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California Project Quietly Battles Maternity Risks

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California Project Quietly Battles Maternity Risks

Maternal deaths are rising in the United States

As maternal mortality in the United States has risen in recent years, the rate of maternal deaths in California has dropped to one-third the national level.

[Related: Georgia Reports Huge Disparities in Maternal Mortality]

That has drawn attention to an under-publicized organization that now boasts partnerships with 126, or half, of the state’s hospitals providing maternity care.

The group, the California Maternal Quality Care Collaborative, was founded in 2006 with a mission to end preventable morbidity, mortality and racial disparities in maternity care.

In the years since, with just 12 staff members—not all of whom work full time for the program—and very little fanfare, the group has worked with birthing facilities throughout the state to implement “safety bundles,” a standardized set of best practices.

Its first sets have targeted two major culprits in maternal death: obstetric hemorrhage and pre-eclampsia.

A forthcoming set, to launch in early 2016, will aim at reducing unnecessary Cesarean section births and promoting vaginal delivery, particularly among first-time mothers. The group recently received funding for this new initiative from the California HealthCare Foundation.

The California Department of Public Health singled out the group’s “hospital quality improvement strategies” as one of several likely factors behind the state’s decline in maternal deaths,  in a Maternal, Child and Adolescent Health Bulletin published in May 2015.

Over the next year, the California Maternal Quality Care Collaborative will use incoming data from each of its 126 participating hospitals to determine whether there is a correlation between implementing the safety bundles and improved patient outcomes.

Certainly, the group’s efforts have coincided with an extraordinarily positive trend in California, which has the highest number of annual births of any state in the country.

Over the first six years of the group’s existence, California’s maternal mortality rate dropped by more than half, from around 17 deaths per 100,000 live births in 2006 to around 7 deaths in 2013, according to the California Department of Public Health. Those figures refer to deaths from obstetric causes within 42 days postpartum.

Maternal deaths in the state are declining among both African-American and white women, though mortality rates among African-American women in California remain three-to-four times higher than those of their white counterparts. That is a slight decline from the period between 2005 and 2007, when an African-American woman’s risk was four-to-five times greater than a white woman’s.

Those improving numbers made California a model for a national maternal mortality initiative launched earlier this year by a federal bureau that administers child and maternal health programs.

One of the first actions of that bureau was to fund a $4 million, four-year project, the Alliance for Innovation on Maternal Health, made up of public-private partners, including the California initiative.

In addition, last September, the Centers for Medicare and Medicaid Services announced $110 million in funding for 17 national, regional and state health care facilities and organizations to focus on 10 core safety topics over the next year, including obstetrical hemorrhage and pre-eclampsia.

“The more attention anybody pays to these problems, the better,” Elliott Main, M.D., the medical director of the California initiative, said in a recent interview at its Stanford site.

Dr. Main, a San Francisco Bay Area OB-GYN, travels back and forth to Washington, D.C., almost weekly to weigh in on various efforts to bring down a national maternal death rate that surpasses every other developed country.

Women in the U.S. face a 14-in-100,000 risk of maternal death; twice that of women in Canada, according to a recent report by the United Nations and the World Bank. The report relied on data from a survey led by the World Health Organization, which found that the U.S. was one of just 13 countries where maternal mortality rates have worsened between 1990 and 2015.

In Dr. Main’s home state, the numbers are improving, but he is still troubled by the higher rate of maternal mortality among African-American women. The reasons behind that disparity remain poorly understood, he said.

{Related: NYC Reports Black Moms’ Risk 12 Times Above Whites]

Tracy Flanagan, M.D., is director of women’s health for Kaiser Permanente Northern California, a network of 15 hospitals that perform a combined 39,000 deliveries every year. Her network has been involved with the California Maternal Quality Care Collaborative for more than five years.

Dr. Flanagan, in an email interview, lauded the initiative for providing a “comprehensive, organized and evidence-based approach in identifying and treating women at high risk for adverse outcomes.” She said her group has also been able to share their expertise with other local and state maternity systems and clinicians.

California’s efforts to combat maternal mortality have drawn the attention of health-care providers and women’s health advocates from all over the world.

Between January 2014 and July 2015, the online toolkit provided by the maternal care collaborative, “Improving Response to Pre-eclampsia,” was downloaded 5,781 times by users in 70 countries.

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