Despite its economic, technological, and clinical prowess, the United States is the most dangerous place to give birth in the developed world, and among the most dangerous in which to raise a newborn. The maternal mortality rate in the U.S. is nearly three times higher than in any similar country (approximately 26 deaths per 100,000 live births, according to a 2015 study in The Lancet). And, while other countries around the world are reducing maternal mortality, the rate in the U.S. keeps climbing. Many of those deaths—sixty percent, according to the Centers for Disease Control and Prevention (CDC)—are preventable. Annually, another 50,000 mothers suffer severe complications or life-threatening injuries while giving birth, according to the CDC. Babies are also in peril, with the U.S. ranking 33rd in infant mortality (5.9 deaths per 1,000 live births) among countries studied by the Organisation for Economic Co-operation and Development.
JHF President and CEO Karen Wolk Feinstein, PhD, kicked off the Symposium by explaining that she founded WHAMglobal to channel the energy of recent women’s marches for concerted action, and to address unmet women’s health needs—a focus of JHF throughout its nearly 30-year history. WHAMglobal sought a “Big Idea,” a focus for its energy and activism that would improve the most lives. WHAMglobal challenged the region’s nonprofit organizations to pitch their top idea for improving women’s health, and crowdsourced the broader community to select a winning issue.
By the end, WHAMglobal had its directive: to address the shockingly high maternal and infant mortality rates in the U.S. WHAMglobal aims to accomplish those goals by studying high-quality maternal care models from around the world, championing policy and practice reforms, and forming a strong network of women’s health advocates
“Whether you’re a researcher, policymaker, advocate, obstetrician, nurse-midwife, health insurer, or a doula, you are here because you are part of the solution and care passionately about the well-being of mothers and babies,” Dr. Feinstein said. “There is no magic bullet solution to our maternal and infant health crises. But we can learn from other regions and countries, and create a comprehensive support network for pregnant mothers through teamwork.”
The Maternal Health Leaders Symposium featured action-oriented panels that covered a variety of maternal and infant mortality and morbidity-related topics. Jeannette South-Paul, MD, chair of the department of family medicine at the University of Pittsburgh School of Medicine, moderated a panel on translating research into action to lower maternal mortality that featured Ginger Breedlove, PhD, CNM, APRN, FACNM, principal consultant for Grow Midwives and a past president of the American College of Nurse-Midwives; Renee Montagne, a special correspondent and host for NPR news who spearheaded the NPR/ProPublica investigative series on maternal mortality called “Lost Mothers”; and Yoel Sadovsky, MD, executive director of the Magee-Womens Research Institute (MWRI), which is the largest research institute in the U.S. devoted exclusively to women’s health research.
A panel on addressing infant mortality through evidence-based interventions featured Ryan Adcock, executive director of Cradle Cincinnati; Rachel Berger, MD, MPH, chief of the Child Advocacy Center at UPMC Children’s Hospital of Pittsburgh; and Tausi Suedi, MPH, co-founder and CEO of Childbirth Survival International and an adjunct professor of Global Health at Towson University. Network for Excellence in Health Innovation President and CEO Susan Dentzer moderated the discussion.
During lunch, attendees engaged with leaders who are transforming maternity care through innovative payment reforms. David Kelley, MD, MPA, CMO of the Office of Medical Assistance Programs at the Pennsylvania Department of Human Services, moderated a panel that included John Bulger, DO, MBA, CMO of Geisinger Health Plan; Robert Edwards, MD, chair and professor of obstetrics, gynecology and reproductive services at UPMC; Eric Lantzman, MD, OB/GYN, co-director of the division of family planning and Ryan Program at Allegheny Health Network; Jessica Schwartz, MHA, episodes strategy manager at TennCare; and John Sullivan, MD, senior VP and CMO at St. Clair Hospital.
The last panel focused on national and global best practices in using a patient-centered approach to lower maternal mortality. Lamaze International President Liz DeMaere; Christine Morton, PhD, a research sociologist at the California Maternal Quality Care Collaborative; and Saraswathi Vedam, RM, FACNM, MSN, an associate professor at the University of British Columbia, joined the conversation that was moderated by Jennifer Moore, PhD, RN, executive director of the Institute for Medicaid Innovation and a research professor at the University of Michigan’s Medical School.
Following the panel discussions, attendees broke into smaller groups to develop strategies to elevate the quality of maternal and infant care. Joanne Conroy, MD, President and CEO of Dartmouth-Hitchcock and Dartmouth-Hitchcock Health and Elisabeth Erekson, MD, MPH interim chair of Dartmouth-Hitchcock’s department of obstetrics and gynecology, led a breakout focused on creating a team-based workforce and examining scope of practice.
Stacy Beck, MD an assistant professor of maternal-fetal medicine at the University of Pittsburgh and Hyagriv Simhan, MD, MS, division chief of maternal-fetal medicine and medical director of obstetrical services at Magee-Womens Hospital of UPMC, facilitated a breakout on redesigning practices and procedures to support high-quality, coordinated maternal care.
Naima Black, coordinator for the Maternity Care Coalition’s North Philadelphia Breastfeeding and Community Doula Program; Stephanie Glover, senior health policy analyst at the National Partnership for Women & Families; and Tamar Krishnamurti, PhD, an assistant professor at the University of Pittsburgh School of Medicine, led a breakout on optimizing maternal and infant health communication, education, and media campaigns.
Maternal Health Leaders Symposium attendees identified promising strategies, including incorporating midwives and doulas into an expanded maternal care team, creating an accountable system to track and improve pregnancy outcomes, and assessing mothers’ pregnancy risk levels and needed physical health, mental health, and social service supports more frequently. These are cornerstones of the maternal and infant health system of Australia, which has a maternal mortality rate that is five times lower than that of the U.S.
Other states could also learn from California, which has dramatically reduced its maternal mortality rate (to a nation-leading 7.3 deaths per 100,000 live births) by implementing basic safety science principles, including checklists, toolkits, and safety carts. Attendees also emphasized the need to respect mothers’ cultural and religious preferences, and to expand the use of innovative bundled payment models that empower health systems to redesign the birth experience for high-quality outcomes.
WHAMglobal and its partners will strive to make some of the programs, policies, and advocacy strategies showcased during the Symposium the standard of care for mothers and babies. These efforts include establishing the Maternal Coalition and Action Network (MOMsCAN), along another JHF supporting organization, the Pittsburgh Regional Health Initiative (PRHI). MOMsCAN is a perinatal quality collaborative that will build a statewide, multi-stakeholder coalition and use research, training, quality improvement, technical assistance, and policy/advocacy to lower maternal mortality rates in Pennsylvania and achieve excellent attachment and outcomes for mothers and babies.
In late 2018, WHAMglobal and PRHI will also partner with the Network for Excellence in Health Innovation to hold a national policy summit focused on improving perinatal care through payment, practice, and workforce innovations.
“Collectively, we have the components needed to create a best-in-class maternal and infant health system,” Dr. Feinstein said. “Our charge, our duty, is to assemble them.”