternal population,” said Martin McCaffrey, a professor of pediatrics at UNC Chapel Hill School of Medicine who directors the program, in an email. “We have increased treatment of mothers with critical hypertension in less than an hour from 50 percent to 80 percent.” So it’s possible that this effort contributed, too.