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Policy Action Plan: Maternal Morbidity and Mortality

Mariah Little

Delaware Technical Community College

NUR420: Nursing Policy

Professor Brown

February 18, 2024

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What is Maternal Morbidity and Mortality and the Problem at Hand?

Women dying from childbirth and preventable deaths at that is a crisis that needs to be

solved. The statistics show no improvement in maternal deaths as 1,205 women died in 2021 of

maternal causes versus 861 women in 2020 and 754 in 2019 (Hoyert, 2021). The CDC states:

A maternal death is defined by the World Health Organization as the death of a woman

while pregnant or within 42 days of termination of pregnancy, irrespective of the duration

and the site of the pregnancy, from any cause related to or aggravated by the pregnancy

or its management, but not from accidental or incidental causes. (Hoyert, 2021).

Women are dying from causes such as cardiovascular diseases, infection, hemorrhage,

thrombotic pulmonary embolism, and hypertensive disorders. Socioeconomic factors come into

play as well, such as lack of access to care, increased age of mothers, and rising rates of obesity,

which have also been identified as contributing factors (Judith M. Orvos & Schwartz, 2023).

United States is considered a wealthy country although it has higher maternal death rates than

any other developed country. This should be a joyous moment in every woman's life, but these

statistics show that for many women, it is not. Also, a point to consider is the statistic that black

women have higher pregnancy-related mortality ratios than those compared to white women

(Lubell, 2023). Beyond maternal mortality, maternal morbidity has also increased in the United

States, impacting women's futures, short-term and long-term.

Current Laws

The Preventing Maternal Deaths Act of 2018 and the Improving Access to Maternity

Care Act are currently the only laws in place specifically addressing maternal health. There are

many other bills introduced but no others signed into law yet. The Preventing Maternal Deaths
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Act allows the CDC to support states and support maternal mortality review committees. These

committees are required to review every single pregnancy-related death in their state and come

up with recommendations based on their findings to prevent future deaths (Preventing Maternal

Deaths Act, 2018). The Improving Access to Maternity Care Act is aimed at helping women find

access to maternal care in more rural areas. The bill helps place maternity healthcare workers in

areas of need by placing individuals part of the National Health Service Corps participating in

the 2-year loan repayment program in areas where there are health professional shortages

(Improving Access to Maternity Care Act, 2018).

Navigation of Political System

There are many people and steps that go into forming a bill and passing it into law. First

starting at a local-state level, Bryant L. Richardson who is a senate district leader as well as

Timothy D. Dukes can be reached by phone or email for discussion. From there my senate

federal legislators are Senator Thomas Carper and Senator Chris Coons. The house

representative is Lisa Blunt Rochester (Delaware General Assembly, 2022). By contacting local

state representatives and discussing my concerns and ideas regarding maternal morbidity and

mortality, then local leaders can take the ideas and proposals to Delaware senators and the house

representatives. It is imperative to contact these individuals regarding healthcare needs and bill

proposals. In my professional email, I would explain to my local senators, listing the prevalence

of maternal morbidity and mortality, as well as listing statistics to show the relevance of the

issue. I would also discuss proposal ideas of what needs to be done to fix the issue at a state level

here in Delaware.
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Talking Points

There are many ideas and areas of the topic that need to be addressed with policymakers.

First addressing the access to care during pregnancy and after for women. This is a vital time

when women need to be seen by healthcare workers to reduce maternal mortality. Conditions can

be caught earlier and allow providers to treat and stabilize chronic conditions, address potential

needs, and prepare for a healthy delivery (Improving Access to Maternal Health Care in Rural

Areas, n.d.). Secondly, I would address the problem that black women are three times likelier

than white women to die from a pregnancy-related outcome. The need for more bias training

needs to be initiated country-wide in all healthcare facilities that come in contact with pregnant

women (Lubell, 2023). Thirdly, I would address the fact that Medicaid paid for 43% of

childbirths in 2017 showing the relevance of Medicaid coverage in these individuals. Although

Medicaid only continues coverage up to 60 days post-delivery. No coverage means a likelihood

that women will not seek care for complications which increases their risk of morbidity and

mortality (Improving Access to Maternal Health Care in Rural Areas, n.d.). The fourth talking

point would be the shortage of workforce supply. Many workers play a critical part in the care of

maternity patients. It is projected that by 2050 there will be a shortage by 22,000 of obstetricians

and gynecologists. Many workers who take part in the care of pregnant women before and after

delivery that may not come to mind are dentists, behavioral health providers, and more

(Improving Access to Maternal Health Care in Rural Areas, n.d.).

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Plans and Goals

My goal is to improve points stated before to therefore in return decrease maternal

morbidity and mortality. To combat the decrease in obstetricians and gynecologists, as well as all

health care workers, proposing an expansion of these workers in rural areas could help this. For

example, Georgia established an incentive program for physicians to train new physicians and in

return would provide state tax deductions for those training (Improving Access to Maternal

Health Care in Rural Areas, n.d.). Creating a feasible incentive for physicians in Delaware who

would assist in training new physicians would potentially increase workers in rural areas.

Another goal is to create a training program for all healthcare workers who come in contact with

maternity patients on implicit bias and alert individuals to the alarming statistics that black

women are more like to die from childbirth complications than white women.

In the next 90 days, I will reach out to my local senate representative Bryant L.

Richardson with a detailed email describing the prevalent issue and my proposed plan and goal

that I would like to see take place in Delaware. I will include real statistics and real-life

experiences from a local maternity nurse in Sussex County. I will explain that we must create a

law here in Delaware to protect our mothers who are just trying to enjoy the best time of their

lives and not have to have that cut short and become a statistic when they should not have been. I

hope to make an impact on patient care and reduce the maternal morbidity and mortality rates in

Delaware and the United States.

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References

(n.d.). Improving Access to Maternal Health Care in Rural Communities. CMS. Retrieved

February 17, 2024, from

https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-

health/09032019-Maternal-Health-Care-in-Rural-Communities.pdf

Delaware General Assembly. Find My Legislator - Delaware General Assembly. (2022).

https://legis.delaware.gov/FindMyLegislator?search=14429%2Bjillian%2Brun%2Blaurel

%2Bde%2B19956

Hoyert, D. L. (2021). Maternal Mortality Rates in the United States. CDC.

https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-

2021.htm

Improving Access to Maternity Care Act, H.R. 315, 115th Cong. (2018).

https://www.congress.gov/bill/115th-congress/house-bill/315

Judith M. Orvos, E., & Schwartz, B. (2023, December 8). Major maternal health legislation

signed into law. Contemporary OB/GYN.

https://www.contemporaryobgyn.net/view/major-maternal-health-legislation-signed-law

Lubell, J. (2023, May 25). What’s behind the spike in U.S. Maternal mortality. AMA.

https://www.ama-assn.org/delivering-care/population-care/what-s-behind-spike-us-

maternal-mortality
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Preventing Maternal Deaths Act, H.R. 1318, 115th Cong. (2018).

https://www.congress.gov/bill/115th-congress/house-bill/1318?s=1&r=14&q=%7B

%22search%22%3A%22maternal+mortality%22%7D