Maternal Mortality and Morbidity Supplementation

Qustion: Discuss about the Maternal Mortality and Morbidity Supplementation. Answer: Introduction: In the world, the child bearing mothers and children are treated with highest priority as they are more vulnerable group. Usually maternal mortality rates are higher in the developing countries rather than developed countries but it is different in U.S context (WHO, 2014). It has doubled from the expected rate of 12-28/100,000 births from 1990- 2013. US has increased maternal mortality rate as compared to other high income countries in which half it could be prevented (Main, 2013). It is estimated that there are more than 4 million births in the United States every year (Hamilton, 2010). Basically maternal death is defined as the death of a mother during pregnancy/ within 42 hours after pregnancy termination, (irrespective of the time duration and implantation site of the pregnancy) because of any cause that is caused or aggravated by pregnancy or its treatment but not due to accident or incident (Park, 2010). In US, at least 1200 women develop complications at the time of pregnancy or delivery that endanger their life (WHO, 2014) and 60,000 women develop near-fatal complications (Creanga, 2014). According to WHO (2015), there are three factors that contribute to increasing maternal deaths in US. The first factor is the lack of consistency in obstetric practice. The US hospitals did not have a standardized approach to manage obstetric emergencies. The complications related to pregnancy and delivery is identified too late. The next factor is that there is increased number of mothers with chronic disorders such as diabetes, hypertension and overweight in US that increases the maternal mortality rate. The third factor is the lack of appropriate data and its analysis to determine the outcomes of maternal health. It was found that nearly half of the US states have no reviewing boards for maternal mortality and the collected data are not efficiently used to plan and implement changes. Further US dont have national forums for the states to discuss and share their best practices as well as gained knowledge to improve maternal health. The social ecological model is a theoretical framework that helps to understand the multi-faceted and interrelated aspects of individual (personal) and environment that modifies the behavior, identifies the leverage points of individual and organization and promotes health promotion (UNICEF). It involves 5 levels as individual, interpersonal, community, organizational and policy formulating environment. Based on the factors identified to be the causes for maternal death in US, the following level of this model was integrated. The individual level with economic status and financial resources is integrated. In US, the mothers who are lacking health insurance account for 3 to 4 times at increased risk for maternal death due to pregnancy related complications as compared to mothers with insurance (Chang, 2003). The other level of organization/ social institutions of model involve the governing rules and regulations affecting the maternity services. In US, there is no standardized approach to manage obstetric emergencies. The local/state/national and global level states the laws and policies regarding maternal health. There are no review boards, policies for data collection, analysis and national forums to discuss the maternal aspects. Immediate actions should be taken to prevent maternal mortality. The two important interventions are discussed as follows. At first the national plans should be formulated to manage obstetric emergencies. The hospital should be forced to follow standard approaches to manage obstetric emergencies based on evidence-based care. The steps should be taken to reduce maternal mortality rates by careful monitoring of hemorrhage, sepsis, pre-eclampsia, unsafe abortion and obstructed labour. It is noted that 74% of maternal mortality could be prevented by proper emergency obstetric care. The postpartum hemorrhage should be prevented effectively by prophylactic oxytocin administration in third stage of labor (Westhoff, 2013), uterine massage, proper cord clamping and controlled cord traction. The main obstetric emergency is due to preeclampsia. Its risk is reduced by low-dose aspirin administration (Duley, 2007) and calcium supplements (Hofmeyr, 2014) which half the risk of pre eclampsia (Buppasiri, 2011). WHO (2013) suggests that women with multiple-pregnancies, preeclampsia, previous hypertension, diabetes, kidney, obesity and autoimmune disease should be supplemented with calcium. Preeclampsia should be identified at the earliest and timely intervention with prevention of its progression should be done. Routine blood pressure and urinalysis should be done as a part of antenatal screening. The fetal development should be monitored regularly and referred to specialist centre. The drawback is that lack of evidence-based literature, inadequate medical professionals, absence of clear screening measures and policies. This should be overcome by training medical persons with adequate resources, encouraging research to establish evidence based practice and formulating strict sc reening guidelines. The next intervention involves increasing the fund for hospitals by state and federal government and supporting to implement CDC (2014) recommendations that help to establish multi-disciplinary review boards in all the states. The review boards should be encouraged to use many multiple data sources that help to identify cases and to use standard guidelines in the formation and functioning of hospital (APFA, 2014, Agrawal, 2015). All the states should adopt a common standard for birth and death certificates as recommended by CDC (2014). All the state departments of health should develop electronic data linkages between death and birth certificates to better identify pregnancy-associated deaths. The funding services by government should overcome socioeconomic, legal, psychological and cultural obstacles and provide quality of care by developing a common framework. The government should take steps to expand methods in measuring, analyzing and reporting the pregnancy outcomes including m aternal mortality rates, morbidity and near-misses (APFA, 2014). The fund should be allocated to conduct research funding that helps to examine various aspects of maternal death prevention and to frame and implement various quality indicators.The government should encourage the maternal health care professionals and professional associations to modify the standards of practice and practice guidelines based on evidence based practice (APFA, 2014). Overall the maternal mortality rates should be reduces by passing legislation to improve maternal health by coordinating the maternal services at health Department, promoting number of maternal care providers, providing maternal education and incentives to professionals for beast practices. In US, the cost of maternity care has exceeded 60 billion dollars in 2012. The main drawback is that it requires immediate changes in policies and procedures, difficulty in implementing effectively in all areas, increased need for funding allocation in budget, and cooperation from all ministries. This could be overcome by gaining resources from governmental and non- governmental agencies too to implement these changes effectively. Reference Agrawal, P. (2015). Maternal mortality and morbidity in the United states of America. 93: 135. doi: https://dx.doi.org/10.2471/BLT.14.148627 APFA. (2014). American public health association. Retrieved from https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/11/15/59/reducing-us-maternal-mortality-as-a-human-right Buppasiri, P. (2011). Calcium Supplementation (Other than for Preventing or Treating Hypertension) for Improving Pregnancy and Infant Outcomes.Cochrane Database of Systematic Reviews.10: CD007079. doi:10.1002/14651858.CD007079.pub2. 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Parks Textbook of Prevention and Social Medicine. (21st ed.). Jabalpur: m/s Banasardidas Bhanot. UNICEF. Understanding the Social Ecological Model and ... - Unicef. Retrieved from www.unicef.org/cbsc/files/Module_1_-_MNCHN_C4D_Guide.docx Westhoff, G. (2013). Prophylactic Oxytocin for the Third Stage of Labour to Prevent Postpartum Haemorrhage.Cochrane Database of Systematic Review.10: CD001808. [PubMed] WHO. (2013).Guideline: Calcium Supplementation in Pregnant Women. Geneva: WHO. WHO. (2014). Trends in maternal mortality. Retrieved from https://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2013/en/ WHO. (2016). Maternal mortality and morbidity in the United States of America. Retrieved from https://www.who.int/bulletin/volumes/93/3/14?148627/en/