Too many mothers are dying

Health professionals seek change as the state experiences a high rate of maternal mortality.

BY KHALIA SMITH

Despite medical advancements, women in Missouri die from complications during and after childbirth at a higher rate than almost every other state in America.

Missouri is ranked 44th out of 50 states for maternal mortality, with 75% of pregnancy-related deaths in Missouri from 2017 to 2019 categorized as preventable, according to a 2022 report published by the Missouri Department of Health and Senior Services (MDHSS).

“It’s definitely unfortunate that here we are in 2023, and we have people dying that shouldn’t be dying,” says Ashlie Otto, maternal mortality coordinator for the MDHSS.

How does Missouri’s maternal mortality rate compare nationally?

The maternal mortality rate is calculated by the number of maternal deaths per 100,000 live births. The MDHSS report found that Missouri had a maternal mortality rate of 25.2 deaths per 100,000 live births from 2017 to 2019. At the time, that compared to the national rate of 20.1 deaths. Data released in March by the Centers for Disease Control and Prevention showed the 2021 national mortality rate was 32.9 deaths per 100,000 live births. Missouri data from that same time period is not yet available.

Both reports explore the connection to race. The CDC found that the death rate for Black women was more than two times greater than the death rate for white women. The MDHSS report found that the statewide death rate for Black mothers is more than three times higher than that for white women.

Why are Black women dying at higher rates?

“One of the things that I feel is an issue is systemic racism,” says Erica Dickson, founder of the Mid-Missouri Black Doula Collective.

Historically, health care misconceptions have led to the mistreatment of Black people, ranging from overestimation of pain tolerance to a lack of respect from doctors.

“I think that our socialization based on our different identities is being a barrier to us building the relationship that we need to build in order to give quality service,” Dickson says.

The 2022 MDHSS report estimates 57% of Black mothers “experienced late entry into prenatal care,” such as

BY THE NUMBERS

In 2022, the Missouri Department of Health and Senior Services published a report focusing on key factors contributing to maternal mortality in Missouri from 2017 to 2019.

44th of 50 states for maternal mortality

Missouri ranked of pregnancy-related deaths in Missouri were categorized as preventable 75% physical exams, lab tests and discussing health history. Receiving prenatal care late into pregnancy risks missing detection of complications, according to the U.S. Office of the Assistant Secretary for Health’s Office of Women’s Health.

Deaths and race

Black women had a maternal mortality rate of 187.6 deaths

100,000 live births compared to 54.1 for Hispanic women 65.7 for white women

Why does maternal mortality persist?

Otto says both the opioid epidemic and a rise in mental health conditions have contributed to the long lasting impact of pregnancy-associated mortality. In the MDHSS report, overdose was listed as the most common form of fatal injury for pregnant women. Of the overdose related deaths, 72.7% had opioids found in the toxicology reports.

In terms of mental health conditions, Otto says the state has noticed a inconsistency in health care providers conducting mental health screenings, and many mothers experience issues when pausing medications during pregnancy.

“Conditions like depression and anxiety are exacerbated either in the postpartum period or during the pregnancy because they’re no longer on those medications,” she says.

Anxiety, perinatal and postpartum depression and birth-related PTSD are the most common pregnancy-related complications, with 75% of women affected not receiving help for these issues, according to the American Hospital Association. Suicide is one of the leading causes of death in the postpartum period.

Another factor affecting Missouri mothers is the lack of access to health care.

Pregnancy Support

Mid-Missouri Black

Doula Collective

289-7667

Provides doula services and educational resources to Black women.

MU Health Care Group Prenatal Care

499-6084

Offers guided educational discussion groups for the second trimester.

MU Health Care

Low-Intervention Birth Program

499-6084

Offers childbirth with less medical intervention for low-risk pregnancies.

“We’ve had a number of both hospital closures over the last decade in rural Missouri,” says Tracy Greever-Rice, director of the MU Center for Health Policy. “Sometimes hospitals stay open, but they start to limit the services they provide.”

Otto says in addition to a limited number of OB-GYNs, expecting mothers can also experience transportation issues, especially in rural areas.

What legislation is being proposed to improve maternal healthcare?

On Jan. 18, Missouri lawmakers proposed a bill that would grant mothers up to 12 months of postpartum Medicaid coverage, as opposed to the current 60-day coverage. The bill is still in the legislative process. If passed, the state would use the 2021 American Rescue Plan Act funds and would provide about 4,600 women with extended postpartum coverage.

Both Greever-Rice and Otto say the passing of this bill would not only help women in the state but also lower the amount of deaths that occur later in the postpartum period. According to the CDC, about one-third of maternal deaths happen between 40 days and one year postpartum.

The MDHSS report found that pregnancy-associated deaths for Missouri women on Medicaid was more than eight times greater than Missouri women on private health insurance.

When it comes to next steps for Missouri, there is much work to be done. In addition to Medicaid extension, the MDHSS recommends all health care providers screen for mental health conditions, substance use disorders and cardiovascular disease.

From her perspective as a doula, Dickson emphasizes the importance of women’s education on the birthing process to make it as smooth as possible.

“You’re going through the process with them being a part of the team,” Dickinson says. “You’re not there to do something for them, but with them.”

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Watch…

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