The United States is the only industrialized nation where the rate of women who die during pregnancy or within a year of delivery is actually increasing. Appallingly, the risk of death for a pregnant or recently pregnant woman in Tennessee is even worse than the national average.
The state of Tennessee has created an excellent document that reviews the 2017 maternal deaths; our legislators can be complimented for investing in the tabulation of this information. The report states that 85% of maternal deaths appear to be preventable. Eighty-five percent. Just counting the cases is not enough. We must do something.
The three most common causes of pregnancy-associated deaths were overdose, motor vehicle accidents and violence. Many of these deaths therefore were not directly related to doctors and hospitals. That means the “we” in “we must do something” refers to all of us. Doctors and hospitals of course have their roles in combating the unacceptable and rising rate of maternal mortality, but they don’t function in a vacuum. This is everybody’s problem, not just healthcare providers and systems, not just women, not just the families involved. Everybody’s problem.
So what can we do? Here are some things to consider.
Of course we must address substance abuse. One-third of all maternal deaths in Tennessee involved substance abuse or overdose as a contributing factor. This sad fact gives us yet another reason to stand up to the opioid and methamphetamine abuse threatening our region We must make sure that our efforts to prevent and treat substance abuse reach women who are pregnant or are of child-bearing age.
Reducing medical errors would improve maternal outcomes. Generally speaking, errors in hospitals frequently involve multiple factors, including poor communication. Communication in my opinion is more fractured that it was in the past; I find that electronic health record systems have made communication between doctors and institutions more difficult than it was previously. When electronic medical records were forced on healthcare providers and patients more than a decade ago, there were many promises for healthcare improvement. These promises are unmet. When I think how much an I-phone has improved in the last 10 years I’m impressed. When I think about how little change has occurred in electronic health records in the last 10 years, I’m depressed. Healthcare systems and politicians must demand accountability from electronic health record vendors.
We know that when people can’t access healthcare, death rates go up, so we must ensure that the region’s rural hospitals stay open. But we also need to make sure pregnant women continue to have access to medical care in all communities; maternal mortality is strongly influenced by healthcare access. In the past, legislators have ensured Tennessee’s health care system (TennCare) was very protective of pregnant women and children. The Tennessee legislature’s recent plan for federal block grant funding for Medicaid (TennCare) has been announced, but many critics of this plan feel that patient benefits will eventually be severely cut. If so, less healthcare access may be available for vulnerable populations such as pregnant women.
Too many women still start their pregnancies at increased risk because of inadequacies in our healthcare system. A few years ago I shifted my own practice away from delivering babies to focus on prenatal care and office gynecology practice. In my opinion, many patients are in generally poorer health than when I arrived in Johnson City 27 years ago. There is more obesity. There is more substance abuse. Too many patients still arrive at their first prenatal visit with unaddressed basic healthcare problems such as diabetes and hypertension.
Finally, continuing steps to improve overall population health are essential (thank-you community leaders for the Tweetsie Trail).
The loss of a young mother is a devastating blow to her family and her community. Her children are raised without their mother’s guidance or the comfort of their mother’s touch. We can do better. We can make progress if we have the will to do so. We need to combat the opioid epidemic, we need to keep rural hospitals open and we need to make sure vulnerable populations have access to healthcare.
Dr. Marty Olsen is an obstetrics and gynecology physician in Johnson City. He has interests in international medicine and in confronting the opioid epidemic.