In the wake of increased attention to a rising maternal death rate, a growing chorus is calling on Alabama to investigate the deaths of mothers from pregnancy and childbirth complications.
“Each and every maternal death is devastating to families, and leaves everyone asking ‘why?’” said Dr. John Meigs, president of the Medical Association of the State of Alabama, in a statement. “As physicians, we feel like our state has got to do better, can do better and must do better, and our coalition partners feel the same way.”
In recent weeks, the Alabama Department of Public Health asked Gov. Kay Ivey for $478,000 to better investigate why Alabama mothers are dying from pregnancy and childbirth complications.
If the request makes it into the governor’s state budget recommendation, then the Medical Association, the nonprofit March of Dimes and consumer giant Johnson & Johnson are gearing up to push for the funding in the upcoming legislative session.
In states like Texas and Tennessee, efforts to investigate maternal deaths have found most of the deaths could have been prevented. Investigations in states like California and North Carolina led to changes in healthcare and services provided to mothers.
Alabama doesn’t really know why mothers are dying from childbirth and pregnancy complications. Or even how many.
“But until we have a thorough review of the maternal death data, we can’t answer the all-important question of ‘why?’ and take steps to stop maternal deaths,” said Meigs.
Officially, 41 mothers died from pregnancy or childbirth complications in 2017, according to death certificate data reported by the state. It’s the highest number of deaths related to childbirth and pregnancy that Alabama has recorded in recent years.
But using just the death certificate data has been shown to be unreliable. The U.S. Centers for Disease Control and Prevention doesn’t recommend using those numbers alone to get an accurate count of maternal deaths.
Instead, the gold standard for investigating deaths of mothers from pregnancy and childbirth is a statewide task force called a Maternal Mortality Review Committee, which reviews medical records and other documents related to every death of a mother, related to childbirth or pregnancy.
All of Alabama’s neighboring states have one already.
If the $478,000 is approved by the state legislature next year, it would fund Alabama’s new MMRC. Late last year, a coalition of Alabama doctors, nurses, public health leaders and other formed the state’s first MMRC under the umbrella of the Alabama Department of Public Health.
Right now, the MMRC operates on a shoestring budget, limiting the number of cases it can review. It’s mostly staffed with volunteers.
A group of Alabama OBYNs and the Medical Association worked with ADPH to come up with the $478,000 figure, said Trace Zarr, director of political development at the Medical Association.
The bulk of the money, about $300,000, would go toward hiring paid staff to compile and organize the case files of Alabama women who died from pregnancy or childbirth-related issues.
Another $108,000 would go toward autopsy reviews, and the rest would pay for support staff, equipment and supplies.
“We want to make sure we get not only a good count of the number of deaths, but qualitative data on the broader factors associated with these deaths,” said Britta Cedergren, director of maternal-child health and government affairs with the March of Dimes, which has partnered with the medical association and the state health department to lobby for funding.
“We want to determine whether these deaths were preventable. If it was a postpartum depression-related suicide, what could have been done differently? Or was there an undiagnosed issue related to pregnancy, like hypertension?”
If the MMRC is fully-funded, it could have a lasting impact on the health of mothers in the state.
Tennessee, which launched its MMRC program two years ago, found a whopping 85 percent of its maternal deaths were preventable.
California, one of the first to launch a review committee back in 2006, has since cut its rate of women dying in childbirth by 55 percent. That’s due in large part to is committee identifying two complications that were killing mothers but were largely preventable: hemorrhage and pregnancy-induced high blood pressure.
And Alabama already has a similar program that investigates infant deaths. Meigs credits the state-funded infant mortality review for reducing Alabama’s infant mortality rate in recent years. In 2017 Alabama’s infant mortality rate, still high by national standards, hit a state-record low.
“But Alabama currently doesn’t fund maternal mortality review, and until we appropriately do so and dig down into the root causes of maternal death in this state,” he said, “we can’t expect to be able to make informed health policy decisions as a state, to move forward in eradicating maternal deaths.”
The Medical Association, a private professional organization that lobbies state lawmakers on behalf of doctors, has recently launched a new initiative, the Save Alabama Moms campaign. On its website, alabamamedicine.org/savealmoms, is the tagline: “It’s time to solve the maternal mortality crisis.”
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