It Takes A Village - California's Step to Improve Maternal Mortality

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It may come as a shock to hear, but Texas has the highest maternal mortality rate in the developed world and Houston has the highest maternal mortality rate in Texas. There are many factors into why our rate is so high in America. For one, we do not have universal health care, so for low income moms who are on Medicaid during their pregnancy, their insurance usually drops one month after birth in 37 states including Texas. We also do not have national maternal leave. Mothers are at the whim of their employers and their policies. We have to take into account that the maternal death rate is during pregnancy and 42 days after birth. This is a critical time for moms who are in their most vulnerable state. Mothers who no longer have insurance may not go to get medical help when they need it most, or can not afford to be away from work.

California maternal mortality

While national rates continue to rise, one state is trying to make a difference, California. The CMQCC, California Maternal Quality Care Collaborative, was founded in 2006 at Stanford University School of Medicine committed to ending preventable morbidity, mortality and racial disparities in California. In three years California’s maternal mortality rate dropped by 55 percent. You are three times less likely to die in California than any other state. America’s maternal death rate is three times higher than the UK, eight times higher than Norway, and 11 times higher than Sweden. We are in comparison to Zimbabwe and North Korea in maternal health care.

Besides CMQCC’s innovated maternal data center, and the first in-depth medical record reviewing of pregnancy related deaths, CMQCC has developed five toolkit’s to help stop maternal death. One of them being the OB Hemorrhage Toolkit. Hemorrhage is one of the top five causes of maternal mortality in the U.S. but is the most preventable.  

The OB Hemorrhage Toolkit helps obstetrical providers, clinical staff, hospitals and healthcare organizations develop methods within their facilities for timely recognition and an organized, swift response to hemorrhaging. The toolkit was initially released in July 2010, and was updated March 2015 to Version 2.0.

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So what is in this toolkit? Well it is more like a cart, filled with many red drawers. Red for blood. Each cart comes with an algorithm, a series of steps, for what to do in at different stages of blood loss. And the best way they have worked out how to measure blood loss is by weighing the mother’s pads on the scale provided. Right now providers are measuring blood loss by eyeballing it. This is a key feature that tells the staff when a hemorrhage goes from being manageable through medication and pain relief, to needing to go into surgery - all the way up to interventional radiology for embolization. They way they determine this is through the stages. Stage one is blood loss of 500cc to 1000cc, stage two is blood loss from 1000cc to 1,500cc and so on. With this step by step guide on how to stop a massive blood loss,staff are no longer making spur of the moment decisions, delaying responses/acting in denial, and are no longer running around the hospital looking for different supplies. Everything in this guide is thought out beforehand, decisions are made through intense research and evaluation on how to stop a hemorrhage, and everyone is using that same system.

CMQCC are making their toolkit’s available for all healthcare providers, from small rural hospitals to big urban ones. How can we bring this to our local hospital? Ask your care provider if they know what this is. If not encourage them to look into it by providing the CMQCC’s website where health care providers can attain more information. We as a nation have a long way to go to bring our mothers better health care and drop our maternal mortality death rate. California is taking steps to do this, but it  takes a village.

XO -  Adilah Yelton, Birth Doula