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Pursuing healthy birth outcomes: At MLC meeting, legislators learn how states can help save babies’ and mothers’ lives from before birth through infancy

by Jon Davis ~ August 2017 ~ Stateline Midwest »
In pursuit of healthy birth outcomes, nothing grabs attention like a personal story. So when Lezlie Mestdagh, outreach coordinator for the Count the Kicks campaign — an educational effort founded by five Iowa mothers who suffered stillbirths and are determined to prevent that pain for other mothers — showed Midwestern legislators a “Good Morning America” video clip featuring an Iowa couple whose infant daughter was saved by Count the Kicks’ phone app, they applauded.
That video illustrated the heart of Mestdagh’s message to the region’s lawmakers in July at the MLC Annual Meeting: Invest pennies in prevention to save dollars down the road, both in direct costs (stillbirths require greater resources than live births) and indirect costs such as funerals, ongoing counseling, lost income and reduced or delayed employment for parents, and more expensive medical care during subsequent pregnancies.
The United States Centers for Disease Control and Prevention estimates there are 24,000 stillbirths annually in the U.S. — more than 10 times the number of babies who die from sudden infant death syndrome, she said.
We’ve done a good job reducing SIDS rates; we need to do likewise for stillbirths, Mestdagh said.
“If you invest in stillbirth prevention … you’re gonna save a lot of money,” she said. “It is not that expensive to save babies.”
Count the Kicks’ free app guides expectant mothers though the process of, literally, counting her fetus’ kicks during the third trimester, tapping a foot icon on the app for each of 10 kicks. After a few days, a “normal” pattern emerges. The pattern diverging from “normal” could indicate a problem and is an indication to call a medical provider. (Moms can also use the app to set counting-time reminders.)
Iowa Sen. Janet Petersen, current chair of the MLC, is one of the five mothers who co-founded Count the Kicks in 2009. She has made “Healthy Birth Outcomes” her MLC Chair’s Initiative for 2017. (A list of other articles written on this topic can be found at csgmidwest.org).
Mestdagh’s talk on Count the Kicks was preceded by a presentation from Dr. Barbara Levy, vice president of health policy at the American Congress of Obstetricians and Gynecologists. She implored legislators to not overlook the other side of healthy birth outcomes — the mother’s health and well-being.
Maternal mortality — defined by the World Health Organization as the death of the mother within 42 days of the end of a pregnancy, regardless of cause — is a serious and growing health crisis in the United States, despite the belief that it doesn’t happen here, Levy said.
Citing figures reported in the September 2016 edition of Obstetrics & Gynecology, Levy said the U.S. maternal mortality rate (for 48 states and the District of Columbia) rose from 18.8 per 100,000 live births in 2000 to 23.8 percent in 2014, a 26.6 percent increase.
Moreover, she added, the U.S. is the only industrialized country whose maternal mortality rate is rising; all other countries’ rates are dropping. “We have a higher maternal mortality rate than many Third World countries,” Levy said to legislators. “Something is very, very wrong.”
The issue is hard to perceive outside of raw data, because while the national mortality rate is trending in the wrong direction, individual incidents don’t happen all that often; for example, a hospital with 5,000 births annually might see a maternal death once every 10 years, Levy said.
The two most prevalent causes of maternal deaths are pre-existing conditions exacerbated by pregnancy (28 percent) and severe bleeding (27 percent). Conditions contributing to maternal mortality can begin in or during pregnancy, and can affect a mother’s health up to a year after she gives birth, Levy said.
The study of “epigenetics,” or the factors that turn genes on or off, is key to solving that puzzle and, perhaps, also explaining persistent racial disparities in maternal death rates, she added. While the prevailing hypothesis for those disparities is chronic stress, which is known to affect hormones, blood flow, and other factors, the science isn’t in on that yet, she said.
“What happens to the fetus in the uterus turns those genes on and off” and can set a family’s genetic course through multiple generations, Levy said.
State legislation can help create the kind of access needed to improve outcomes, however. California, for example, reduced its maternal mortality rate compared to the U.S. overall rate by 50 percent since mid-2006. The difference was requiring a hemorrhage cart (the equivalent of a cardiac arrest “crash” cart) at medical facilities for births and other quality-improvement initiatives.
If they haven’t already done so, Levy said, states should create maternal mortality review committees to look at every incidence of maternal death. In Michigan, a recently enacted law seeks to ensure that its review committee has access to the relevant data. Under HB 4235, signed into law in December 2016, physicians and hospitals must report the death of a woman who was pregnant at the time of death or within one year before her death. The goal of this new law is to provide legislators and health professionals with the information they need to adopt medical practices and policies that prevent maternal deaths.
Meanwhile, the American Congress of Obstetricians and Gynecologists and its partners launched the Alliance for Innovation on Maternal Health to promote better evidence-based maternal care; Illinois and Michigan are the only participating Midwestern states, although Iowa, Ohio and Wisconsin have indicated interest in joining.
“If you don’t look into the root causes of these deaths, you’ll never affect change,” Levy said.


This article was written as part of this year’s Midwestern Legislative Conference Chair’s Initiative of Iowa Sen. Janet Petersen. This initiative, Healthy Birth Outcomes, is examining ideas to improve the health of mothers and their babies.