National Edition

New programs aim to save lives of American moms in childbirth

Published: Friday, July 4 2014 4:00 a.m. MDT

A Momobile manager steps out of her car on her way to a visit with a client.

Courtesy Merck

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Two to three women die every day in the U.S. from pregnancy-related complications, according to a new United Nations and World Health Organization report.

Even worse news? The U.S. ranks 47th out of 180 countries for mother mortality rates — last in developed countries. This news comes on the heels of a recent Save the Children report that also ranked the U.S. low among developed countries, adding to the mounting evidence that the U.S. is dropping as a safe place to have a baby.

But the good news is that people are starting to pay attention, says Dr. Priya Agrawal, executive director of Merck for Mothers, a $500 million initiative to put a stop to deaths related to childbirth. The program is innovating ways to save mom — from "Momobile" services that provide home visits to pregnant women, to delivery room protocols for the most common delivery room emergencies, like severe bleeding.

"There is a real lack of awareness — up until now all the attention has been on infant mortality rates," says Agrawal. "Considering that this is not a disease, and that other countries are safe places to deliver, this is unacceptable — especially because most of these cases are preventable."

Problems at home

In her work as an OB/GYN, Agrawal has traveled the world and seen pregnant women who arrive at the hospital to deliver having had little or no prenatal care. The surprising thing, she says, is that she's seeing the same thing in the U.S.

In some low-income neighborhoods, women don't make it to the doctor because they don't have the money or the insurance. Only 50 percent of pregnant women in Camden, New Jersey, which ranks as America's poorest city according to the U.S. Census Bureau, receive first trimester care, she says. This makes it much harder to detect and treat conditions that can lead to a life-threatening childbirth — such as hypertension, diabetes or substance abuse.

For every 100,000 births in Philadelphia, 18 women die, and in Camden it's 30.

"These issues are actually not confined to the developing world. Sadly, there are communities in the United States that face challenges not all that different than those facing women in places like sub-Saharan Africa and South Asia," says Agrawal.

Helping Mom

To address this problem, the Maternity Care Coalition has a home-visiting program called the "Momobile." Underwritten by Merck's program, the Momobile delivers health workers who do in-home visits to help pregnant women navigate the health care system and understand their options.

Has the health care system become so convoluted that people need a dedicated health worker just to map it? For low-income families, the answer is often yes, says JoAnne Fischer, executive director of Maternity Care Coalition in Philadelphia.

Mothers have to find out what health care plans they're eligible for and find a managed care plan and provider that will accept them. Then, they have to find out if they're eligible for food stamps and sign up with that agency. They may also be eligible for help with gas and electric bills. If they have a chronic health problem, like diabetes and hypertension, they may need multiple specialists.

There are resources, but the agencies, paperwork and phone calls pile up fast.

"Meanwhile, some of these people may not have a phone, or they use up all their minutes waiting on hold," she says. "Some have no transportation or child care, and they can't bring their 3-year-old to the appointment."

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