Protecting women from maternal mortality

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A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

I vividly remember the first time I saw someone who had died. She was in her late 20s, wearing tattered clothes, and alone. Her friends and family never came. I watched from a distance as police and crime scene investigators worked. I had just started work as a television reporter in a small West Texas town. And in a wind-whipped, dirty parking lot of a pay-by-the-hour motel, I stood confronting death. This was just the beginning. During the next six years, I reported on hundreds of deaths: from severe weather, kids drowning, school shootings, astronauts, police officers, military members, terrorist attacks, house fires, car crashes. But the one crucial death I never covered was the tragedy of a mother dying during pregnancy or childbirth.

Maternal mortality in the United States is higher than in any other developed country. Historically, this public health concern received sparse media attention, despite U.S. maternal mortality rates doubling over the past 30 years, while declining in other countries. However, a critical shift occurred in 2017 when innovative investigative journalism efforts began focusing attention on the maternal mortality crisis. At a time when journalists come under frequent attack, award-winning efforts like Lost Mothers, Deadly Deliveries, and a New York Times Magazine feature story about maternal mortality in black women, focused needed attention on the issue.

This devastating issue is especially close to my heart in my current career as an obstetric physician anesthesiologist. In this role, I lead care teams focused on ensuring each woman enjoys a safe pregnancy, delivery, and postpartum recovery. While most women know their physician anesthesiologist as the doctor who provides pain management during and after childbirth, the true value of physician anesthesiologists is far more important. Physician anesthesiologists are patient advocates who focus intensely on patient safety, improving outcomes, and ensuring the best experience for women during labor and delivery. That’s why it’s important for expectant mothers to work with their physician anesthesiologist to develop a birth plan which ensures the safest outcome.

Across the country, physician anesthesiologists are leading multi-disciplinary efforts to reduce maternal mortality and improve care. These include implementing early warning systems which signal a mother’s declining health, designing “safety bundles” to manage common causes of maternal death, and describing strategies to care for pregnant women with opioid use disorder. Continued study and refinement of labor and delivery pain management techniques, including epidurals and spinal anesthesia, have also led to a significant reduction in maternal deaths.

Women’s health care advocates have worked tirelessly for decades to improve maternal health. Their work and insight helped direct and inform news reporting about maternal mortality which created a national conversation leading to decisive action. In December 2018, the Preventing Maternal Deaths Act was signed. It gives federal money to states to establish and support committees for review of every maternal death. Maternal Mortality Review Committees are multi-disciplinary groups which seek to understand the cause of each maternal death, determine preventability, and recommend future strategies for prevention. Physician anesthesiologists serve on many of the committees already in existence. This landmark legislation will help all states systematically study maternal deaths.

One of the most striking findings about maternal mortality is that many deaths are preventable. While concerning, it also means we can decrease the number of women who die each year during childbirth. I recently spent five days with hundreds of obstetric physician anesthesiologists at the annual Society for Obstetric Anesthesia and Perinatology meeting. The passion, knowledge, and sense of care and responsibility among these physician anesthesiologists to the lives of women is remarkable. Mothers, these are the physician anesthesiologists you want leading your team during labor, delivery, and recovery, ensuring the health and safety of you and your baby.

James Lozada is an anesthesiologist.

Image credit: Shutterstock.com

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