Content warning: Maternal Mortality, Maternal Morbitity, Maternal death, Racism
With the outbreak of COVID-19, public health has been a subject of major conversation. This month we are talking about a new topic! We will highlight Public Health and Obstetrical Care. We will review current resources and information across the United States, locally in California and the San Luis Obispo and Santa Barbara communities.
Discussing public health and obstetrics together can help us better understand the importance of health and wellness from preconception through the first year of parenting. Ninety-eight percent of all births in the United States occur in hospitals. Locally, since the pandemic, this number has decreased to about 96-98%, with an increase in birth center and home births. Many of the public health statistics we share locally and across the state are generally in the care of an obstetrician in the hospital setting. Right now, the United States must continue to make great strides in maternal health compared to other countries around the world despite the most significant financial investment in maternal health.
According to the Department of Health New York, "The American College of Obstetricians and Gynecologists recommend that all health encounters during a woman's reproductive years, particularly those that are a part of preconception care, should include counseling on appropriate health behaviors to optimize pregnancy outcomes and prevent maternal mortality." We know that access to preconception care, care before pregnancy, for all people of reproductive age can significantly improve outcomes.
Additionally, the CDC Foundation defines public health as "the science of protecting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing, and responding to infectious diseases." Learn more about the 10 Essential Public Health Services described by the CDC here.
According to the American Public Health Association, Maternal and child health is an important public health issue because:
"we have the opportunity to end preventable deaths among all women, children, and adolescents and to greatly improve their health and well-being."
"far too many women, infants and children worldwide still have little or no access to essential, quality health services and education, clean air and water, and adequate sanitation and nutrition."
"investments in prevention, health care and education last a lifetime."
California programs and research improving maternal/child outcomes
There are numerous reputable United States and California-specific programs/resources that offer information surrounding healthcare from preconception through early parenting. However, it is difficult to find current, up-to-date data. Much of the information we have for maternal/perinatal health may be several years old.
The following resources will offer you a wide variety of information about maternal and newborn healthcare, pregnancy-related statistics in the U.S., and organizations that provide help. These resources include The National Center for Biotechnology, The Maternal Health Task Force, ACEs Aware, the California Maternal Quality Care Collaborative (CMQCC), and the California Health Care Foundation.
Maternity care is complex, making it difficult for consumers to understand their options. The National Center for Biotechnology includes a variety of information about maternal and newborn healthcare in the United States. This resource discusses the history of birth settings, the different types of health professionals, care in hospitals and other birth settings, and more. If you are interested in learning more about maternal and newborn care in the United States, we invite you to look at this article. Coming soon, the CCCN has been collaborating on a peer-reviewed mini birth settings guide with local resources.
According to The Maternal Health Task Force, the United States does not do as sufficient of a job preventing pregnancy-related deaths compared to other developed nations. Additionally, the U.S. spends more than any other country on hospital-based maternity care. There also exists a notable disparity by race regarding maternal mortality rates as Black women "die at a rate that ranges from three to four times the rate of their white counterparts…this difference in risk has remained unchanged for the past six decades". In addition, American Indian and Alaska Native women also fare worse than white women. Women of color often have less access to high-quality reproductive health information and services. They are often discriminated against in the healthcare system.
Additionally, according to the California Health Care Foundation, Black mothers/birthing people have the highest maternal morbidity and mortality rates of any racial group. "They are four to six times as likely to die from pregnancy/birth-related causes and twice as likely to suffer a maternal morbidity (such as hemorrhage and infection) than those in all other racial/ethnic groups." Due to this fact, many organizations exist in the hopes of raising awareness and improving health-related outcomes. Here, you can learn more about Birth Equity in CCCN's post blog post.
ACEs Aware is an initiative to screen patients for Adverse Childhood Experiences to improve lives. This initiative is created within the UCAAN, University of California ACEs Aware Family Resilience Network. Use this resource to educate yourself about their plan to support pregnant patients to improve maternal health outcomes.
The California Maternal Quality Care Collaborative (CMQCC) is an organization that hopes to end preventable morbidity, mortality, and racial disparities in maternity care in California. According to CMQCC, Obstetric hemorrhage is one of California's leading causes of severe maternal morbidity and mortality. The CMQCC has been working with hospitals to improve standardized care practices and reporting of obstetric hemorrhages. "Since its inception, CMQCC has documented the following changes in maternal health outcomes in California: a decline in rates of maternal mortality by more than 55%, a decline in maternal morbidity by 20.8% among hospitals participating in the quality collaboratives for hemorrhage and preeclampsia, an increase in full-term births by 8%, and a potential increase in public interest in maternal health outcomes and health care performance due to increased public reporting of quality data." (Improving Access to Maternal Health Care in Rural Communities)
What is an OB-GYN?
According to the American Board of Obstetrics and Gynecology (ABOG), "Obstetricians and gynecologists are physicians who, by virtue of satisfactory completion of an accredited program of graduate medical education, possess special knowledge, skills, and professional capability in the medical and surgical care of women related to pregnancy and disorders of the female reproductive system. Obstetricians and gynecologists provide primary and preventative care for women and serve as consultants to other health care professionals." Many Obstetricians practice in private and hospital settings. A local OB-GYN is a provider that can assist you before, during, and after pregnancy and help you navigate this transition.
