According to a recent report by the Center for Disease Control and Prevention (“CDC”), 700 women die each year in this country from pregnancy-related complications. Morbidity and Mortality Weekly Report, CDC, May 10, 2019. The report found the leading cause of maternal death during the periods of pregnancy and postpartum to be cardiovascular disease (CVD). The American College of Obstetrics and Gynecologists (“ACOG”) recently released a practice bulletin that supported this finding, with the bulletin confirming that cardiovascular disease accounts for 26.5 % of all maternal deaths, with the highest death rates being among black women and women with lower incomes. ACOG, ACOG Releases Comprehensive Guidance on How to Treat the Leading Causes of Maternal Death: Heart Disease in Pregnancy, May 3, 2019.
The most common risk factors for CVD death include race, age, hypertension during pregnancy, and obesity. However, the ACOG in its practice bulletin cited data confirming that race is the leading risk factor. Statistically, black women’s risk of dying from CVD is 3.4 times higher than that of white women. The reason for this extreme disparity is primarily two-fold: First, CVD is far more common among black women and can occur at earlier ages than in white women. Second, racial bias and blatant racism within the U.S. health care system is contributing significantly to this disparity. This racism asserts itself in many forms: from delayed diagnosis of CVD even though black women are at a much higher risk for this condition, to lack of transportation for black women to access healthcare, to inequities in the quality of hospital care that black women receive. Dr. Wanda Barfield, director of the Division of Reproductive Health for the CDC and assistant surgeon general in the U.S. Public Health Service, recently commented that: “Minority women are delivering in different and lower quality hospitals than white women,” and that “black women often feel they are not being heard when they raise concerns about a particular aspect of their care.”
To bridge this racial gap, the CDC, in its report, identified several prevention strategies that it believes if implemented, would lower the overall maternal death rate in this country and remedy the racial disparity. For health facilities, the prevention strategies would include implementing emergency obstetric protocols, simulation training, providing telemedicine for facilities without on-site obstetric expertise, and establishing systems to promote communication among multiple providers. For medical providers, the recommended strategies would consist of offering continuing provider education to reduce missed or delayed diagnosis, establishing a maternal early warning system, and improving hand-off communication between obstetricians and other providers.
In addition to these strategies, the ACOG set forth guidelines in its practice bulletin for medical providers to follow to help treat CVC.
These guidelines would require that:
- All women be assessed for CVD in the prenatal and postpartum period.
- That women with known heart disease see a cardiologist prior to pregnancy and receive pre-pregnancy counseling.
- That patients determined to have moderate and high-risk CVD be managed during pregnancy, delivery, and postpartum in a medical center that is able to provide a higher level of care, including a multidisciplinary pregnancy heart team that includes obstetric providers, maternal-fetal medicine specialists, and cardiologists and anesthesiologists at a minimum.
- Follow-up visits with a primary care clinician or cardiologist to occur within seven to 10 days for all women with hypertensive disorders and seven to 14 days for all women with heart disease or cardiovascular disorders.
- A comprehensive, cardiovascular postpartum visit take place at the three-month mark, at which time the clinician and patient can discuss collaborative plans for yearly follow-up and future pregnancy intentions.
Maternity care payment models exist that provide coverage for these additional visits.
According to the CDC, 60 percent of the maternal deaths that occurred in the U.S. last year were preventable. Oftentimes, there were multiple contributing factors to these deaths ranging from doctors’ mistakes to difficulties that some women experienced getting housing and healthy food. Again, these factors have disproportionately impacted black women.
The desire of many within the maternal health field is that the strategies and guidelines referenced above will be adopted by healthcare providers nationwide. And that their adoption will help curb the rising tide of maternal deaths and eradicate the racial disparity that exits between black and white women regarding obstetric healthcare. One can only hope that this desire becomes an established reality in the maternal health field in the very near future.
The Magna Law Firm represents individuals who have lost family members as the result of doctor negligence. If you or a loved one has lost a family member under these circumstances, please contact our law firm to schedule a free consultation with our attorney.