Keeping the Focus on NJ’s High Maternal-Mortality Rates

Precedent-setting Maternal Health Awareness Day seeks to educate patients, providers in reducing avoidable deaths

Ryan and Tara Hansen, with their first son. Tara died six days after the baby was born.
A growing array of healthcare providers have teamed up to focus attention on what they say are unnecessarily high maternal-mortality rates in New Jersey and are now looking to work with patients, families, policymakers and others to reduce avoidable deaths.

The campaign includes what could be the nation’s first Maternal Health Awareness Day – set for Tuesday – an effort to underscore the importance of healthy pregnancies and institute evidence-based protocols to help providers ensure successful births for moms and babies. The event will be marked by public gatherings, educational outreach, academic seminars at Rutgers Medical School, and a social media presence with the hashtag #123forMOMS.

The campaign has been fueled in part by Ryan Hansen, who in 2012 created the Tara Hansen Foundation to honor his wife, a 29-year-old special education teacher, who died six days after giving birth to her first son. Despite her requests for medical assistance, providers apparently failed to address what was a preventable infection.

“I cannot overstate the importance of empowering women’s voices in the management of their healthcare,” said Dr. Gloria A. Bachmann, director of the Women’s Health Institute at Rutgers Robert Wood Johnson Medical School. Bachmann helped spearhead the campaign, which has gained support from a number of clinical professional groups, hospital leaders, and public health officials.

Pay close attention

Physicians and family members should not overlook a new mother’s complaints, or attribute pain or discomfort to childbirth alone, Bachmann stressed, but should take her concerns seriously and investigate any complaint. Among the campaign’s goals is to emphasize to providers the need to “Stop, look, and listen” – a three-step protocol designed to ensure patients’ are fully heard, and save lives.

“Every concern” – even seemingly unrelated issues like blurry vision or itchy skin – “could be an indication of something serious,” she said.

The U.S. lags 49 other industrialized countries with lower maternal mortality rates; in 2015, some 26.4 out of 100,000 American women died within a year of giving birth, according to data compiled by advocates, more than three times the rate recorded in 1987. New Jersey’s rates have largely tracked the national trend; in 2013, it ranked 35th among states for its high rate of pregnancy-related deaths.

(The issue also was the focus of an NJ Spotlight roundtable discussion in March.)

New Jersey’s own Maternal Mortality Review Program, a decades-old program operated under the Department of Health, has reviewed more than 700 cases since 1999. In its most recent report, covering 2009 to 2013, the maternal death rate for white women went from 10.2 to 12.8 per 100,000 births; among black women, it started at 48.8, dropped to 25.7 in 2011, and had climbed back to 46.5 by 2013.

Cause of death

The report includes a detailed analysis of each death and concrete recommendations for improvements, including better screening and care of pregnant mothers, clear provider protocols for all deliveries, and greater public education about the importance of prenatal care and healthy birth outcomes. But more must be done to educate patients and providers about these issues, event organizers agreed.

“It was apparent from our discussions at the New Jersey Maternal Mortality Meetings that our detailed reports which included recommendations and suggested improvements for the more common pregnancy-related maternal death issues often went unacted upon,” said Dr. Joseph Apuzzio, vice chair of Obstetrics, Gynecology and Women’s Health at Rutgers New Jersey Medical School, who has led the maternal mortality review panel.

Maternal mortality is also a priority for Democrats in the state Senate, including Sen. Joe Vitale, (D-Middlesex), the longtime health committee chairman, who has pledged to hold hearings on the issue and the racial disparities in death rates, which are significant.

Vitale – who led an effort to pass legislation to create the awareness day, which former Gov. Chris Christie signed in May – is scheduled to join an event at Monmouth Medical Center Tuesday afternoon.

Need for greater investment

And leaders at the New Jersey Health Care Quality Institute have also flagged maternal mortality as a concern, highlighting the need for a greater investment in contraception and family planning, as well as prenatal care, in its Medicaid 2.0 blueprint for reform released last year. Medicaid pays for 42 percent of the births in New Jersey, the institute found, and improving outcomes would result in better health outcomes, stronger families and communities, and economic savings.

The Quality Institute is also promoting maternity “episodes of care,” or payment systems designed to encourage physicians, nurses, and other providers to work together to improve care. The group is also encouraging “centering programs” that bring pregnant women, particularly those who have high risks, together to discuss common challenges and encourage proper prenatal care.

Bachmann, with Rutgers, is also advocating for “safety bundles,” or clear, evidence-based protocols physicians can follow whenever a woman raises concerns about specific conditions, like bladder pain, or reveals concerning test results, like elevated blood pressure. Educating the public on the importance of quality care and stressing a patient’s rights through the “stop, look, listen” message is a key focus of the Tuesday events.

“Community awareness of this issue is vital. As they say, it takes a village, and we believe that everyone plays a role to ensure a healthy pregnancy,” said Robyn D’Oria, CEO of the Central Jersey Family Health Consortium, which works with providers and community groups to improve care.