California decided it was tired of women bleeding to death

June 30, 2017 8:19 AM

Even within America’s imperfect health system, death in childbirth is not an inevitability. The American maternal mortality rate has been increasing. But thanks to Stanford's California Maternal Quality Care Collaborative (CMQCC), it's dropping in California -- now at 7.3 deaths per 100,000, half of what it was in 2006. Why is it so high in the rest of America? And what is California doing to make childbirth safer for women?
posted by Hypatia (17 comments total)

I was just thinking about posting this here!

This article is infuriating and terrifying.
posted by showbiz_liz at 8:59 AM on June 30, 2017 [2 favorites]

Man, California is always doing something to piss off Republicans.
posted by Artw at 9:05 AM on June 30, 2017 [32 favorites]

Maternal mortality — defined as the death of a mother from pregnancy-related complications while she’s carrying or within 42 days after birth — in the US soared by 27 percent, from 19 per 100,000 to 24 per 100,000, between 2000 and 2014.

So let's talk about how utterly insane this number is. Almost all of Europe, Australia, NZ, Canada, etc.. is in the single digits. Most are under 5/100k, some even approaching 1/100k. Canada, which is far from the best, hasn't been higher than 20/100k since 1968! That's a 50 year old health care standard even prior to the decline post 2000.
posted by bonehead at 9:16 AM on June 30, 2017 [19 favorites]

A couple things not addressed in this article - maternal death among black women is 3-4x higher than white women, despite the fact that they are no more likely to develop pregnancy complications like hemorrhaging. Also, I think the article too quickly glosses over the fact that more women are giving birth while they are already suffering from medical diseases like cardiovascular disease, hypertension, and diabetes. According to the CDC the primary cause of maternal death is cardivascular disease, and the second-most-common causes is non-cardivascular disease. We need a better healthcare system for women, period, and we need better health care system for black women in particular.
posted by muddgirl at 9:23 AM on June 30, 2017 [34 favorites]

Giving actual numbers from the CDC:

12.1 deaths per 100,000 live births for white women.
40.4 deaths per 100,000 live births for black women.
16.4 deaths per 100,000 live births for women of other races.

posted by muddgirl at 9:28 AM on June 30, 2017 [28 favorites]

A couple things not addressed in this article - maternal death among black women is 3-4x higher than white women, despite the fact that they are no more likely to develop pregnancy complications like hemorrhaging.

That is actually mentioned in the article near the end:

In the US, we haven’t bothered to create national health policies around maternity care that are focused on improving outcomes for mothers, such as a federal maternity leave policy or universal health care.

Maternal health is also becoming more complicated. The clinical complications CMQCC has focused on so far — hemorrhage, preeclampsia — are being outpaced by lifestyle-related health issues, like cardiovascular disease and opioid addiction. There are also astounding racial disparities in maternal health: Black mothers are three times more likely to die in childbirth than white women. It’ll require more than well-meaning doctors and nurses to fix these problems.

Still, California has demonstrated that even in our messy and imperfect health care system, progress is possible. They’ve shown the rest of the country what happens when people care about and organize around women’s health. Policymakers owe it to the 4 million babies born in the US each year, and their mothers, to figure out how to bring that success to families across the country.

I think the bolded part is the reason it wasn't emphasized as a main point of the article.
posted by showbiz_liz at 9:28 AM on June 30, 2017 [6 favorites]

A couple things not addressed in this article - maternal death among black women is 3-4x higher than white women, despite the fact that they are no more likely to develop pregnancy complications like hemorrhaging

A large part of this is related to 1) higher birthrates (repeat pregnancies) among poor black women in the US and 2) a lack of prenatal care and 3) overall pre-pregnancy health of the mother. I'd be interested to see how these break down for white/black and rural/poor--in Philadelphia, if you're a poor black woman from southwest philadelphia who has never received any prenatal care, you call 911 when you go into labor and an ambulance takes you to one of the best hospitals in the world. In rural areas, that scenario simply doesn't happen.
posted by MisantropicPainforest at 9:37 AM on June 30, 2017 [4 favorites]

Thanks for posting this. If you read through the links in the Vox article, you can see more details both about the stats and the work being done.

I personally think the main takeaway from the article is that there are quite a few relatively simple changes all hospitals could do to lower these rates. (FWIW, the article mentions other countries are seeing similar issues in terms of weight and age and their rates aren't rising.) Yes, there are some larger issues at play that absolutely need to be addressed. But why doesn't every single hospital have a hemorrhage cart, for example? Why isn't blood loss being measured accurately every single time?

