California’s surgeon general has unveiled a new initiative to reduce maternal mortality and set a goal of halving the rate of deaths related to pregnancy and birth by December 2026.
Health officials say that more than 80% of maternal deaths nationwide are preventable. California has achieved a much lower rate of such deaths than the U.S., but maternal mortality resurged in recent years amid the COVID-19 pandemic, state data show.
“We have the lowest rate in the country. Now we can do better,” California Surgeon General Dr. Diana E. Ramos said in an interview.
Ramos was joined in announcing the effort Tuesday by First Partner Jennifer Siebel Newsom, the wife of Gov. Gavin Newsom.
In California, leading causes of such deaths include heart disease, bleeding, “behavioral health” issues such as mental illness and substance use, and infection. More than a fifth of pregnancy-related deaths in California occur the day of delivery, but the majority happen in the days, weeks and months that follow, according to state data.
The crisis has been especially stark among Black women, who have faced a maternal mortality rate more than three times that of white women in California. In Los Angeles County, there has been a public outcry in recent years over the deaths of women like April Valentine, 31, and Bridgette Burks, 32 — Black mothers who left behind devastated families.
Health researchers have faulted numerous factors for the higher rates of maternal mortality among Black women, including the physical effects on the body of enduring years of racism; higher rates of diabetes and other chronic conditions that increase risk; and inequities in the care received by Black patients.
California officials said they are also concerned about rising rates of maternal mortality among Latinos and Asian/Pacific Islander communities in the state.
The “Strong Start & Beyond” initiative, officials said, would help patients understand potential risks before they become pregnant and prompt earlier action to address hazards such as heart disease. It would also alert Californians to doula services and other programs intended to support people before, during and after birth.
Ramos said California had reached the lowest rate of maternal mortality in the nation through its system of reviewing maternal deaths and other efforts centered on hospitals, physicians and other healthcare professionals. Up until now, “the focus has been primarily on the healthcare setting,” she said.
But “if we keep on doing the same thing — just focusing on the healthcare team — we’re going to get the same results,” Ramos said. Health officials and experts decided they needed to bolster that work, “and that’s why we’re bringing in the patient.”
“It seems so simple, but oftentimes, the pregnant person doesn’t feel like they have a voice or they have the information they need to make informed decisions,” Ramos said.
U.S. Secretary of Health and Human Services Xavier Becerra said in a statement accompanying the launch of the new effort that “reducing maternal mortality isn’t a ‘should,’ it’s a ‘must.’ California gets it.”
The planned strategies outlined in the California Maternal Health Blueprint, released Tuesday, include a new questionnaire that patients can take at home to assess their risk of pregnancy complications and get recommendations for next steps based on their results.
As an obstetrician-gynecologist, Ramos said she found that it was often at their first prenatal appointment that a patient would first hear, “You’re going to be a high-risk patient.’ And more times than not, patients would say … ‘I wish I would have known that I could have done X, Y or Z to decrease my risk.’”
California officials also want all medical facilities in the state to use an existing screening tool for gauging the risk levels of pregnant patients.
Ramos said those results could help guide where patients go for births. Hospitals with limited resources could refer patients with a higher risk of complications — such as someone who “is going to be at risk for hemorrhage, is going to be at risk for ICU admission” — to the medical facilities best equipped to handle them.
The new effort comes as pregnant patients may face dwindling choices for hospital births: Nationally, roughly 1 in 25 obstetric units closed in 2021 and 2022, according to a March of Dimes report.
Under “the modern fee-for-service healthcare model … hospitals must fund round-the-clock capacity but are only reimbursed when their facilities and staff are in action,” wrote Dr. Anna Reinert, an assistant professor of clinical obstetrics and gynecology at USC’s Keck School of Medicine, in a recent op-ed.
“So if not enough deliveries are happening, expenses outweigh reimbursement. This drives hospitals to get out of the baby delivery business altogether,” Reinert wrote.
California has faced a wave of such closures in the last decade, including at many hospitals in Los Angeles County. A CalMatters analysis found that such closures had disproportionately affected Black, Latino and low-income communities. Among the latest hospitals to announce it would shut down a labor and delivery unit is USC Verdugo Hills Hospital in Glendale, which plans to halt maternity care on Nov. 20.
Emily Alpert Reyes
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