Blogger’s thoughts
There are multiple articles in this post about maternal health. The reasons are to keep this major healthcare issue on a continuum, identify the efforts of progress if any, review from a contextual perspective, and things are simpler when it’s together instead of compartmentalized. Please share this with others and encourage them to address all matters of health.
Reposts from NJSpotlight
‘Pretty astounding’ reduction in C-sections in 2021 As NJ health providers work to address maternal mortality, they’re already seeing results
Lilo H. Stainton, Health Care Writer April 18, 2022
It’s a simple, but important question now asked every time a woman of child-bearing age arrives at a New Jersey emergency room: Have you been pregnant within the last year?
As of January 2020, state law requires hospitals in New Jersey to ask all emergency department patients about their recent reproductive history to help diagnose their condition and better identify post-partum preeclampsia, a rare but serious form of hypertension that requires immediate medical care.
This change is just one of many steps hospitals across New Jersey have taken to improve maternal health care and reduce what is one of the highest maternal mortality rates in the country. These efforts are part of a broad spectrum of reforms now underway, and planned, to improve birth outcomes. And they are starting to show results.
The 2020 law was informed by a program launched years earlier at RWJBarnabas Health, one of the state’s largest hospital systems, to try and improve care for new moms who came into the network’s emergency rooms with hypertension, or high blood pressure.
A team of doctors, nurses and other maternal health leaders worked with emergency room staff and IT experts to create an alert system designed to quickly flag these patients and ensure they get proper care.
Narrowing racial gap
“We really use this team to identify issues within our system, issues within each of our unique communities, and determine what changes need to be made,” said Suzanne Spernal, an advanced practice nurse and vice-president of women’s services at RWJBarnabas.
The maternal leadership collaborative, organized in 2015, is one of the tools RWJBarnabas is using to improve maternal health and narrow the gap in racial disparities. Black mothers die at nearly seven times the rate of white mothers in New Jersey, more than double what it is nationwide, according to the most recent state data available.
The collaborative also serves to advance the goals outlined by Nurture NJ, a campaign launched in 2020 by first lady Tammy Murphy to cut the state’s maternal mortality rate in half and eliminate the racial gaps within five years.
Nurture NJ’s work is proceeding well, Murphy told NJ Spotlight News last week, with dozens of legislative proposals signed into law by her husband, Gov. Phil Murphy, and a wide array of state agencies collaborating to reduce inequities, improve access to care and elevate the voices of mothers, particularly Black moms.
“We are just doing everything within our power to see that we are moving the needle,” she said.
The first lady’s office has also partnered with community organizations to host festivals, pop-up giveaways of food, diapers and other goods, and health clinics with COVID-19 testing and vaccinations. The work has been supported by hospitals, physicians’ groups and Horizon Blue Cross Blue Shield, the state’s largest health insurance company, among others.
Delivery can spell danger
The majority of maternal deaths occur during delivery or in the first few weeks after birth, often related to severe bleeding. Three in five are preventable, experts note.
Improving these outcomes has long been a focus of the New Jersey Hospital Association, which represents the roughly 50 hospital-based birthing centers that help deliver some 100,000 babies each year.
Through its perinatal quality collaborative, the hospital association has provided its members with maternal mortality data and benchmarking options, best-practice toolkits and checklists to help medical teams navigate emergencies, plus webinars and other educational opportunities. Last week the association posted an online video course focused on reducing implicit bias in maternal and child health, timed to coincide with Black Maternal Health Week.
“Understanding more about implicit bias is such a hot topic right now,” said Dr. Meika Tylese Neblett, chief medical officer at Community Medical Center, an RWJBarnabas hospital in Toms River, who is featured in one of the segments.
“It’s understanding how your unconscious self … that is creating this implicit bias has a direct effect on how you are caring for your patients,” she said.
Preliminary C-section data
New Jersey Hospital Association president and CEO Cathy Bennett said the perinatal collaborative aims to “achieve measurable, sustainable quality improvement, and we have data that shows the impact of this work,” starting with a significant reduction in births by cesarean section, or C-section.
In 2016, New Jersey had among the nation’s highest rates for C-sections, she said, with nearly 40% of births involving the major surgical procedure that is necessary in some situations but involves significant risk. Preliminary data for 2021 shows the rate for regular C-sections dropped to 27.8%, Bennett said, calling it “a pretty astounding reduction.” (Experts have set 23.6% as the nationwide goal.)
