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Maternal Health Issues
Barbara Parker R.N., M.P.H.Division of Women’s and
Infants’ HealthVirginia Department of
HealthOctober 25, 1999
Major Issues Regarding Maternal Health
Maternal MortalityInfant MortalityLow Birth WeightAccess to Care
The 3 leading causes of maternal death in the
United StatesHemorrhage, including
ectopic pregnancyPregnancy-Induced
HypertensionPulmonary Embolism
Reasons for reduction in maternal mortality
Sulfa and antibiotic drugsDecrease infections
secondary to illicit abortionsAvailability of banked bloodSafer surgical procedures,
including Cesarean
The Year 2000 goal (3.3 maternal deaths per
100,000 live births) will not be reached
nationally or in Virginia.
Maternal mortality is not reduced through general
improvement in nutrition, education, or
elevation in social status.
Maternal Deaths by RaceVirginia Residents, 1991-1997
Year Number ofDeaths
Maternal Mortality Ratio
White Black Other Total
1991 3 1.4 8.4 0.0 3.1
1992 6 2.9 12.7 29.5 6.2
1993 4 4.4 4.3 0.0 4.3
1994 6 2.9 18.1 0.0 6.4
1995 4 1.5 14.2 0.0 4.4
1996 3 3.0 0.0 20.8 3.3
1997 4 4.6 0.0 18.9 4.4
Components of maternal death reviews
Investigation of individual maternal death
Multidisciplinary discussion of each case
Recommendations to prevent future deaths
Infant mortality is a health status variable
which is widely recognized as a measure of a nation’s, as well as a
state’s, maternal and child health status.
Countries with lower infant mortality rates
than the U.S. have comprehensive medical
care systems that provide virtually all
pregnancy and infant health care visits.
African-American babies are more likely to die in America than their white counterparts when born with the same medical
risks.
Social standing in a community is linked to favorable outcomes in
perinatal care even when access to services
is constant.
Role of men in pregnancy and childbirth:
Encourage reduction of risky behaviors such as smoking, drug and alcohol use
Follow healthy nutrition Promote early and regular prenatal care
Increase assistance with household chores
Observe for complications of pregnancy
Strategies to reduce infant mortality:
Expand Medicaid eligibility
Simplify and shorten eligibility requirements
Provide “wrap-around” services
The improvement in infant mortality rates is
not an indicator that babies are healthier, but
medical technology is enabling sicker babies
to survive.
Resource Mothers - home visiting mentors for pregnant teens and
their familiesBaby Care - case management
services after completion of a “risk assessment” with coordination,
follow-up and monitoringVirginia Healthy Start Initiative - mentoring services for pregnant
women; nutrition services for prenatal patients and infants; male
support services for fathers; and community-based death reviews.
Regionalization of perinatal care was
successful in the 1970s and 1980s by
concentrating the births of very low birth weight infants to the tertiary
centers.
RPCCThe Regional Perinatal Coordinating Councils
(RPCCs) are public/private coalitions charged with the goal to improve the system by which perinatal health care is provided within
Virginia.
Quality of Care
Guidelines for Perinatal Care -ACOG/AAP
Toward Improving the Outcomes of Pregnancy - March of Dimes
National Fetal and Infant Mortality Review
National Fetal-Infant Mortality Review (NFIMR) Program
Established in 1990Public-private partnership
American College of Obstetricians and Gynecologists (ACOG)
Maternal and Child Health BureauMarch of Dimes Birth Defects
Foundation
FIMR is:Community-based, action-
oriented processEarly warning system that
describes health careMethod of continuous quality
improvementMeans to implement core
public health functions
Objectives:
Initiate an interdisciplinary review of fetal and infant death from medical and social records and maternal interview.
Describe significant social, economic, cultural and systems factors that contribute to mortality.
Design and participate in implementing community-based interventions determined from review findings.
Low Weight Births:
7.7% of all Virginia BirthsHas not significantly changed since 1970s
Single most important contributor to infant death
Low Birth Weight is associated with multiple factors:
Medical Risk Factors High parity Chronic diseases Previous Low Birth Weight infant Genetic factors Multiple gestation Poor weight gain Infection Placental problems Premature rupture of membranes Fetal anomalies Maternal stress
Low Birth Weight (continued)
Demographic Risk Factors Age < 17 years and > 34 years African-American race Low socioeconomic status Unmarried Low education
Behavioral Risk Factors Smoking Poor nutrition Toxic exposures Inadequate prenatal care Substance abuse
Efforts to reduce Low Birth Weight are either:
Population-level activitiesIndividual-level strategies
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