PROTECTING OUR MOMS & NEWBORNS

The state of Missouri is ranked 44th in the United States for maternal mortality, according to America’s Health Rankings 2019. Missouri’s maternal mortality rate for black women is nearly three times higher than that for white women. And, according to the Missouri Foundation for Health, approximately 600 infants die every year in Missouri; 33% of those deaths occur in St. Louis and in the Bootheel, in the southeasternmost part of the state.

According to the Institute for Public Health at Washington University, “This represents an increase of 42.8%—from 28.5 to 40.7 deaths per 100,000 live births—since 2016.” Maternal mortality, and especially the racial disparity related to maternal mortality, is at the center of an urgent national conversation, says Roxane Rampersad, MD, maternal-fetal medicine specialist at the Women & Infants Center, a collaboration by Barnes-Jewish Hospital, Washington University Physicians and St. Louis Children’s Hospital. “We all know there are opportunities to try to tackle our morality rates.”

PREGNANCY DOESN’T END AFTER THE DELIVERY OF THE BABY. THE ‘FOURTH TRIMESTER’ COMES WITH SIGNIFICANT RISK. EXPANDING MEDICARE COVERAGE, WHICH WOULD AFFECT MEDICAID COVERAGE FOR PREGNANT WOMEN, COULD HELP SAVE LIVES.

Rampersad and colleagues are addressing this complex problem with a variety of strategies, from implementing national initiatives to providing hands-on training in rural communities, where obstetric specialists are scarce and hospitals are closing.

Assessing the risk

Lack of obstetric care is the leading contributor to rising mortality rates, a fact that is especially true in Missouri’s more rural counties. In fact, rural hospitals are closing at alarming rates. The National Rural Health Association reports that, between 2010 and 2018, 100 rural U.S. hospitals shut down; another 700 are financially vulnerable and at risk for closure. Missouri and many southern Illinois counties have not been spared. For example: In 2018, the Twin Rivers Regional Medical Center, a 116-bed facility in Kennett, Missouri, Dunklin County, closed. Before this closing, Dunklin already had one of the highest neonatal mortality rates in Missouri, as well as the second-highest rate of infant deaths (occurring prior to the first birthday). In a story published in the online newspaper The Guardian, a local pediatrician noted that obstetric care in the area was so scarce that pregnant women often arrived at the hospital so far into labor that they delivered immediately after arrival or before, sometimes in the facility’s parking lot.