But Bennett said this is only a start, with the COVID-19 pandemic posing new challenges. “We know that more work remains to achieve further improvement, including reducing disparities in outcomes for women and infants of color and to address COVID vaccine hesitancy among expectant mothers and women of child-bearing age,” she said.
The hospital association is tracking the impact of the COVID-19 pandemic on maternal health outcomes and monitoring data to determine if an initial uptick in poor outcomes recorded at the start has continued in the years since, Bennett explained.
Pandemic complications
“Birthing hospitals had to address never-before-seen issues to keep mom, baby and staff safe,” she said. “If you think about it, even the very process of laboring was potentially a situation where the virus could easily spread to others.”
At RWJBarnabas, leaders are also evaluating their COVID-19 response and its impact on maternal health, Spernal said. At the pandemic’s start the system’s hospitals sought to release healthy new moms within 24 to 48 hours to lessen their infection risk, she said, but despite the “best of intentions” there were limited support systems set up to help them once they got home.
“For the right patient, that rapid discharge is completely safe. But in other cases, it might not be prudent to send these new moms home so quickly,” Spernal said, adding, “We probably could have done a better job” connecting them with telehealth follow-ups or other services after their release.
RWJBarnabas has also taken steps to better incorporate doulas into its birthing protocol, Spernal said, but these trained advocates for the mother can be hard to find in some communities. State officials have been working to increase the size and diversity of this workforce through various programs and partnerships.
The hospital system also hosted online support groups, thanks to telehealth technology, which Spernal said has enabled more than 3,000 participants to join sessions on breastfeeding, mood disorders and pregnancy itself.
‘No matter how far we think we’ve come, we haven’t come far enough.’
“Over the past year we’ve seen an increase in the number of Black women participating” in several of these groups, Spernal added. “You don’t necessarily get that in the brick-and-mortar setting.”
But despite these gains, maternal health experts agree more work is needed, particularly to reduce the racial disparities. This is especially true with unconscious bias, Neblett said. “No matter how far we think we’ve come, we haven’t come far enough,” she said.
“Some nurses still have the thought that a Black women’s body is different than a white woman’s body. So they still have the thought that the difference in care and the difference in outcomes is due to a biological or genetic difference,” Neblett explained, noting this is not the case.
Neblett said recruiting and training more Black and Hispanic health care providers will also help strengthen the connection with patients of color, allowing for better care.
“It’s a big push in all fields, not just maternal medical care, to ensure that Black women, when they are coming to this space, feel comfortable,” she said. “And it’s not just the doctors. It’s the nurses, it’s the technicians, it’s the frontline staff and the registration, every part of it, so they feel empowered and understood when they are coming here.”
Black maternal health week: Vast disparities among Black and white mothers Interview with Dr. Damali Campbell-Oparaji, OBGYN at University Hospital in Newark
Briana Vannozzi, Anchor April 13, 2022
New Jersey is ranked 47th in the nation for maternal deaths. It also has some of the worst racial disparities for both maternal and infant mortality. A Black mother in New Jersey is seven times more likely than a white mother to die from maternity-related complications. A Black baby is more than three times as likely to die before their first birthday than a white baby. Dr. Damali Campbell-Oparaji is an OBGYN with Rutgers New Jersey Medical School and University Hospital in Newark. She’s been among the most vocal in the state for the need to fix what many call a shameful problem.
First Lady Tammy Murphy sees progress on maternal mortality. ‘There’s a lot of indicators that things are going in the right direction’
Briana Vannozzi, Anchor April 14, 2022
As the pandemic dragged on in the winter of 2021 first lady Tammy Murphy keyed in on what she called a “crisis” growing worse — the state’s maternal mortality rate, with Black women seven times more likely to die of maternity-related complications than white women. Launching her Nurture NJ program, she set an ambitious goal to halve the rate in five years.
We caught up with the first lady in Black Maternal Health Week. Noting that Gov. Phil Murphy “has signed over 42 pieces of legislation in this area to make sure that we are doing everything to establish best practices,” she acknowledged the difficulty of addressing the complicated issues involved during the pandemic. “I know we are moving the needle; it’s not the easiest thing to quantify because maternal mortality and infant mortality are lagging indicators… But there’s a lot of indicators that things are going in the right direction,” she said.
