Why you should start reporting on how your local health care system treats pregnant women

No woman should die as a result of pregnancy and childbirth.

And yet more than 250,000 women worldwide still die every year from complications and illnesses related to either being pregnant or giving birth. Millions more lose years of healthy life because of disabling conditions that arise during and after pregnancy.

Earlier this year, I was able to participate in a series of discussions with faith-based organizations, socially conscious business leaders, and academic researchers about maternal health.

There were three dominant themes: 1) There are positive signs that maternal health is improving worldwide. 2) We should find ways to replicate the successes we are seeing. 3) When it comes to maternal health, the U.S. continues to have a strongly negative trend.

A high rate of women dying or suffering harm in a health care system is a sentinel sign that a system is not working. But how do you know what a well-functioning system looks like? If we can find examples of what works, we can then see how different health systems measure up.

As part of the gathering, I had the chance to meet Jennie Joseph. The Florida midwife was profiled in 2018 in the New York Times Fixes column.

What she is doing in Florida to improve maternal health, particularly among women of color, is remarkable and independently validated. It’s also a checklist for what others in health care may not be doing. I’m going to detail some of what she is doing in this post and return to the theme of maternal health in future posts.

A recent study by the U.S. Centers for Disease Control and Prevention showed that rates of maternal-related deaths among women of color were higher than those of white women.

For the period from 2011 to 2015, there were 17.2 pregnancy-related deaths for every 100,000 live births. (Lower is better.) For non-Hispanic black women, the rate was 42.8, the highest rate in the study. And for American Indian and Alaska Native women, the rate was 32.5, nearly double the average and more than three times as high as the rate for white women (13 deaths for every 100,00 live births). You can read the full study here.

How can you find out if hospitals or other health centers near you are doing something similar? Start by pretending you are a first-time mother in crisis. You don’t have the resources to cover your health care expenses. You might not speak English very well. And you may not fully understand the changes that are happening to your body and what might be a signal that something is going wrong.

Where would you turn?

Try something as simple as typing in the name of your city and “pregnancy” in Google. What comes up?

Call that number and ask what is required to make an appointment with someone who can help assess whether a pregnancy is off to a healthy start. What happens? Did the person on the other end of the phone ask you for your insurance card? Did they punt you to a PR rep?

If they do punt you to a PR rep, ask that person how many women have had any sort of prenatal care at that facility in the previous year. How many had a second visit? A third? How many ended up delivering there? Do they even know? Understanding the nature of their own patient population is vital for being able to make sure that women have healthy pregnancies and child births.

One of the key’s to Joseph’s approach is making sure no woman is turned away when trying to receive care, regardless of their ability to pay. She secures charitable donations to cover any costs that aren’t covered by insurers. She also tries to get her low-income patients enrolled in Medicaid.

Let’s say you get past that initial hurdle. Now how does the interaction feel to you? Ask them if they speak Spanish or French or if they could get you on the phone with someone who does.  At Joseph’s clinic, there are staff trained in multiple languages ready to answer patient questions.

Consider every aspect of the interaction. Did the person make you feel understood? Did they talk to you at your level? Did you feel welcomed, cared for even?

This is what Joseph tries to achieve at the Birth Place.

“When a patient of ours says, ‘I’ve got a question,’ I want it answered,” Joseph told Fixes.

At the same gathering on maternal health earlier this year, the dean Harvard’s School of Public Health retold the frightening story of tennis star Serena Williams’ delivery in 2017. Williams repeatedly notified health care providers that something was wrong with her breathing, and yet she was ignored. Finally, she demanded that she undergo some tests to find out why she her breathing felt wrong. The test found that Williams had a life-threatening blood clot in her lung that needed immediate action. Williams had already survived a life-threatening blood clot in 2011, so her health care providers should have been on red alert.

That concept of respect seems so simple, and yet it can be elusive. Health care centers can be overwhelmed and overwhelming. If you have spent any time in a hospital you may have had the sense at different times that you had been forgotten, simply because of the sheer volume of patients being cared for is outmatched by the resources of the staff.

How can you find out if women are being treated with respect? One way would be to put a query out in social media or on your outlet’s website. Ask women to tell you about their experiences with their pregnancies and childbirths. Try to come up with some standard questions to ask, and, if you receive enough responses, you can report your findings in the form of poll results. Sample questions could include: “Was the front desk clerk respectful toward you? Did your health care provider listen to your concerns and answer your questions? How much time did your physician or nurse spend with you?”

By reporting what you find, you are contributing to a healthier culture for women and babies in our communities.