Over half of pregnancy-related deaths in Ohio were preventable and black women died at a rate more than two and a half times that of white women, according to the state’s first comprehensive report on pregnancy-associated maternal deaths.
The report found 186 Ohio women’s deaths were related to or aggravated by the pregnancy or pregnancy management. This includes 14 deaths in the Dayton metro area.
“There are a lot of moms that passed during this period. And that has had a profound effect on their families,” said Dr. David McKenna, maternal fetal medicine physician at Miami Valley Hospital.
Over half of the deaths (57 percent) were thought to be preventable among deaths occurring from 2012 through 2016, which is when the state started to consistently determine whether there was a chance to alter the outcome.
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The release of the report coincides with the Ohio Department of Health getting $12 million in federal funding to address maternal mortality across the state.
According to the U.S. Health Resources and Services Administration, the rate of pregnancy-related maternal deaths in the U.S. has more than doubled since 1987, and the agency is funding state efforts across the U.S. to address this issue.
“The American College Obstetricians and Gynecologists and then also the Society for Maternal Fetal Medicine have all for the past, I would say, four or five years been calling attention to maternal mortality in the United States, because the rates are higher than other developed nations,” McKenna said.
Ohio will be starting a maternal health task force to make a plan to prevent these deaths. The state will get $10 million to support prevention efforts and the CDC also warded a $2.2 million grant to continue its Pregnancy-Associated Mortality Review program, which authored the report.
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Dr. Amy Acton, director of the Ohio Department of Health, said the department’s Pregnancy-Associated Mortality Review program was developed in 2010 to identify and review pregnancy-associated deaths with the goal of developing interventions to reduce maternal mortality, particularly for preventable pregnancy-related deaths.
“There is more that we can, and must, do to prevent maternal deaths in Ohio,” Acton said.
Women died from pregnancy-related causes in Ohio at a ratio of 14.7 per 100,000 live births from 2008 through 2016. The rate of deaths related to pregnancy did not change significantly over that time.
The leading causes of death related to pregnancy were cardiovascular and coronary conditions, followed by infections, hemorrhage, pre-eclampsia and eclampsia, and cardiomyopathy.
Out of the 186 deaths declared pregnancy-related, nine of the deaths — about 5 percent — were suicides. Five were homicides, according to death certificates.
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McKenna said the hospital has been adopting practices in the airline industry, which uses checklists and drills to prevent rare but devastating events. About a decade ago, they created a “code green,” which calls a response team for obstetrical emergencies.
“We practice and drill and we debrief after these events in order to improve our care, and that directly parallels the airline industry,” he said.
From 2008 through 2016, the pregnancy-related mortality ratio was 11.5 for white women and 29.5 for black women. Other groups with higher mortality ratios include women with only a high school education, women living in metropolitan counties or Appalachian counties, unmarried women, and women aged 30-34 years.
“It is shameful that we have a report that shows over half of the maternal or pregnancy related deaths could have been prevented,” said Ohio House Democratic Leader Emilia Strong Sykes. “And we should all take that very seriously to ensure that we are allowing women to be mothers the way that they intended and not experiencing death when trying to give life.”
Sykes, also with the Ohio Black Maternal Health Caucus, said the the state should act quickly and efficiently and be especially concerned about the maternal health disparities.
Pregnancy deaths facts & figures
57%: Pregnancy-related deaths deemed preventable from 2012-2016
11.6: Ohio pregnancy-related deaths per 100,000 live births in 2016
16.9: U.S. pregnancy-related deaths per 100,000 live births in 2016
$12.2 million: Federal grants toward Ohio maternal mortality prevention
For the majority of the women, there were multiple factors that contributed to their death.
Factors at the provider level (32 percent) and system of care or facility level (22 percent) together comprised more than half of the factors identified that contributed to pregnancy-related deaths. Some examples were delays in diagnosis, failures to screen, or poor case coordination.
Factors at the patient or family level accounted for the remaining 46 percent of identified factors.
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While these factors operate at the patient or family level, the report noted that the woman does not necessarily have control over factors at that level. For example, a woman may have a chronic condition that she was born with, be a victim of domestic violence, or have limited access to resources such as transportation or paid time off from work for appointments.
“Pregnancy related deaths are heavily influenced by social determinants of health … Things like the stress associated with racism, poor access, or no access, to care, those are all things that affect a woman’s overall health,” McKenna said.