Bias at root of maternal health crisis, Tammy Murphy says Issues are complex, she says, as NJ works to bridge gap in minority communities
Lilo H. Stainton, Health Care Writer December 6, 2021
Real bias training for doctors, nurses and other medical professionals involved in reproductive health. Helping women to optimize their health before they become pregnant. Better engagement with the faith community on maternal and infant health initiatives.
These were among the recommendations participants shared during first lady Tammy Murphy’s 4th Annual Nurture NJ Black Maternal and Infant Health Leadership Summit, which convened online last week. New Jersey has struggled with one of the nation’s highest maternal mortality rates and massive racial disparities and Murphy said Black mothers are seven times more likely to die from childbirth-related causes than white mothers in this state.
“I’m incredibly proud of the steps we have taken so far,” Murphy said in welcoming the participants, “but we must understand sweeping change requires persistence and unfailing dedication. At the same time, we know that the urgency of this crisis remains and that its root cause is institutional racism, plain and simple.”
Initially she had believed barriers to health care caused these massive disparities, Murphy explained in an interview following the event, but eventually came to realize the problem is much more complex, involving everything from nutrition to transportation to individual finances. But the root cause is clearly bias, she said, pointing to the birthing struggles shared by entertainment icon Beyoncé and tennis star Serena Williams as examples.
“The fact that those two women were disregarded and had traumatic pregnancies, that speaks volumes,” Murphy said. She explained that despite the fact that they are wealthy, prominent and educated women, clinicians did not take their complaints seriously because of their race — both women are Black — and serious complications resulted. “If those types of people are having problems, can you imagine if you are feeling insecure, you don’t know the language or the terminology and you’re a person of color?” Murphy said. “God help you.”
Plan to improve
To address these issues, Murphy launched the Nurture NJ campaign in 2019. By the following January the group had attracted philanthropic support, drafted a national expert to lead the charge and outlined a bold public health goal: to cut New Jersey’s maternal death rate in half and eliminate racial gaps by 2025. A formal plan followed in early 2021 that identified nine areas of opportunity to improve birth outcomes in New Jersey.
The plan is not a set of instructions, Murphy told summit participants, but a “living, breathing document” that must allow for flexibility and innovation — and the event itself was “ground zero” for that work.
“We are not simply seeking to improve our maternal health statistics or data,” she said. “We are here to make sure every New Jersey mom and baby gets off to a healthy start and is put on a trajectory toward a full and healthy life.”
Working closely with state lawmakers, Gov. Phil Murphy’s administration has already acted on specific recommendations from the plan and has codified in law three dozen reproductive health-related proposals. The current state budget includes new money to extend Medicaid coverage for pregnant individuals for a full year after they deliver and expand access to doula care. It also funds the launch of a universal home-visit program for new moms, something that has been shown to reduce post-partum depression, maternal mortality and emergency care costs in Oregon, which began a similar program in 2019.
“It’s a game changer,” Murphy said of the home-visit initiative, scheduled to start this spring. “It’s going to expand our ability to help people in such a meaningful way,” she said, explaining how such visits can effectively connect new parents with critical housing, nutrition and other social services. “I’m proud of everything we’ve done but that piece is a massive, massive move on the chess board.”
Significant racial disparities
March of Dimes President Stacey Stewart said her organization’s latest report card show some minor improvements in New Jersey’s maternal health metrics in the past year — the state went from a C to a C+ and its pre-term birth rate declined slightly — but racial disparities remain significant. The rate of pre-term, or early, deliveries is at least 50% higher for Black women than mothers of other races, it notes, and pre-term birth rates increased in several counties, including Essex, Ocean and Middlesex.
Last week’s summit provided a chance for diverse stakeholders — government officials, academics, doulas, midwives and other reproductive care providers, advocates and moms, among others — to review the plan and provide feedback. The event included keynote remarks from Tammy Murphy, Stewart and U.S. Rep. Bonnie Watson Coleman (D-NJ) but Murphy made clear that everyone’s input added value to the process. “The moms have to be at the table before the table is built,” Murphy said.
Nearly 300 people signed up for the virtual event — Murphy’s staff said they had to limit participation — and more than half stayed engaged for much of the three-hour event, a lot of which was dedicated to breakout groups that discussed how to build racial equity and infrastructure, support community-led initiatives and better share information. Other groups focused on addressing social determinants of health — things like housing, trauma and poverty — and making health care services more respectful and human-centered.
