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Seeking to close the gaps in maternal mortality and morbidity

Article

Federal figures point to a chilling rise in maternal deaths. Irogue Igbinosa of Stanford Medicine Children’s Health talks about improving equity in maternal care.

Dr. Irogue Igbinosa says her interest in helping others was sparked early in life.

The daughter of a social worker, Igbinosa developed a passion to engage with those in need when she was young.

Now she’s a maternal fetal health specialist at Stanford Medicine Children’s Health, and she does research on health disparities in maternal health.

“I really wanted to provide help, evidence-based or evidence-informed care, for people who have the rare diseases … and to potentially provide hope,” Igbinosa says.

Igbinosa spoke with Chief Healthcare Executive® recently about her work, maternal mortality and morbidity, and the need to close disparities for underserved groups.

Maternal mortality remains a grave problem in America. Maternal deaths rose 40% in 2021 compared to the previous year, according to figures released in March by the Centers for Disease Control and Prevention. Nationwide, 1,205 women died of pregnancy-related complications in 2021, up from 861 in 2020.

Most maternal deaths can be prevented. A CDC study released last year found that 84% of maternal deaths are preventable.

The figures are even more sobering for Black women, who are 2.6 times more likely to die than white women. But Igbinosa points out that America’s maternal health outcomes lag behind other nations for patients of all backgrounds. A Commonwealth Fund analysis of 2018 data showed America’s maternal mortality rate was more than twice as high as other high-income countries.

“This is not really an issue that is just unique to black pregnant women,” Igbinosa says. “It's all of our pregnant women in the U.S.”

“So as we look to address equity, we can actually raise the bar of care for everyone,” she adds.

Beyond maternal mortality, Igbinosa says it’s critical to understand and address the number of patients who suffer serious complications, even if they aren’t fatal. Thousands of women suffer severe maternal morbidity each year.

“That is actually a more actionable area,” Igbinosa says. “How can we prevent these ‘almost’ events?”

(See part of our conversation with Irogue Igbinosa in this video. The story continues below.)

Finding the gaps

Health systems can take steps to improve equity in maternal healthcare.

Stanford Medicine is examining the role of structural racism in inequalities, and that’s an approach other health systems should consider, Igbinosa says. And that involves looking at hospital policies.

She says organizations can ask, “Is there any policy that is causing unintentional harm? Or is there any policy that can be made more equitable, and that is maybe not taking into account different patients?”

Hospitals need to consider access and how easy, or difficult, it is for patients to get care throughout their pregnancy, including areas such as nutrition counseling. For patients who don’t live close to their nearest hospital or obstetrician, offering more telehealth options can improve access.

Millions of Americans live in areas without obstetric providers. About one in three Americans lives in “maternal care deserts,” because they reside in counties without hospitals offering obstetric care or obstetric providers, according to the March of Dimes.

Health systems also need to get good data to get a better sense of the gaps in care and outcomes.

“I think how we look at our data really informs our next steps,” she says. "I am a big proponent of looking at race, and how does that factor in."

However, Igbinosa says data alone doesn’t tell the story. Stanford Medicine interviews patients to hear them talk about their own pregnancy experience in their own words.

Work with partners

Hospitals and health systems that are looking to close disparities need to work with other community groups to improve outcomes, Igbinosa says.

“If we stay within the walls of our hospital institutions, we're capturing one experience,” she says.

Maternal health is influenced by where patients live, their access to nutrition, and other factors.

But to make a difference in prevention, it’s critical to work with community partners, including non-profit groups, social service agencies, and public health agencies. As hospitals foster more partnerships, they can learn more about the needs of certain communities.

Igbinosa says it’s vital for health systems to work with other partners early to assist patients early in pregnancy.

“If we're waiting until the delivery, to try and intervene, it's often too late,” Igbinosa says.

It’s also important to work with community organizations to develop viable remedies to gaps in healthcare. Health systems need to be sure they have the input of community partners who are working on the ground.

“What you don't want is to propose a solution that was never realistic for a group,” Igbinosa says.

Finding hope

As a maternal fetal specialist, Igbinosa treats patients with higher risk factors. And it’s immensely rewarding to help patients recover and take their babies home.

“The highs are great,” she says, with a laugh. When patients at high risk have a good outcome, she says, “It’s amazing.”

On the flip side, when patients don’t have good outcomes, it’s devastating.

“I think the lows keep you humble,” she says. “It reminds you that, as much as we try and do our best, ultimately, everything is not up to us.”

“You also learn from them,” she adds. “You also don't forget the poor outcomes, you know. It stays with you in terms of like, what, ‘What can we do with this information to help the next person?’”

Igbinosa says she’s optimistic about seeing progress in improving maternal health equity.

“I'm a hopeful person,” she says. “It’s how I operate. And I would say though, the hope is not unique to me.”

“I think there's a lot of efforts that are really encouraging, at several places,” Igbinosa says. “Now, is this going to happen right away? Is it going to happen even in a few years? I don't know that that time will be short. But I do think it is promising that, as more and more people decide to take on the mammoth that is structural racism, that take on a mammoth that is inequality and disparities, we start to chip away. And that makes me hopeful.”


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