Investigating the Maternal

Maternal Mortality :

Arkansas legislature establishes review committee

BY Charlotte LoBuono

The committee will review all pregnancy-related deaths, or maternal deaths that occur up to one year after the end of pregnancy. Its first report goes to the legislature in December 2020.

According to the 2019 America’s Health Rankings Report on the Health of Women and Children from the United Health Foundation, Arkansas ranks 46th in maternal mortality compared to other states. So, in April 2019, the Arkansas State Legislature, with passage of ACT 829, authorized formation of a review committee to explore why the maternal mortality rate is so high and how to reduce it.

The Maternal Mortality Review Committee (MMRC) is guided by policies and statutes that allow access to medical records for review. William Greenfield, MD, medical director of Family Health at the Arkansas Department of Health, says reviewed cases will be de-identified prior to MMRC’s review.

As an interprofessional group with members from across Arkansas, the new MMRC held its first meeting January 9. The current members all share a commitment to improving maternal outcomes. The makeup of the committee is being finalized.

“The committee will have about 20 members representing a diverse group of health care practitioners,” says Dr. Greenfield. Most members will be from the field of obstetrics/gynecology, but behavioral health, cardiology and psychiatry will also be represented. “Ideally, the representation of different demographics will allow everyone to bring something unique to the table,” he explains.

A first objective of the MMRC will be to recruit and train an abstractor. The abstractor will gather information from medical records to accurately capture the events of a woman’s life leading up to and including her death.

MMRC members will review the cases to determine if the deaths were pregnancy-related. “We already know each case we review will end in tragedy. We want to determine if the woman would have died even if she was not pregnant,” says Dr. Greenfield. This protocol has been recommended for these types of review committees by the Centers for Disease Control and Prevention. William Greenfield, MD

MMRC tas ks

In addition to reviewing individual deaths, the MMRC will make recommendations about how to reduce maternal mortality. When the committee meets, it will ask six questions:

• Was the death pregnancy-related? • What was the underlying cause of death? • Was the death preventable? • What were the factors that contributed to the death? • What are the recommendations and actions that address those contributing factors? • What is the anticipated impact of those actions?

“A deep dive on each individual death will help us determine what resources are needed, and how to best allocate those resources to make a difference,” Dr. Greenfield says. For example, Southwest Arkansas is less densely populated than other areas of the state and has fewer health care resources. So that region may benefit from some intervention to support the medical community, such as more or different resources, and more providers.

The MMRC should predict how much each of its recommendations might help to reduce maternal mortality rates. For example, patient education and counseling might have a small impact on mortality rates, whereas clinical interventions would be expected to have a larger impact.

Findings and recommendations will be combined with information from other states using a standard abstracting format and a standard reporting method.

Current comm unity initiatives

Dr. Greenfield gave a presentation on maternal mortality at the 2019 March of Dimes Marshallese Women’s Conference in Springdale on November 7. He also presented on the topic at the Arkansas Department of Public Health Grand Rounds on December 12. “One of the things we are doing now is focusing on education,” he says. Education efforts involve making sure patients, providers and hospitals are aware of best practices and early warning signs of complications associated with severe maternal morbidity.

Maternal mortality among African Am erican women

An educated African American woman has a greater risk of her baby dying than a white woman with an eighth-grade education. Even when age and other factors are considered, the disparity still exist. Research suggest that a lack of trust in the health care system among African Americans may be a factor. Delivery-of-care inequalities may also be an issue. “I think that really gets to the heart of the question, and highlights why we need to have these assessments,” Dr. Greenfield says.