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Maternal deaths increased during the pandemic. How California is fighting that trend

With federal data showing a spike in deaths among pregnant women during the pandemic, California advocates say it’s fueling their resolve to continue trying to prevent as many of those deaths as possible.

The National Center for Health Statistics reported Thursday that 1,205 pregnant women died in the United States in 2021, a 40% increase from 2020, when 861 deaths occurred. The total was 754 in 2019.

Pregnant black women continued to have the highest risk of dying, according to the report. In 2021, the maternal mortality rate for black women was 69.9 deaths per 100,000 live births, 2.6 times the rate for white women with 26.6 deaths. Among Hispanic women, the report found that there were 28 deaths per 100,000 live births.

The report did not specify causes of death or provide state-by-state data, but a federal Government Accountability Office report released in October found that a quarter of maternal deaths in 2020 and 2021 were related to COVID-19.

“We were afraid to see the real numbers,” said Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative, which brings together state agencies, hospitals and health provider associations to find ways to prevent pregnancy complications and deaths. .

“It sort of overwhelms all the other work that we’ve been doing to work on deaths from hypertension, deaths from hemorrhage and deaths from blood clots,” Main said. “All of those are now overwhelmed or downplayed by the pandemic.”

In recent years, California has become a national leader in reducing maternal mortality. The rate of maternal deaths in california in 2006 it was 16.9 per 100,000 live births, according to the California Maternal Quality Care Collaborative. By 2016, the rate had decreased by 65%.

There was 18.6 maternal deaths per 100,000 live births in 2020 in California, up from 12.8 in 2019, according to the state Department of Public Health.

Among pregnant women in California, cardiovascular disease was the leading cause of death between 2018 and 2020, followed by hemorrhage, sepsis, thrombotic pulmonary embolism, and amniotic fluid embolism. More than a quarter of the deaths occurred on the day of delivery.

Not enough of the public are aware of how serious maternal mortality is, said Sonya Young Aadam, executive director of the California Black Women’s Health Project, an Inglewood-based nonprofit.

She said “it’s mind-blowing and heavy” to constantly hear stories of black people remembering bad birth experiences that happened to them or family members involving complications, or doctors not listening to them. Too often, she said, those stories include the person feeling something was wrong before, during or after delivery.

But even amid the lack of awareness, Aadam said she and other advocates try to walk the fine line of informing Black communities about maternal deaths and pregnancy complications without causing fear to the point where people give up. completely to pregnancy.

“It’s letting our community know that they have a voice and helping to build advocacy around this so that people don’t walk away from a situation wondering, ‘What did I do?’” Aadam said. “(It is like this) they enter armed and willing to demand a happy birth, which they should be able to accommodate in any health system in the state. Right now, we know that’s not what’s possible.”

The new report comes as families, health advocates and health providers express their dismay at the number of deaths and pregnant women who did not have the physical, emotional and social support they needed during the pandemic. Pregnant women often had to be isolated in hospitals to prevent potential COVID-19 infections, limiting potential support in hospital rooms.

Parent and community support groups have moved from in-person calls to Zoom for the sake of social distancing. Some pregnant women were unable to maintain social distancing because they were essential workers and exposed to COVID-19. Additionally, public health leaders at the federal, state, and county levels have struggled with messaging during the pandemic to encourage more pregnant women to get vaccinated against COVID-19.

Main said women giving birth today “are much more complicated patients than we had 20, 30 or 50 years ago” because many are 35 or older and arrive with high blood pressure, diabetes or other problems that can complicate pregnancies.

The federal report found 20.4 deaths per 100,000 live births for women younger than 25, 31.3 for those 25 to 39 and 138.5 for those 40 and older.

When it comes to addressing the severe mortality gaps between black mothers and white mothers, Main said that part is due to differences in rates of high blood pressure, diabetes and obesity. She also cited the “weathering effects” on black health due to continued exposure to racism over the years. But implementing protocols that all providers must follow for each patient can help reduce complications.

“It’s when you start to engage in subjective decision making that … biases kick in,” Main said. “The more we can reduce some of the subjective decision making, the better we can do to reduce disparities.”

Part of the California Maternal Quality Care Collaborative’s work has included helping to develop bleeding carts that are now in every hospital in the state, so health providers can quickly provide care if mothers lose blood quickly. The collaboration has also worked with health providers to develop protocols to help mothers who experience high blood pressure after childbirth, known as preeclampsia.

In recent years, California has also extended Medi-Cal benefits for new parents up to 12 months after birth and now allows doulas to become eligible providers under Medi-Cal.

Doulas are considered a key part of providing physical and emotional support and advocacy for mothers before, during, and after childbirth, particularly for black women. The state has also established a fund for midwifery training programs that prioritize the admission of underrepresented groups.

The California Black Women’s Health Project launched training for black birthing workers and creating a business toolkit to help them start and run circles of support for black birthing workers throughout the state. The organization is also developing training to help birth workers apply to become Medi-Cal providers.

The organization has also been a fiscal sponsor to help birth workers receive funding from the Los Angeles County Department of Public Health. While progress is being made, Aadam said, more “unapologetic investment” is needed in Black-focused community efforts.

“There are many, many, many, many of us who will possibly die from this Earth before this issue is really addressed,” Aadam said. “It will take time, but no matter how we save someone along the way, that’s what we’re trying to do to reduce those stories: arm our sisters with someone by their side and a support team around them.”