Murphy joined a session on engaging multiple sectors where people discussed the creation of a maternal health center in Trenton, something the strategic plan identifies as a critical step to foster collaboration among the multiple stakeholders involved. It would be a place to coordinate research, evaluate state programs and reforms, map areas without maternal health services and more. Murphy also wants the center to fill needs in the Trenton community, perhaps with a clinical component that allowed people to give birth on site.
Trenton, a ‘birthing desert’
“It’s looking at everything at once,” Murphy said after the event. “Trenton is a birthing desert, it’s a food desert. We want to solve some of these things.”
The New Jersey Economic Development Authority, which is overseeing the Trenton project’s development, has already collected ideas for the center from dozens of academic and policy groups, health care providers, maternal health organizations, and people involved in reproductive health. Murphy said the next step is to hire someone to assess this information to clarify the mission and create a structure, both physical and organizational.
The current state budget includes nearly $3 million to get the process started, Murphy said, while construction will also involve funding from private sources. The Nurture NJ initiative and groups in other states are also interested, she added.
“My dream is that we take this entire initiative outside of government and we create an entity that will protect (this maternal health work) going forward,” Murphy said. “We can be the Cleveland Clinic, the MD Anderson of this space.”
sistateacher’s thoughts
Maternal health is a very important matter for babies, families, neighborhoods, and communities.
Black maternal health is essential for the Black family to not only survive but THRIVE!
There are intersections of inequities that contribute to the morbid matter of Black maternal health. It is race, class, gender, generational trauma, cultural mistrust of the medical establishment, and an intimate community. NJ is a wealthy state but a very segregated one within the Union. It is the segregation that fuels the disparities, especially in the area of health and Black maternal health.
Although these efforts are taking place now to address this matter, it will take time and much effortful investment for progressive change. The ROI may take a generation or 2 to determine the outcome of these deliberate efforts for progressive change. However, I believe it can be done. Just as there are intersections of inequities, there must be intersections of equities.
An equitable intersection is to listen to the families and take heed to their needs. In the 12/6/21 article where it discusses the Trenton project, there are plenty of people identified to address the issue except the families who have experienced poor maternal health. Their voices need to be heard about the experiences of gynecological health, obstetrical health, and the birthing process. Yes, before pregnancy and after the birth of the baby.
MY STORY
I birthed 2 healthy children in young adulthood via vaginal delivery with few issues during my pregnancy or delivery. I had an ear infection, 102 degree fever during labor, and he was born 3 weeks before the due date but healthy with my first son. Honestly, the only part I remember is waking up in labor and him scrunching when there was a contraction. I was out of it most of the time until I had to PUSH him out. With my second son, I was 2 centimeters dilated at 32 weeks gestation and placed on bed rest until he decided to enter the world. Well, my son decided on a Tuesday evening while I watched Jeopardy and I wondered “am I having contractions?” Contrary to the first birth, I remember everything. I arrived at the hospital 6 centimeters dilated and my water broke 20 minutes before I pushed him out. The midwife told me the water would trickle during my prenatal visits but it gushed out. 2 healthy baby boys weighing more than 6.5 pounds each. However, my third and last baby was another story. Quite a few years before his birth, I had Charity Care as payment for my medical care. During my annual pelvic exam, I was asked by the gynecologist “has anyone ever told you you had fibroids?” No, I said. That was the end of the conversation, no further diagnostic testing or professional advisement to follow-up, NOTHING ELSE WAS SAID. About 4 years later, I had a myomectomy because the fibroids were on my bladder, causing urine to back up into my kidneys, resulting in nephritis. The following year I was pregnant and knew my baby would be delivered the unnatural way, cesarean section. Two days after we were released from the hospital, I was rehospitalized with post-partum pre-eclampsia. Thank God this time I had health insurance, a doctor, and my godmother present with me to take care of my son during my hospitalization. I’m happy I had natural birth experiences and was not terrorized by them. It was the unnatural experience, a cesarean section that scared me, major surgery. Due to having a hysterectomy in 2015 as a result of the fibroids, no more births for me but I am concerned about mothers with whom my sons may have children.
With the available data bout maternal health and Black maternal health, will the effortful investment be sustainable for generations to come? Inquiring minds want to know but only time will tell. Make sure to tell your friends and loved ones to seek out prenatal care as early as possible for the best possible outcome. It is a matter of life or death for both child and mother.
sistateacher 