Dying in childbirth is not a thing of the past in Indiana.
In fact, the state leads the nation with one of the highest rates of maternal mortality, which is when a woman dies of pregnancy-related complications while pregnant, or within 42 days of giving birth or ending the pregnancy.
For every 100,000 live births that take place in Indiana, 41.4 mothers die from pregnancy-related complications. The national average is 20.7.
This makes Indiana the third worst state for maternal mortality, after Louisiana and Georgia, according to the United Health Foundation’s rankings, which are based on Centers for Disease Control and Prevention data.
The state is just beginning to look at the issue of maternal mortality in depth. The legislature passed a bill this year to create a Maternal Mortality Review Board to investigate each maternal death in Indiana, much like the state does with infant deaths.
Robert Aronson, professor and director of Taylor University’s public health program, said it’s difficult to assess Grant County’s maternal mortality rate and how it’s changed over time because the actual number of deaths is so low that it makes looking at the county’s ratios, the way maternal death rates are typically compared, unreliable.
But Aronson said what is known is that maternal health has a lot to do with a woman’s overall health, and Grant County ranks at the bottom of all Indiana counties in at least one measure of health: tobacco use.
“Maternal health begins long before pregnancy and the overall health status has a lot to do with risks for maternal mortality,” Aronson said. “Grant County has the highest smoking rate of pregnant women among all counties in Indiana. Nearly one-third of all pregnant women in the county smoke. This is a risk for the mother as well as the baby.
“Smoking is a very significant contributor to low birth weight and preterm birth, both of which are important contributors to infant mortality. As smoking is so harmful to the health of the woman, her risk for pregnancy related mortality is also greater,” he added.
Marion General Hospital is targeting the issue of smoking in pregnant women and new mothers through a state-funded program called Baby and Me Tobacco Free.
The program offers a free case of diapers for each month the woman can go without smoking.
If another family member, such as a spouse, quits smoking the family can also win free diapers for that achievement.
MGH has also upped its level of care for delivery of babies before their due date.
According to Gail Elbert, director of MGH’s Family Birthing Center, MGH recently upgraded to a Level 2 facility, called a special care nursery. This means many more preterm babies can be cared for at the hospital instead of having to be taken out of county to Fort Wayne or Indianapolis.
“In the past, your baby would have been transferred to Fort Wayne. Now the baby and mom are able to stay together,” Elbert said.
MGH now has neonatalogists on staff who are specially trained to care for premature babies and mothers, who are at higher risk of complications.
“We’re making big changes,” Elbert said. “... It’s phenomenal for a hospital of this size to have that kind of (neonatology) program.”
Another important step is follow-up care, which Elbert said MGH also provides to new moms.
“We want to make sure new moms don’t fall in the cracks and get left behind,” Elbert said. “You’ll get a call two to three days after discharge.”
In the follow-up check, the hospital monitors blood pressure and looks for signs of hypertension, possibly signs of a dangerous condition called eclampsia.
Members of the Maternal Mortality Review Board are set to visit MGH in the next few weeks, Elbert said, to gather data as well as to look at what services MGH offers to area mothers.
Aronson said another factor driving maternal deaths is health insurance and access to care.
“Having health insurance coverage is not the same as having access to health care. Many people with insurance do not go to health care providers because the deductibles on their policies are so high that they cannot afford to go. A person who is working and barely scraping by will not be able to cover some of the copays, not to mention deductibles that may be as high as $5,000,” Aronson said.
Aronson also suggested a lack of public funding for health programs and health care might contribue to Indiana’s high rate of maternal mortality.
“Unfortunately, Indiana does not want to pay for public health services. The state ranks at 48 out of 50 in per capita funding for public health. This comes back to bite us, as we have to pour money into treating preventable conditions, or do nothing and watch the mortality rates climb even higher,” Aronson said.