Advancing Quality and Equity in Maternal Health – Maternal Health Awareness Day

Partnering with families to bring new life into the world is a great privilege for so many in the medical profession. Obstetricians and gynecologists, certified nurse midwives, family physicians, labor and delivery nurses, doulas, and so many others do incredible work supporting healthy pregnancy, labor, and delivery every day. They work long hours and routinely bring their expertise to complex, high-risk pregnancies and deliveries with positive outcomes.

Despite all of our resources, women in the United States are dying during and after childbirth at an alarming rate, and these numbers are increasing, especially for women living in underserved communities. The Centers for Disease Control and Prevention reports that Black women are three times more likely to die from a pregnancy-related cause than white women. Structural problems and bias cannot be ignored as major causes of this problem. The CDC also estimates that over 80 percent of all maternal deaths in the U.S. are preventable.

What’s more, women in the U.S. experience the highest maternal mortality rate among other wealthy countries, with 23.8 deaths per 100,000 live births. The countries with the next highest rates are New Zealand, Korea, and Canada, respectively. These findings, published in a 2022 study by the Commonwealth Fund, also found that the rate jumps to 55.3 deaths per 100,000 live births when only looking at Black mothers.

New Jersey had a maternal mortality rate of 24.1 with 72 maternal deaths in 2018-2020. Approximately 30% (n=46) of deaths among women during or within one year of the end of pregnancy were pregnancy related. Nearly 70% of pregnancy-related deaths occurred during the postpartum period, within one year of the end of pregnancy Non-Hispanic Black women died from pregnancy-related causes at 7.6 times the rate of non-Hispanic White women Nearly 1 in 4 pregnancy-related deaths were due to hemorrhage.

New Jersey has a dismal and shameful record of caring for our pregnant, vulnerable mothers. We rank 47th in the nation for maternal deaths and have one of the widest racial disparities for both maternal and infant mortality. A black mother in our state is seven times more likely to die than a white mother and her baby is three times more likely to die during the first 30 days.

Our service area is Monmouth County with a focus on the high-risk municipalities of Asbury Park, Freehold, Neptune, Red Bank, Keansburg, Long Branch, and Matawan, which are listed under the Perinatal Risk Index. Within the county, significant racial disparities exist; not just in maternal-perinatal outcomes, but also in poverty, healthcare access, and employment levels. We are also currently seeing incredibly high rates of syphilis in our mothers, and this is stretching a system already decimated by Covid and the loss of our healthcare workforce.

The first step to combating this tragic problem is to better understand it and raise awareness about it. That’s why the VNA Health Group is observing Maternal Health Awareness Day today. We are working hard to address this crisis through our many home and community-based care programs which play such a crucial role in the maternal-care space.

The primary causes of pregnancy-related deaths in the U.S. include hemorrhage, infections, and cardiovascular problems. In addition, mental health issues, like depression and anxiety, as well as deaths by suicide and overdose, are major drivers.

We are proud to join many distinguished organizations which are leading the charge in this important cause. Today, for example, the American College of Obstetricians and Gynecologists campaign reminds us that “to eliminate preventable maternal mortality, we must know why it happens.” Their “Know Why” campaign urges women across America to shine a spotlight on their “why” behind this multifactorial problem. Rutgers Robert Wood Johnson Medical School has also created a significant public education campaign aimed at empowering women’s voices throughout the birth process.

Additionally, the First Lady of New Jersey, Tammy Murphy, has worked to reduce NJ’s maternal mortality by investing in maternal and infant health through her initiative, Nurture NJ. The plan also aims to eliminate racial disparities and have a nurse visit every mother with a newborn.

At the VNA Health Group, we are doing our part as well. Our home care and community-based programs bring women access to doctors, nurses, certified nurse practitioners, doulas, educators, and support groups. We deliver our services in the clinic and in our primary focus area – the home.

Prevention is the mission of much of our work, and three proven national programs are at the core: Nurse Family Partnership, Parents as Teachers, and Healthy Families. Home visitation is the common thread among these three highly effective evidence-based programs. All provide care during pregnancy and beyond, recognizing that care does not end at delivery. In addition, nearly all postpartum and parenting women were screened for depression – an underlying cause behind the mortality crisis.

We also care for women living in New Jersey’s underserved communities through four brick and mortar community health centers. These centers provide comprehensive primary and preventative care for infants, children, and adults, among other things. A team of expert physicians and certified nurse practitioners also provides prenatal and gynecological care – all on a sliding fee scale.

At our various sites, we have a high awareness for maternal pre-pregnancy, during pregnancy, and postpartum care. Our Reproductive Health programs at all our sites provide optimization of maternal health for women who have conditions such as diabetes and hypertension, and provide screening for cervical, breast, and colorectal cancer so that women enter pregnancy in the best of health to improve maternal and neonatal outcomes. In Freehold, we support a ‘Centering Pregnancy’ program of group care, which has been shown to improve outcomes.

We take care of women during pregnancy and postpartum with home visitation by trained doulas and see newborns within a week of delivery to optimize outcomes and continued care.

Contraception is provided to all women who desire it, and all types of contraception are offered. 

We have a board-certified gynecologist obstetrician and family physicians who work collaboratively with our nurse midwife teams to provide the best care before, during, and after pregnancy. 

Through our outreach and education efforts, we have increased our first trimester early prenatal care entry rates significantly. Our aim is to have all women enter prenatal care as early in pregnancy as possible. 

Much good work is being done, but as maternal deaths continue to rise, we must do better. This will require the public, private, nonprofit, and educational communities to continue working and collaborating towards our common goal.

First, we all must become better listeners! The CDC’s national campaign, Hear Her, aims to educate everyone- partners, friends, family, as well as healthcare providers – to really listen when a woman says that something does not feel right. They remind us that acting quickly could save a life.

Prevention is also key to identifying danger signs and empowering women to speak up. Building relationships between nurses, doctors, and the family is imperative, as is earlier treatment of chronic disease.

At the same time, we must reduce barriers to healthcare. The list of challenges is much too long: transportation, insurance, childcare, communication about available programs and services, poor prenatal health, poor nutrition, and food deserts, just to name a few. Additionally, the cloud of a history of racial discrimination and bias hangs over many of these issues.

Finally, and perhaps most importantly, we must educate women and their families to advocate for themselves. Ryan Hanson, founder of the Tara Hanson Foundation, may have explained it best after the tragic loss of his wife just six days after childbirth. “People don’t always want to talk about it,” he said of maternal mortality. “It can happen to anyone. Don’t give up. If someone’s not listening—if you can’t get their attention– You need to fight – fight for it!”

We vow to keep fighting. I pledge that the VNA Health Group will continue our pursuit of health equity until all women achieve optimal maternal health, and we have truly eliminated racial and gender disparities.

Steven Landers, MD, MPH

CEO & President VNA Health Group

Christopher Rinn

CEO, VNACJ Community Health Center (CHC)

Colleen Nelson, RN, MSN

Vice President of Clinical Operations Children & Family Health Institute