April 2022: Public Health and Ob/Gyn Care

Content warning: Maternal Mortality, Maternal Morbitity, Maternal death, Racism

Introduction


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?