Why aren't more states doing this? How do we, as consumers, push our health care facilities to make these changes?
posted by john_snow at 10:40 AM on June 30, 2017 [1 favorite]

Meanwhile, the Democrats who control the California legislature with a supermajority have just shelved statewide single payer health insurance. They could have driven the mortality rate even lower, but you know, at some point the rate of women bleeding to death in childbirth in 2017 is cost effective and it would be immoral to drive it any lower.
posted by indubitable at 11:20 AM on June 30, 2017 [5 favorites]

I'd be interested to see how these break down for white/black and rural/poor--in Philadelphia, if you're a poor black woman from southwest philadelphia who has never received any prenatal care, you call 911 when you go into labor and an ambulance takes you to one of the best hospitals in the world. In rural areas, that scenario simply doesn't happen.

Not sure about Philadelphia, but in NYC:

African-American women are 12 times more likely to die before, during and after childbirth than white women...And for every woman who dies, about 100 come close. Annually, about 60,000 women nation-wide and and about 2,700 in the city face life-threatening childbirth complications such as hemorrhage, blood clots and organ failure. [...] And in the largely African-American communities of Brooklyn, the climb is higher still: to 400 per 10,000 in Canarsie, East New York and Bed-Stuy, and all the way to 500 in Brownsville and East Flatbush. [...]

Black women were twice as likely to deliver in below-average hospitals as white women. And white women were three times more likely than black women to deliver at above-average hospitals. Howell estimated this gap in safety jeopardizes the lives of nearly 1,000 black women in New York City each year. [WNYC]

"500 in Brownsville and East Flatbush" -- 5% of the (predominantly black) women living in Brownsville and East Flatbush will experience life-threatening childbirth complications.
posted by melissasaurus at 11:53 AM on June 30, 2017 [3 favorites]

Meanwhile, the Democrats who control the California legislature with a supermajority have just shelved statewide single payer health insurance.

You can call Assembly Speaker Anthony Rendon at [phone] and ask him to reconsider. He's getting a LOT of calls about it - there's a phone tree item specifically for that (I forget what 1 is, 2 is the state budget, press 3 for the Healthy California bill), and the first time I called, the mailbox was full, so I called back and got a live person who was very nice about taking down my call.
posted by kristi at 12:07 PM on June 30, 2017 [7 favorites]

So this afternoon I got an email about this organization: the Black Mamas Matter Alliance. Their mission is to improve maternal health outcomes for Black women. They're pretty new but the two founding organizations are highly respected and do great work, so this looks like a good place to start for folks interested in learning more and doing something.
posted by john_snow at 1:16 PM on June 30, 2017 [6 favorites]

Women are a class.
posted by amanda at 3:25 PM on June 30, 2017 [2 favorites]

Pro Publica Is doing some really good reporting in this area too.
posted by rockindata at 7:45 PM on June 30, 2017 [1 favorite]

Meanwhile, the Democrats who control the California legislature with a supermajority have just shelved statewide single payer health insurance. They could have driven the mortality rate even lower, but you know, at some point the rate of women bleeding to death in childbirth in 2017 is cost effective and it would be immoral to drive it any lower.

I read that this is effectively pointless to pass without a public vote either repealing Proposition 98 or exempting healthcare from Prop 98's requirements. Is that accurate?
posted by knapah at 4:50 AM on July 1, 2017 [5 favorites]

That's entirely accurate and its pretty gross to say that the Democrats in California could have made the mortality rate for women lower but didn't do so because of money.
posted by MisantropicPainforest at 5:00 AM on July 1, 2017 [5 favorites]

we have recently launched another campaign to improve the England (there are 4 different health systems under NHS in the four countries) rates across all Maternity, including the incredibly important work of perinatal mental health.

It utterly shocked me to read that in almost half US hospitals there is no analysis after a maternal death. I was already aware of the perverse ramifications of the payments system screwing with C section rates and the role of data and more importantly in demonstrating variation among practitioners is so important. No matter how hard they kick & shout cold hard facts will win out every time: when the data is corrected for all the variables and you're still intervening 45% more than the average practitioner across a patch, that changes practice as California shows.

But to not look into every maternal death is simply cruel, ignorant, and exactly the circumstances that allow the rise over 2001-2012. And those bald race stats are simply heartbreaking.

the good news is doing it better actually saves money for the health system, which is why here in England we can devote millions of pounds of education & training resources, ask the units what their training needs are to make the changes they might need and then fund these. One of the greatest joys of my current job is that I can send the money and sometimes where a need is really great, can find extra in more challenged circumstances. And because this is 'investing to save' and the evidence base from our data is so good, some of the more senior medics are sitting back and letting the real enthusiasts who still have reams of energy take the lead. One of my most challenged rural communities has three leads, Obstetrician, community midwife, acute midwife leading a real multidisciplinary team all just turning 30 and they are on fire! So good was their strategy we doubled their funding.

Good DATA practically analyses itself!
posted by Wilder at 7:02 AM on July 1, 2017 [3 favorites]