Wheres the M in MCH Not recognized as a problem No accountability in the system Over 10 years greater attention Maternal mortality review Safety Bundles protocols guidelines CONTEXT ID: 1045888
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1. Families USAJanuary 24, 2020
2. Where’s the M in MCH?Not recognized as a problem No accountability in the systemOver 10 years greater attentionMaternal mortality reviewSafety Bundles - protocols + guidelinesCONTEXT The maternal health crisis in the US
3. NOT High Value CareSpend the most but…Underuse high-value, low-tech strategiesOveruse interventionsHigh rates not linked to improved outcomesMistreatment, disrespectful careDisparities remain unchanged10 YEARS LATER…Maternal mortality and severe complications continue to rise in US.
4. `MOVING FORWARDHIGH QUALITY CARERescue PreventionClinical ComprehensiveTop-down Respect, dignity, rightsDisparities EquityWe don’t need to reinvent the wheel!WHERE WE NEED TO GOQuality, respectful, and equitable maternity care for all
5. `Midwifery Model & Community-based DoulasEvidence-based models to support optimal maternity care practices.RESEARCH SHOWS BOTH MODELS:Result in safer, healthier, more satisfying births Facilitate self-advocacy & satisfactionIncrease health equityReduce spendingHIGH VALUE MODELS OF CAREImproving outcomes, enhancing the experience of care, reducing costs…yet both models are underutilized.
6. Where do we want to go?More women are informed and equipped to exercise their agency Increased availability and visibility of high-value modelsIncrease in respectful and positive maternity care experiencesGreater trust and utilization of the medical system and health servicesImproved health outcomes for women and infantsHigh-value care - cost-effective spending with better outcomes/experiences … better ROI
7. Highlights from 2019Bipartisan commitment to maternal health + Medicaid extension Energy & Commerce billsHelping MOMS ActMedicaid Extension + Doula Report (from MOMMIES Act)Maternal Health Quality Improvement Act of 2019Rural health + Demonstration ProjectsBlack Maternal Health Caucus leadership – 9 more bills
8. Federal Legislation Maternal Health Awareness DayNative Women’s Maternal Health ResolutionBABIES ActMidwives for MOMS ActMOMMIES ActMOMMAS Act + many, many more!Key topics perinatal support, midwifery model, and equity
9. Mistreatment FindingsRate of mistreatment by race
10. 10
11. Mistreatment by Place of Birth
12. Measuring Mistreatment by Place of Birth + Provider Type Women who reported 1+ mistreatment item: Midwife + community birth: 4.8%Midwife + hospital birth: 23.8% Doctor + hospital birth: 30%
13. Implications – Consequences of MistreatmentPrevalence of reports of mistreatment in a high resource setting“being ignored” “providers failed to respond to their requests for help” Additional research needed The California Pregnancy-Associated Mortality Review (CA-PAMR): Healthcare provider factors - most common contributor to maternal deaths, 81% of maternal deaths in that time period. The most common provider factor was delayed response to clinical warning signs, followed by ineffective care