Landmark legislation headed to the president’s desk would provide millions of dollars to help states determine why women are dying from pregnancy and childbirth at troubling rates. But the bill passed last week by both houses of Congress does not specifically require states to examine whether flawed medical care played a role.
Studies have found that at least half of childbirth-related deaths could have been prevented if health care providers had followed best medical practices to ensure complications were diagnosed and treated quickly and effectively.
Yet a USA TODAY Network investigation in September revealed that state maternal death review committees across the country often avoid scrutinizing medical care that occurred in the days and hours before mothers’ deaths. Many state reports instead focused on mothers’ lifestyle choices or larger societal problems, such as women being obese, smoking or failing to seek prenatal care or use seat belts.
Bipartisan sponsors and supporters of the legislation said it’s an important first step, which would provide critical resources to ensure all mothers’ deaths are reviewed for all causes. Its language, they noted, would allow the Centers for Disease Control and Prevention to include scrutiny of medical care as a requirement for states to receive a grant.
“It’s impossible to read the text of HR 1318 and conclude that committees will do anything but study every single death and cause – societal, provider error or other – if they want to successfully compete for this funding,” said Angeline Riesterer, communication director for the bill’s sponsor, U.S. Rep. Jaime Herrera Beutler, R-Wash. The bill, she said, calls for review committees to use best practices.
Supporters of the legislation said it’s crucial that delays in diagnoses and failures to treat women for childbirth emergencies are studied by state review committees – alongside societal factors – to identify trends and take action to prevent deaths.
“The key thing here is to not blame the mother,” said Cindy Pearson, executive director of the National Women’s Health Network, a consumer advocacy organization.
As the number of childbirth-related deaths has risen – making the USA the most dangerous place in the developed world to give birth – Pearson said too much blame has been placed on mothers for being older, overweight or having underlying health issues.
“That does not in any way, shape or form explain the differences in rates in our community or racial disparities,” she said.
USA TODAY’s ongoing “Deadly Deliveries” investigation has focused on the role of hospital care in preventable deaths and injuries of mothers. Each year, about 50,000 U.S. women are severely harmed and about 700 die because of complications related to childbirth. African-American moms are three to four times more likely than white moms to die or suffer devastating childbirth injuries, studies found.
At hospitals across the country, USA TODAY exposed doctors and nurses failing to follow nationally promoted best practices that make childbirth safer. Little information is publicly available to women about childbirth complication rates at maternity hospitals in their communities, and many hospitals declined to answer questions about whether they follow safety practices.
The legislation would create a national program to confidentially collect and analyze standardized data on every mother’s death. Its stated goal is to identify ways to reduce the number of deaths and serious injuries. The legislation would provide $12 million in funding in fiscal year 2019 to bolster states with maternal mortality review committees and help create committees in more than a dozen states that lack them.
“The Preventing Maternal Deaths Act takes an important step forward in putting review teams in place in every state,” said Rep. Diana DeGette, D-Colo., one of the bill’s co-sponsors.
Members of Congress and health care advocates credited news coverage from USA TODAY, ProPublica, NPR and others in getting Congress to pass the legislation.
Rahul Gupta, chief medical and health officer for the March of Dimes, called the bill a “game changer.”
Language in the bill says that for a committee to participate in the program and receive federal funding, it must demonstrate to the CDC that its “methods and processes for data collection and review … use best practices to reliably determine and include all pregnancy-associated deaths and pregnancy-related deaths, regardless of the outcome of the pregnancy.” The legislation would require that committees submit standardized data to the CDC.
Riesterer said it is the legislation’s intent that reviews examine all causes, including issues with the medical care women were provided. She pointed to a model worksheet developed by the CDC for voluntary use by state review committees with fill-in text boxes for contributing factors involving health care providers and facilities.
In a statement, the CDC said that funded review committees “will collect standardized information from all available sources – including medical records and hospital records – for each pregnancy-related death in their jurisdiction. The funded committees would then review this information and provide recommendations for prevention.”
“This legislation is an important first step in what will inevitably be a much broader and ongoing effort,” said Sen. Shelley Moore Capito, R-W.Va., who co-sponsored related legislation in the Senate. “The aim of the bill is to help us, as a country, begin to address maternal mortality rates, to better understand the problem and to draw attention to it – while also ensuring that states still have the flexibility to respond to the specific and unique health needs in their various communities.”
Lisa Hollier, president of the American College of Obstetricians and Gynecologists, said uniformity in how mother’s deaths are reviewed and tracked is key to addressing maternal deaths nationally.
“It’s not untrue that (state committees) could do a better job of investigating and making recommendations for preventing maternal deaths, and that is why the passage of the Preventing Maternal Deaths Act was so critical,” Hollier said.
Some state-to-state differences, she said, can unearth important insights.
“The findings from (committees) will always be somewhat unique because they are based on local data and will reflect the issues of biggest concern for that state,” she said. “Knowledge of local public health issues, such as opioid misuse, smoking, mental health issues, absolutely plays a role in designing programs for preventing maternal deaths and should not be minimized.”