We are awaiting the anticipated release of data and recommendations from Colorado’s Maternal Mortality Review Committee (MMRC) on pregnancy-associated and pregnancy-related deaths. However, from previously released reports and national trends, we have an idea of what the data will show.
We have only seen an increase in maternal mortality rates in the United States since the CDC first implemented the Pregnancy Mortality Surveillance System in 1986.
- From 7.2 deaths per 100,000 live births in 1987 to
- 17.2 deaths per 100,000 live births in 2015 to
- 32.9 deaths per 100,000 live births in 2021
These grim statistics are desperately headed in the wrong direction, especially for Black and Native American moms and birthing people.
Looking at 2022 data from the Colorado Hospital Association, Black moms are 53% more likely to experience severe maternal morbidity—such as heart failure, eclampsia, hysterectomy, and blood infection or need for blood transfusion—than their white counterparts which is only surpassed by Native American mothers who are twice as likely (98%) as their white counterparts. Alongside these disparities, In Colorado, 39.7% of counties are maternity care deserts. Maternity care deserts are counties in which access to maternity health care services is limited or absent, either through lack of services or barriers to a woman’s ability to access that care within counties.
And we would be remiss not to mention the Supreme Court Dodd Decision which changed the landscape of perinatal health and maternal/fetal medicine with long-lasting, and increasingly alarming national reverberations.
We do not intend to sit idly by with this data. Because these are not just “data.” These statistics represent the people who have influenced and nurtured us, our mothers and grandmothers and parents—humans. These numbers are not just an episode of care or a bundled payment, they represent someone’s body, someone’s emotions and experiences. There is a level of anonymity in talking about data that makes it seem like it isn’t personal, that it is a thing without an owner, without a cause, without an opportunity. But, it isn’t. We have heard from many voices that are the lived experience of some of this data.
The Colorado Perinatal Care Quality Collaborative began operating 47 years ago in recognition of the fact that quality improvement doesn’t just happen. It is a deliberate process of assessment, evidence gathering, intervention, review, and realignment…and repetition. It requires commitment, it requires funding, and it requires a growth mindset – aligned with incentives.
We acknowledge that health systems, hospitals, and clinics are one piece in supporting a change in the trajectory of maternal health and outcomes across Colorado. However, medical care is only part of a large, dynamic array of factors that influence pregnancy, birth, and the start of a new family. It is important that we consider all the complexity and the social and structural factors that contribute in large part to where we are today. It will take strong leadership and partnership to realize our vision: that EVERY pregnant and postpartum person, infant, and their families in Colorado have access to and receive safe, equitable, high-quality care.
We are at an inflection point both as an organization and as a perinatal health community. The status quo is not okay. We must start to shift the curve. Here are some of the ways CPCQC is looking to support the shift:
Our quality improvement initiatives are designed to support our hospital partners in improving health outcomes. One key focus area in perinatal patient safety works with labor and delivery units across the state to to reduce maternal mortality and severe maternal morbidity through the implementation of Alliance for Innovation on Maternal Health (AIM) patient safety bundles—including Safe Reduction of Primary Cesarean Birth and Care for Pregnant and Postpartum People with Substance Use Disorder. Roughly 30% of Colorado labor and delivery units are participating in each of these programs. That’s not enough. To affect real change, we need to see all health systems and hospitals involved in these patient safety bundles.
We’re expanding our hospital-based programs to support perinatal substance use care through critical partnerships with healthcare facilities and community-based organizations. Taking a multi-tiered, integrated approach to behavioral health care ensures better care coordination with an emphasis on patient-centered care. We’re working to fill the gaps in care through a combination of programs, including:
- Colorado Alliance for Innovation on Maternal Health: Substance Use Disorder Learning Collaborative (CO AIM: SUD), a cohort-based learning collaborative where hospital teams learn alongside peer labor and delivery units to implement quality improvement approaches focused on improving screening and referral rates for substance use disorder (SUD) and perinatal mood and anxiety disorders (PMADs);
- Colorado MOMs (Maternal Overdose Matters) Initiative, a partner distribution program that provides birthing hospitals with free naloxone to dispense to at-risk perinatal patients and families;
- IMPACT BH aims to integrate behavioral health care by bringing together hospital- and community-based care teams to provide wrap-around support and care navigation through pregnancy, birth, and one-year postpartum; and,
- Maternal Overdose Matters Plus (MOMs+) a one-on-one technical assistance program supporting labor and delivery units in developing the ability to immediately begin life-saving, medication-assisted treatment for patients with substance use disorder during admission, while creating connections for patients to continue care outside of the hospital.
While our quality improvement initiatives and community-based programming are integral in improving maternal health outcomes, perhaps one of the most critical areas that we need to address in order to affect significant change is by listening to and incorporating the voices of lived experience into our work. We know that health care systems are not meeting the needs of pregnant and postpartum people, especially in communities of color, low-income families, and those with substance use and mental health disorders. To ensure culturally relevant, safe, equitable, high quality care for all pregnant and postpartum people, we must increase our community and patient engagement efforts. We need to hear from birthing people themselves to understand their challenges and incorporate their perspectives into solutions to address maternal mortality.
Our work should not only look inward, but also look to improve public awareness and public policy as a catalyst for systems change. We have to activate our communities to become advocates for the women who have influenced and nurtured us, our mothers and grandmothers—humans. We must support health policies and legislation that advance integrated maternal behavioral health and wellness, reduce the preventable risks and causes of maternal mortality and morbidity, and address social determinants of health. In alignment with the National Governors Association Maternal and Infant Health Playbook’s recommendations, we hope to work with our own Governor’s office and Cabinet officials to build infrastructure for sustained success, increase access to perinatal care, focus on disparities in affecting Black and American Indian and Alaskan Native persons, focus on non-medical root causes, and grow and diversify the perinatal workforce. And, we will continue to support policies already in place, such as paid family leave, the PUMP Act, and Family Connects home visiting program.
We look forward to the policy and implementation efforts that will follow the release of the Colorado MMRC report on pregnancy-associated and pregnancy-related deaths, the National Governors Association Maternal and Infant Health Playbook, and Colorado’s Maternal Health Task Force strategic plan. With these recommendations in place, this could be the catalyst we need to make real strides in reducing disparities and preventable risks, and shifting maternal mortality trends toward better outcomes.