Maternal mortality became a subject of discussion this year in the state General Assembly, while in Washington, D.C., U.S. Rep. Buddy Carter, R-1, and other members of Congress are seeking solutions to the issue on the federal level. Friday afternoon, Carter was at the Brunswick campus of the Southeast Georgia Health System to hear from obstetrician-gynecologists on what they’re seeing and what they think may be driving the numbers.
Carter said he came to the topic through a subcommittee hearing of the House Energy and Commerce Committee, on which he sits.
“I serve on the Health Subcommittee, and we had a hearing in the Health Subcommittee on maternal mortality, and I was shocked,” Carter said. “I had dealt with it when I served on Health and Human Services in the state Senate, and I was vice-chair of that committee, and I knew that we had a problem in the country and we had a problem in Georgia. But when we brought in the witnesses and they testified, two things really raised my concern.
“First of all, how high it was in our country — for a developed country like America, to be that high, it was just alarming to me. And I guess I knew it, but I didn’t recognize it and i just didn’t realize it.”
According to statistics from the Centers for Disease Control and Prevention, Georgia is No. 2 in the country in maternal mortality, with 46.2 deaths per 100,000 people. That’s more than double the nationwide average. Also, the mortality rate among black mothers is 66.6 in Georgia, compared to white mothers at 43.2. However both of these statistics are also significantly above the national averages.
Carter said he understands that there are places in Georgia without access to quality health care, and that black mothers are disproportionately affected, but expressed confusion as to how these numbers aren’t affected by income level, as someone might assume.
He also wondered if part of the issue regards how these statistics are reported from state to state, and whether Georgia’s data is better or more complete because of the CDC’s location in Atlanta.
The definition of maternal mortality in use in these statistics is “deaths from any cause related or aggravated by pregnancy or its management — excluding accidental or incidental causes — during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy….”
Dr. Mitch Brock said that in terms of everyday impact, the numbers are still so low that a lot of doctors may not have a lot of first-hand experience with patients who died because of issues surrounding pregnancy or childbirth.
“You’re talking about something that’s not common,” Brock said. “So, if you’re 46 out of 100,000, that’s high. If you’re working in a community where the rate’s even lower than that, you could go your whole career as a physician and never see one.”
He said the issue could be dealing with a high-risk population — people with chronic hypertension, smoking, morbid obesity and other problems.
In regard to seeking proper treatment early and often during the pregnancy, Dr. Shirley Wilson said one of the factors could also be transience combined with substance abuse.
“We were talking earlier about there’s a lot of transient movement of patients in and out of practices here, just among the physicians here, because of the increase in drug use, substance abuse in this population,” Wilson said. “Some of these people are showing up late into the pregnancy for their first visit … because they’re running from being detected for substance abuse….”
Dr. Darrin Strickland suggested, and other doctors voiced their agreement, that there are people who are now getting pregnant or trying to who, in prior years, would have been discouraged from doing so because of the effect on their health.
“I’ve noticed, and of course we’ve all noticed, obesity is the biggest overall thing that’s changed the most high-risk patients we have,” Strickland said. “When I started, ’96 versus now, we have so much more … it’s nothing for us to see people over 350 pounds. So, their individual risk is so much higher.”
Carter said he, U.S. Sen. Lisa Murkowski, R-Alaska and U.S. Rep. Katherine Clark, D-Mass., are working on a bill currently that will hopefully provide the resources to drive down these numbers.