As a pediatrician, I read the editorial “Take action for mothers” in The Joplin Globe (July 15) with more than a passing interest.
I only remember one time that I sent a baby home with the father because the mother died, but one was still too many. That said, the numbers printed in the article did not make sense to me. If we have 213 deaths per 10,000 live births in Black women, that should be 2,130 deaths per 100,000 live births; and if we have 92 deaths per 10,000 live births in white women, that would be 920 deaths per 100,000 live births. You stated there were only 26 deaths per 100,000 live births in Missouri. These figures did not compute.
When I looked up the report (health.mo.gov/data/pamr), the reference cited in the beginning of the article, I found that when they use the term severe maternal morbidity, they are not talking about things that only cause death; they are counting things that may cause death or affect a woman’s short or long term health — and include blood transfusions, renal failure, cesarean sections or some similar issues.
Black women do experience 213 severe maternal morbidities per 10,000 births, while white women have only 92 severe maternal morbidities per 10,000 births. The pregnancy associated death rate is still 56 per 100,000 births; and the pregnancy related death rate is 26 per 100,000 births, with Black women approximately four times higher in both. The difference is the pregnancy associated death rate can include motor vehicle accidents, substance abuse and mental health problems, while the pregnancy related death rate means the death was related to the pregnancy.
Another variable is that the Pregnancy Mortality Surveillance system was initiated in 2017 and looks at birth to one year postpartum, while the World Health Organization and National Center for Health Care Statistics, which were used before 2017, only look at birth to 42 days postpartum. This caused us to identify six more pregnancy related deaths, bringing the number to 67 in 2017. Maternal mortality is still rare, and of the 67 deaths in 2017, 19 were determined pregnancy related, 37 were pregnancy associated and four were unable to be determined.
This is not to say that we don’t have a lot to do, and we need to be working on changing the variables that we can change. I was very discouraged to see that being on Medicaid was a risk factor, because in this community, I had not thought I was seeing a significant difference in the care provided to Medicaid recipients.
On further reading, it seems that women on Medicaid start getting their care later in the pregnancy, and we may need to work on helping them get women established with an obstetrics provider sooner.
It is difficult to read medical studies, and one has to be used to looking at what we call the methods to understand the conclusions in these studies. I appreciated The Joplin Globe for printing this, and this is reason to mistrust social media interpretations of medical studies, where there is no good mechanism to have reasoned response to what is printed.
Dr. Fredric Wheeler is a Joplin pediatrician.