Hundreds of women in the United States die during and after pregnancy and childbirth every year. Deaths are even higher among Black women, who die at a rate nearly 3.5 times higher than white women. Black women are also more likely to experience preterm births, low birthweight births, and infant mortality. The hopeful news is that over 80% of pregnancy-related deaths are preventable.
Ericka Gibson, MD, an ob-gyn at Kaiser Permanente in Georgia, sat down with Deb Friesen, MD, host of the Kaiser Permanente podcast Health Views, to share her insights on how health care organizations can eliminate preventable maternal mortality — including addressing Black mothers’ disproportionate risk of injury and death. Dr. Gibson is the physician program director for perinatal safety and quality at the Southeast Permanente Medical Group and was instrumental in the creation of the Cocoon Pregnancy Care Program. She is also the national clinical lead for digital health for The Permanente Federation. Dr. Gibson was recently appointed to the U.S. Preventive Services Task Force.
The following excerpt from their conversation has been edited for brevity.
Q: How do you define maternal health?
A: Maternal health refers to the health and well-being of women before, during, and after pregnancy. It encompasses a wide range of factors, including not just routine medical care of the patient during her pregnancy. It also includes maternal mental health, social determinants of health, and other psychosocial factors that play huge roles in the care that women receive and in their health outcomes. The goal is to ensure that all women and their babies can reach their full potential for health and well-being.
Q: You mentioned social determinants of health, which can mean everything from the air we breathe and the water we drink to having reliable transportation or access to your doctor when you need them. What does an awareness of social health look like in your practice?
A: One of the biggest obstacles that we’re trying to solve for as maternal health experts and caregivers of women and their families is that there are disparities in outcomes. We know that multiple factors contribute to these disparities. Social health has a huge impact on overall health. Where and how people grow, work, live, and play has a huge impact.
For example, I had a patient who had high blood pressure and diabetes. We know that these are common medical conditions, and they’re becoming more common in our pregnant patients. They are risk factors for some common pregnancy complications.
This patient was enrolled in one of our remote perinatal monitoring programs, and we were seeing that her blood pressure and blood sugar levels weren’t well-controlled. I was able to talk to her and ask her about these issues. I asked, “What are some of your barriers to achieving better health?” One of the things she revealed was that she couldn’t afford the blood pressure medication that we had prescribed for her. She also lived in a food desert, so she really didn’t have access to healthy food options. And she wasn’t sure what to cook.
We partnered with a social worker who was able to help the patient apply for financial assistance to afford her medication. We helped her get the blood pressure and blood sugar monitors she needed. We helped connect her with resources for healthy food. If we had only been focusing on her blood pressure or blood sugar level, we would have missed these things.
Q: How do unique needs around mental health come into maternal health care?
A: Mental health is a huge part of whole person health. One in 4 women will experience a mental health condition during pregnancy or postpartum. Mental health conditions are among the top contributors to maternal deaths. Racial disparities persist when we look at the number of women who suffer from mental health disorders and their access to treatment. Studies have shown that Black women have a higher burden of disease and are less likely to be offered treatment, so they don’t get access to the care that they need. We have given a lot of thought to screening and how we build trust.
For example, we have a patient advisory council that includes several women of color who were recently pregnant. They shared with us that some women may worry that if they say they are struggling with depression or anxiety, the health care team would then loop in agencies like Child Protective Services, and they would be at risk of having their children taken away from them. Now, we make sure to clarify that our reason for asking these questions is that we have a therapist who can help. Patients have to trust that you are asking the question with good intent.
Q: What role does data play in maternal health? How can we use data to ensure that we are doing a good job and to close care gaps?
A: Data is a cornerstone of quality improvement. You need data to understand where you are, and where you have been, to help drive towards where you want to be. Having data lets us ask and answer questions like, what is the prevalence of high blood pressure among our patients based on their demographics? Is there a difference that we’re seeing in C-section rates or pregnancy complications among different groups? The data tells a story that doesn’t just help to quantify the problem — it also helps us create targeted interventions that help us achieve the results we want to see.
Q: What does it mean when we talk about maternal-child health equity?
The work of maternal health equity is about striving to eliminate poor health outcomes. Every woman who becomes pregnant deserves to have the best health outcome for both herself and her baby. And every patient deserves all the resources we have available to make that happen. I think back to the saying, “A rising tide lifts all boats.” When we provide what our most disadvantaged patient needs, that ultimately is going to help all patients. Whatever solutions we design to address the needs of our most marginalized patients will positively impact everyone.
Listen to the full conversation on Health Views with Deb Friesen, MD.