Above photo: Yoel Sadovsky, MD, executive director of the Magee-Womens Research Institute, and Renee Montagne, a special correspondent and host for NPR News, at the Maternal Health Leaders Symposium.
Months later, she founded the Women’s Health Activist Movement (WHAMglobal), in partnership with Women of Impact, to rally support for women’s unmet health needs. Since its kick-off in 2017, WHAMglobal has focused its action-based efforts around the issue of maternal and infant mortality. The issue is an important one in this country, with the U.S. maternal mortality rate nearly three times higher than any other developed country.
Earlier this month, WHAMglobal held the first Maternal Health Leaders Symposium in Pittsburgh. The symposium identified evidence-based solutions for reducing maternal and infant mortality and morbidity. Around 130 researchers, health providers, policy-makers and community advocates were in attendance.
We talked with Dr. Feinstein about the important themes that emerged from the symposium and what they could mean for reducing maternal and infant mortality here in Pittsburgh.
What were the key ideas that emerged?
At the top of the list was choice: supporting cultural and religious choice as well as racial preference around women’s health choices such as natural childbirth, breastfeeding and contraception. This was modeled really well during the Symposium by Cradle Cincinnati where whole communities are brought together to talk about specific issues, such the barriers to seeking prenatal care, especially if you are poor, struggling, and/or a single mom. We have to really listen and give people choice and then respect what their choices are.
The next theme was respect: it is not optional. … When a woman asks for help, you have to treat her knowledge of her body with respect.
Next is just basic safety science and quality control. In California, they have had the most amazing reduction in maternal mortality, simply due to implementing basic safety science and quality control with things such as basic checklists and birth carts, really, things everyone should and could be doing.
In the United States, we also have to look at new workforce roles. We need to consider the scope of practice, new payment roles, and midwives versus OB-GYNs.
We also have to look at best practices from around the world. The U.S. does not have all the answers here. For example, assessment should be a rigorous thing, yet here in the US, it is left to individual OB-GYNs to create on their own assessment models.
Another example of the assessment gap is that many pediatricians do not get reimbursed for doing post-partum depression screenings on moms when they will likely see her many more times than her OB-GYN, who is likely to only see her once and frankly focus mostly on her uterus.
It is also critical to have more teamwork. In Alaska, there are pods with doctors, a behavioral health specialist, a social worker, someone doing data entry, and a nurse. They are very closely aligned with community services, and this teamwork is routine. In most cases right now, the OB-GYN and pediatrician aren’t even a team, and this is a gap I would underline many times!
Q: Which of these strategies are most applicable in Pittsburgh and how can they be best implemented?
A: My sense is there is energy toward reform with both of our big healthcare systems. There is a lot of potential through a new payment bundle model where health systems get reimbursed in a bundle and can use the money however they think, which makes lower-cost options like midwives more appealing.
This could also mean healthcare systems might want to pay for things like babysitting or translation services for patients because they have an incentive not to have things go wrong.
Locally we need a better system and support for midwives and more work on postpartum screenings for moms. That’s got to be changed. Everyone agrees we’ve got to change it.
There is excellent attention and support locally to these problems. The issue is that we have so far to go. It will involve a lot of changes and our payment system will have to catch up unless we adopt the bundle.
Q: In Allegheny County, the mortality rate for black infants is significantly higher than that of white infants. How did the symposium address this disparity?
A: This issue was so central to what we talked about that it was not just one speaker or one session. It was interwoven into every speaker and every session. Magee Women’s Research is looking at how stressors for African-American women, as well as things like epigenetics, can lead to small birth weight or bad outcomes for both mothers and babies. Race is a central issue.
Cincinnati Cradle is an organization that works with African-American women and neighborhoods and takes a community organizing approach. They ask the community to think about the problem and what they want to do about it to get their voices heard.
The difficult thing about maternal mortality is that it is a problem that does not respect any boundaries. A doctor or caregiver should never get complacent thinking that only certain groups are at risk.
Maya Henry, LCCE, is a Lamaze International Certified Childbirth Educator.