Many Obstetricians belong to a membership organization known as ACOG, the American College of Obstetricians and Gynecologists. According to ACOG.org, the College produces practice guidelines for health care professionals and educational materials for patients, provides practice management and career support, facilitates programs and initiatives to improve women's health, and advocates for members and patients. ACOG also offers numerous resources and information to the public.
Many Obstetricians practice in the following hospitals on the Central Coast: *Denotes Midwifery care available.
Freestanding Birth Centers with Midwifery care:
*Santa Lucia Birth Center-San Luis Obispo, CA
*Intimate Journey Birth and Wellness- Arroyo Grande, CA
Public Health Departments and Resources in San Luis Obispo and Northern Santa Barbara Counties
There are a variety of resources and local organizations that support the public health and safety of our communities and specifically focus on Maternal and Child Health and Wellness. Some providers in public health include Obstetricians, physicians, nurses, midwives, lactation and childbirth educators, community health workers, social workers, therapists, dentists, scientists, and doulas. Locally, we have both the SLO County Public Health Department and Santa Barbara County Public Health Department. Many public health workers can also work in public and private settings not limited to community-based, nonprofit sector, and public settings such as the hospital.
Within each of these local health departments is the Maternal, Child & Adolescent Health (MCAH) program. The MCAH program of San Luis Obispo and the MCAH program of Santa Barbara "promotes the health and well-being of women of childbearing age, infants, children and adolescents who are at increased risk of adverse health outcomes." These web pages offer more information surrounding these programs and how each area is committed to supporting maternal and newborn care.
SLO County Help Me Grow is "a county-wide system that supports children and their families by providing free developmental screenings and linkage to services that promote optimal growth. Check out their resources and ways to ensure your children have access to developmental screenings and services by visiting their website.
SLO Health Counts is a source of community health information for San Luis Obispo County. You can access health data and demographic data, track progress and identify the socio-economic needs of our county compared to the United States. Check it out here. SLO County's two goals are to improve social and emotional support for new mothers and implement a Help Me Grow™ (HMG) system in SLO County. You can learn more here.
First 5 of San Luis Obispo and Santa Barbara County provide services and programs that "allocates funds and advocates for quality programs and services, supporting children, prenatal to age 5, to ensure that every child is healthy and ready to learn in school."
Locally, CCCN vision is to be a leading organization for the birth and wellness professionals on the Central Coast, building a platform to bridge the professionals' information and education to the community. If you are looking for additional resources and support on the Central Coast, check out our CCCN low-cost/free local resources, web resources or our public CCCN Member Directory.
Evidence shows we can do better.
There is a plethora of information that highlights physician and hospital care, the benefits, potential drawbacks, and more. It is essential to educate yourself about your local hospitals and medical needs before, during, and after pregnancy. According to Americashealthranking.org, Maternal mortality increased 16% from 17.4 to 20.1 deaths per 100,000 live births between 2018 and 2019. Additional concerns currently in maternal/perinatal health is the overrepresentation of obstetrical care per midwives despite the evidence supporting midwifery care for low-risk populations, as well as health disparities that have remained for decades for Black, Indigenous, and People of Color. The U.S. also lacks postpartum support for new families when compared to other countries around the world. The U.S. remains one of the only countries that does not guarantee Paid Leave for families. As consumers, we can better advocate for more robust policies in maternal/perinatal health and understand rights in childbirth.
Obstetricians and hospital settings can offer higher care for high-risk pregnancies and births, such as cesareans and NICU (Neonatal Intensive Care Unit) or pain management like an epidural. Some hospitals locally incorporate midwifery care by Certified Nurse-Midwives in the hospital setting.
To learn more about local birth setting statistics available to the public, such as cesarean rates, VBACs, breastfeeding/lactation rates, episiotomies, etc. is Leapfrog. Using this resource, find your local hospitals' cesarean rates and vaginal birth rates. Some birth settings may be better for you and your family than others, so we invite you to do your research! Click here for hospital statistics on LeapFrog in SLO and Northern Santa Barbara.
Barriers to care
Some barriers to accessing or improving maternal health have been provider shortages, hospital closures, lack of access to care such as midwifery care, doula support, lack of education/training for providers, language barriers, and systemic and structural barriers such as racism in healthcare. COVID-19 affected many populations, especially pregnant people." Pregnant people with COVID-19 are at an increased risk for severe illness from COVID-19 —including illness that results in ICU admission, mechanical ventilation, and death—compared with non-pregnant people. Additionally, pregnant people with COVID-19 might be at increased risk for other adverse outcomes, such as preterm birth. (Source: CDC)," Black Mommas Matter.org The impacts of COVID-19 and affirming practices in the LGBTQ+ community were collaboratively discussed in a recent project Unmasking The Truth How the COVID-19 Pandemic is Impacting the LGBTQ+ Community & Creating Healthcare Inequities, with a contribution from a #CCCNmember Dr. Lindsey Faucette at the SLO Health Center.
Here are a few current solutions and progress forward to address these barriers:
Discussing Public Health and Obstetrical Care in the United States, California, San Luis Obispo, and Santa Barbara communities is essential for everyone's health. It is important for consumers to know their options. As advocates we can continue to use our voice and work collaboratively for policy changes and fill in the gaps of care together with other community-based organizations and local health departments. We hope you learned more about community resources near you and why public health is vital for our communities. We are happy to share this information with you.
Authored in collaboration with:
Morgan Jamati, CCCN Intern
Zabrina Cox, CtP Program Director