Risks of Childbirth Do Not End at Delivery

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It is an awful, well-known fact that people in the U.S. are far more likely to die during childbirth than other developed countries, with people of color facing the greatest danger.

But the risks of childbirth do not end at delivery. New data demonstrates that up to one-third of life-threatening complications occur weeks after the mother and child leave the hospital.

Respiratory distress, sepsis, significant blood loss, and eclampsia are collectively known as severe maternal morbidity (SMM) events, and they have two major factors in common: they can all lead to death, and they are preventable.

We examined real-world data from Blue Cross and Blue Shield companies from 700,000 births covered by commercial insurance. We also examined 1.5 million births insured under Medicaid and these two distinct populations both showed that Black mothers are experiencing these serious events at nearly 90% higher rate than white mothers.

These outcomes challenge the conventional wisdom that the deepest disparities are among people with lower incomes. In fact, Black patients with both commercial insurance and Medicaid are afflicted by higher rates of complications.

We were able to unlock these insights because we have access to data that comes from insuring one and three Americans, covering every zip code in the country. But there is so much more to learn, and we need federal and state partners to help gather more comprehensive data.

The Centers for Disease Control and Prevention (CDC) currently operates a system of state-based Maternal Mortality Review Committees that track and analyze deaths from pregnancy-related complications. But we believe these efforts will fall short until federal officials set up a similar system at the national level to report and track morbidity.

We cannot manage what we cannot measure, so these committees are essential for success. We need to pinpoint, among other things, why Black and Latina women experience disproportionately higher rates of postpartum complications compared to white women – regardless of their insurance coverage.

We have advocated for solutions that improve outcomes during the postpartum period, including extending Medicaid postpartum coverage from just 60 days to 12 months.

Forty-four states have adopted this change; however, the federal government has a crucial role in furthering this support by extending Medicaid postpartum coverage nationally and enacting additional changes to help save the lives of thousands of women.

In addition to national standards, the health care industry should expand efforts that we know are already working, such as collaborating with trusted community organizations that serve mothers in the weeks after delivery and patients choosing medical centers of excellence for their maternal care. We know that high-quality, affordable perinatal health care reduces morbidity. But too many communities continue to experience gaps in access to these services.

We also know that midwives and doulas can play a crucial role in a woman’s postpartum care, addressing both physical and emotional needs. Their proactive approach reduces the risk of potential complications going unnoticed, benefiting both mother and baby.

We know that doulas can help mitigate disparities by providing personalized support. Congress and the Centers for Medicare & Medicaid Services should establish incentives such as an enhanced federal match for doula services to encourage more states to add this important benefit to their Medicaid programs. Additionally, states should enable expanded access to midwifery care by supporting policies and practices that promote full-practice authority without being limited by regulatory and legislative restrictions.

America’s maternal health crisis requires everyone – providers, payers, policymakers and community leaders – to work in partnership to do right by our mothers. By taking these actions, we can prevent pain and suffering that should never happen in the first place, ensuring that every mother receives proper care at every stage of pregnancy, including after they leave the delivery room. By working together and advocating for commonsense solutions we can create a better system of health, one that ensures every mother and baby go home healthy and remain healthy.

Kim A. Keck is president and chief executive officer of the Blue Cross Blue Shield Association (BCBSA), a national federation of independent, community-based and locally operated companies that collectively provide health care coverage for one in three Americans. Data equity and maternal health are central to BCBSA’s Health Equity Policy Platform, a multi-year effort to change the trajectory of health disparities and reimagine a more equitable healthcare system.



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