How Can We Improve Chicago’s High Rate of Maternal/Infant Death?

Maternal and infant mortality rates are at an alarming rate across the nation. In Chicago, infant mortality exceeds the national rate. This is unacceptable. It is critically important to reduce these statistics and improve the outcomes and death rates of mothers and infants.

For this reason, a very important event occurred in Chicago in early October, with an impressive panel of area practitioners representing the continuum of care for maternal and child health in gynecology and obstetrics, neonatology, and pediatrics who led a discussion to bring awareness to the high rate of mothers and infant death in Cook County. The goal of this meeting was to bring together community businesses and policymakers to better understand evidence and start considering cost-effective measures to improve health outcomes for mothers and babies in the Chicago area. 

In my role as a Clinical NICU Specialist for Medela, I had the privilege of attending this event. I have attended similar events in the past, however, this event was like no other. More than 260 attendees filled the large banquet room with the same question in mind: “Can this be turned around?”

The event was hosted by Medela LLC and the March of Dimes (MOD), in cooperation with the office of U.S. Senator Tammy Duckworth and the University of Illinois-Chicago. This impressive meeting of community leaders who came together and hosted an exceptional panel discussion did not hold back answering the tough questions. The experts on the panel included Dr. Aloka L. Patel, Neonatologist, Dr. Maura Quinlan, Obstetrics and Gynecology, Dr. Jenny Thomas, Pediatrician, and Paula Meier, PhD. Dr. Ngozi Ezike, Director, Illinois Department of Public Health moderated the event and asked questions to the panelists. 

5 things I learned

You can read the full transcript on Medela’s web site, but I would like to share some key points I captured at this discussion:

1.  Chicago has a higher rate of infant deaths, above the national average of 7.9 deaths per 1,000 live births (compared to 5.9).1

The Illinois state data is alarming, annually 149,390 babies are born and 985 babies die before their first birthday. The infant mortality rate has remained steady with minimal changes between 2010-2015. Disproportionately, Non-Hispanic Black infants have a mortality rate that is approximately three to four times higher than Non-Hispanic White infants.

The U.S. maternal mortality rate is higher than most other high-income countries and the rate has increased over the last few decades.3   In 2015, maternal deaths continued with at least 200,000 women living in a maternity desert. Maternal mortality rates disproportionately impact black women.3 On average 73 women in Illinois die every year from pregnancy related deaths. These are horrifying statistics that have significant impact on families and businesses in the Chicago area.

2. There is work being done and going well in the healthcare community.

Each panel member spoke about advances and new programs being implemented, including the American Academy of Pediatrics working along with the United States Breastfeeding Committee, and a grant awarded from the Centers of Disease Control and Prevention to fund nationwide education for physicians in training.

Chicago area hospitals have a commitment to the promotion and protection of breastfeeding during the initial hospital stay, and several are moving towards baby-friendly designation. Hospital systems have taken on quality improvement programs and implemented initiatives based on science and research supporting breast milk (along with other interventions) that have decreased morbidities for premature infants.

The Illinois Maternal and Mortality Review Report has been a resource pointing to causes of maternal death for women. This document has permitted birthing hospitals to implement specific bundles to address categories causing maternal death including cardiovascular conditions, hypertensive disorders infection, and hemorrhage to name a few.

3. The disparities among communities, specifically maternal and infant racial disparities, was also discussed.

Dr. Jenny Thomas shared that maternal disparities remain, despite the same medical conditions a white woman versus a non-white woman share.

In 2017, 14% of black women gave birth prematurely, significantly more than 9% of white women, according to CDC data.4   Dr. Thomas asserted that it is not about taking care of the individual, but that it is important to take a closer look at the reasons this occurs, specifically addressing risks like social determinants of health –  what does her community look like and does she have support. It was noted that more work needs to be done to educate, teach, and train about implicit bias.

4. The insights and solutions brought forward by the panelists about what can be implemented to help end this crisis are important to highlight:

• Mothers are getting sicker and sicker and they are not getting the help they need soon enough. For this reason, the recommendation was made to provide women of childbearing age access to healthcare to make them healthy prior to pregnancy. Access to health care for birth spacing and empowering women to have babies in the interval of their choosing, along with educational support, is shown to reduce the second baby from being born early.
• Support for mothers who choose to provide their baby with breast milk. There is data that human milk benefits both maternal and infant morbidities.  There is a strong relationship between mother’s own milk feeding and a reduction in infant morbidities (sepsis and necrotizing enterocolitis). Multiple studies have found the more mother’s own milk received by very low birth weight infants reduces the cost of hospital stay. Breast milk feeding is associated with a decreased risk of sudden infant death syndrome (SIDS).
• Recommendation from the AAP that all babies are seen by their pediatrician at day 3-5 post discharge from hospital to assess for jaundice and weight loss. However, often there is no Lactation Specialist available in the office to provide crucial support at this critical time with complications related to breast milk feeding. This is a critical opportunity for improvement.
• Request for business leaders to offer maternity and paternity leave now and not wait for the federal government to mandate.  Also, make sure there is a place or designated space for (a non-bathroom space), that is lockable for moms to pump. For businesses offering both recommendations, recognition of the return on investment with improved engagement and employee retention.

5.  It was clear to me following this event that the Chicago healthcare community has the heart and the passion to turn this crisis around.

It was impressive to see the medical, academic, and businesses in the community come together to support this very important topic. This is a complex issue that requires a multifaceted approach, and as Dr. Ezike said, “We all need to roll up our sleeves and play our part.”  Clichés aside, more help is needed, and turning this around requires many hands: the entire village, in fact.

In the words of Senator Tammy Duckworth, we are the only developed nation in the world where the rate of women dying of pregnancy-related complications is still rising. This is unacceptable!

I was proud to be in attendance at this event and share what I learned to help bring awareness AND a call to action to the healthcare community, because a community-wide effort is essential to improving care for all women of child bearing age. To learn more or get involved, consider some organizations that are actively working to improve these health outcomes for families, mothers and babies:

• March of Dimes at www.MARCHOFDIMES.ORG
• Illinois Perinatal Quality Collaborative (ILPQC) http://ilpqc.org/?q=get-involved
• UNCIEF  https://data.unicef.org/topic/maternal-health/maternal-mortality/

 

 

References:

1. http://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/periodlinked/LinkPE15Guide.pdf
2. CDC. Pregnancy Mortality Surveillance System. Available at:  https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmass.html
3. MOD. March of Dimes Position Statement: Maternal mortality and severe maternal morbidity. Available at: https://www.marchofdimes.org/materials/March-of-Dimes-Maternal-Mortality-and-SMM-Position-Statement-FINAL-June-2018.pdf
4. https://www.cdc.gov/vitalsigns/maternal-deaths