Legislators want to solve mysterious maternal deaths

Yvette Cravins knew something was wrong after her second baby was born. More than a week after leaving the hospital, he went to the emergency room and told the doctors that he was in terrible pain. They gave her some pain treatment and told her that she was tired and that she should go home.

"My initial symptoms were ruled out and my health problems decreased," said Cravins, who is now chief of staff to Rep. Lacy Clay, a Democrat from New York, recently outside the Capitol.

The next time he returned to the emergency room he was on a stretcher, after having suffered a stroke related to childbirth. It took her two years to recover, and then she had to find a doctor who would help her give birth to her third child.

Each year, 65,000 women have similar experiences when they almost die of pregnancy or childbirth. Hundreds more die and the fact that babies are left without a mother in the United States attracts the attention of Congress.

"I think there's really a willingness on both sides to talk about this and deal with this," said Rep. Raja Krishnamoorthi, D-Ill. " It's about making sure it has the right priority, I'm trying to highlight it and move it up on people's priorities so we can deal with this sooner rather than later."

It is not clear why the deaths are occurring, but the numbers appear to be increasing, a trend that is not seen in other developed countries, and many are related to conditions that involve bleeding or high blood pressure. Many occur several weeks after the women leave the hospital. Because there are many questions, the bills that have been presented focus on stimulating better monitoring and investigations of maternal deaths, as well as finding ways to prevent them.

The health subcommittee of the Chamber of Energy and Commerce plans to hold a hearing on maternal mortality after it finishes work on a mbadive legislative package related to the opiate crisis, which the leaders hope the House can pbad before of the Day of the Fallen. Senator Patty Murray, the top Democrat on the Health, Education, Work and Pensions Committee, said she has been pushing for a bill to prevent maternal mortality with 26 co-sponsors.

The Senate bill, the Maternal Health Accountability Act, would allow the federal government to support the creation of maternal mortality review committees in the states, which study maternal deaths and make recommendations on how they can be prevented. The groups, which do not exist in all states, are made up of epidemiologists, obstetricians, social workers, nurses and patient advocates, and make suggestions that include an encouraging treatment for diabetes, obesity or substance use disorder. Some hospitals are addressing maternal mortality by keeping cars in their facilities containing drugs and tools prepared for when women begin to show signs of problems during or after childbirth, an initiative that has saved lives.

"There is no reason why the United States is the only industrialized country where maternal deaths are on the rise," said Senator Heidi Heitcamp, DN.D., one of the authors of the bill. "That's unacceptable, and we need to get to the bottom of why that is happening, and fast, and find solutions."

Senator Shelley Moore Capito, Republican co-author of the bill, said data on maternal deaths are "shocking and sad" and that she expected more states would develop committees as a result of her bill.

"Maternal mortality review committees like the one in my home state of West Virginia help to see the problem locally, illustrate trends nationally and, hopefully, help reverse these statistics." He said in an email : "Unfortunately, 18 states still do not have commissions."

The Maternal Death Prevention Act is the House of Representatives version of the Senate bill, and other laws have been introduced in the lower house. The final maternal mortality law would require federal health officials to develop a plan with the goal of reducing death rates by half for a decade, and the Mothers and Foreigners Maternal Mortality Awareness Act, or MOMMA Act, would improve the reports, within a range of other measures.

Federal data suggest that the estimated maternal mortality rate in the US UU increased by 26.6 percent between 2000 and 2014, even when pregnancies in general are declining. Health officials say maternal mortality rates in the US UU They are the worst of any developed country. For example, women in the US UU They are five times more likely to die from pregnancy or childbirth than in England.

But it is difficult to know precisely to what extent the rates are increasing, since the figures may be a reflection of a better follow-up. The World Health Organization also defines that maternal deaths occur up to 42 days after birth, while the EE. UU They measure deaths up to one year. Even so, more standardized information suggests that the United States is behind.

"When there are data that are more comparable, it seems that the US mortality rate is higher than in other developed countries," said Dr. Lisa Hollier, president of the American College of Obstetricians and Gynecologists.

It is estimated that between 700 and 900 women die from causes related to pregnancy or childbirth, and that 60 percent can be prevented.

"At this moment our first challenge is that we know that rates are rising but we do not." t have quality and uniform data to help us make better informed decisions about next steps, "said Rep. Robin Kelly, an Illinois Democrat, president of the Congressional Black Caucus & Health Braintrust and one of the authors of the Act. MOMMA

The racial disparities are apparent in the available data Although women of all origins are at risk, black women are three to four times more likely to die from pregnancy or childbirth than women The black women have reported that their concerns about their health are not addressed, and research reveals that racism produces stress, leading to complications in pregnancy and premature births.Women are also more likely to have diseases such as diabetes or hypertension that make pregnancy more dangerous.

"The numbers did not surprise us, they surprised others that I just They are learning about the issue, "said Elizabeth Dawes Gay, chairwoman of the Black Mamas Matter Alliance steering committee, which advocates for reproductive health issues. "What is most striking is listening to mothers who have had recent experiences of disrespect and abuse at the edge of health care providers.When they hear what they experience trying to bring new life to the world, it is horrible that by 2018 women are experiencing that kind of attention, the United States because they are black. "

A provision of the MOMMA Act would help physicians receive training on how biases can affect medical care, and the differences are being recognized by groups of doctors. The Council on Patient Safety in Women's Health Care, of which the American College of Obstetricians and Gynecologists is a member, has recommended that health centers reduce disparities in part by helping staff understand the role implicit bias can play. have in health care.

Experts also suspect that other contributing factors may be attributing to mortality statistics, including the high rate of cesarean deliveries that can lead to more complications after leaving the hospital. Because half of pregnancies in the US UU They are not planned, women who do not seek treatment for chronic health problems before becoming pregnant face more risks during pregnancy and after delivery. Women are delaying pregnancy until they are older, and doctors often do not know how to recognize the first signs of life-threatening symptoms. Data from the American College of Obstetricians and Gynecologists also show that suicide and drug overdoses are playing a role.

"In different places, I think they will be different things, but nobody has gathered all that information and compared it." said Representative Jaime Herrera Beutler, R-Wash., who introduced the Prevention of Maternal Deaths Act creating commissions, which has 122 co-sponsors.

Hollier agreed. "By understanding the details at the state level, their solutions can be individualized to a state," he said.

The MOMMA Act includes additional measures that include expanding the amount of time new mothers can stay in Medicaid, a government-funded program that covers half of births in the United States. UU The project would extend coverage from 60 days to a year. The legislation also encourages health centers to develop better protocols when women need emergency obstetric care. Kelly said he hopes his bill can go "hand in hand" with other proposals.

Herrera Beutler said he was more grateful for the interest in the issue, but expressed some concern about whether broader legislation could get entangled in similar debates about health care that often play on Capitol Hill.

"I certainly did not want to drag the entire health care debate into this because I want this to happen soon," he said of the Prevention of Maternal Death Act. "I want to see what happens this summer."

For Krishnamoorthi, who sponsored the Final Maternal Morality Act establishing a 10-year plan to reduce deaths, his concern is that few bills tend to move forward during an election year, despite growing support for action. The bill has 19 co-sponsors, directed by Herrera Beutler.

"We should be able to deal with this," Krishnamoorthi said. "And we can do it if we just focus on it." If we do, we will significantly reduce maternal mortality. I'm convinced of that. "


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