Missouri doctor grapples with state's high rate of deaths in childbirth | St. Louis Public Radio

Missouri doctor grapples with state's high rate of deaths in childbirth

Jul 25, 2017

Twice as many United States women are dying in childbirth today as in 1990, even though all other wealthy nations have seen declines in maternal mortality rates.

Rising rates of obesity and women having children later in life may help explain the rising number of deaths, said Dr. Shilpa Babbar, who specializes in high-risk pregnancies at SSM Health St. Mary’s Hospital in St. Louis County.

At over 28 deaths per 100,000 live births between 2010 and 2014, Missouri’s maternal mortality rate is among the highest in the country. Illinois measured 16 deaths per 100,000 births, according to America’s Health Rankings. The national rate was 20 deaths per 100,000. 

Uninsured women also are more likely to die in childbirth, and as many as half of all pregnancy-related deaths among U.S. mothers are preventable.

But Americans spend more on maternity care than expectant mothers in any other country. So what's going on? 

Here are some of the highlights of Babbar's conversation with St. Louis Public Radio's Durrie Bouscaren: 

A map of maternal mortality rates across the country, compiled by America's Health Rankings in 2016.
Credit America's Health Rankings

On witnessing the death of a patient 

BABBAR: It was during my residency, I wasn’t directly involved. But it's usually a sudden thing. It was a sudden thing ... it starts off as a panic, right? Because you don’t know what’s going on. You walk into the room, you do your best to resuscitate, do your best to figure it out, put all the pieces together about what happened. After the dust settles, it just hits you, about what just happened. Your heart just falls to the ground.

But we have to figure out how we can do better, you know? We can’t just give up after one thing. We have to figure out what’s the next step and figure out how to prevent this in the future.

Related: Milwaukee Public Radio explores the intersection of race and maternal mortality

What are the most common causes of maternal death? 

BABBAR: The top three causes are hypertension, thromboembolism — having a blood clot from the legs that goes to the lungs — and hemorrhage, or bleeding profusely. Infections and postpartum depression leading to suicide are concerns, as well.

We’re in the middle of an obesity epidemic, so that, in of itself, increases risk during pregnancy. That goes hand in hand with pre-existing medical conditions like hypertension and diabetes. We also, though, have an improvement in data collection. So we’re actually collecting more information and being able to put the two together.

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Those are trends that we see nationally. But the maternal mortality rate is getting lower in some states, like California, while it’s rising in states like Missouri. What accounts for the disparity?

BABBAR: When you look at the map of the United States, one thing you want to look at is the obesity rates. In California vs Missouri, the obesity rates are higher in Missouri than they are in California. I think if you were to overlay the maternal mortality map on top of the obesity map I think you’d see similarities.

Related: NPR and ProPublica investigate maternal mortality in the U.S.

St. Mary’s Hospital, where you work, has an initiative to reduce C-section rates. Can you tell me why that’s important, and how you did it?

BABBAR: Typically, after you do one C-section, there’s a chance in subsequent pregnancies that you’re going to have the next C-section. Once you have two C-sections you’re kind of committed to C-sections for the rest of your pregnancies. With a C-section, it’s a major surgery, so there are life-threatening complications that can occur.

But it’s on the rise; the national rate is around 30 to 33 percent. There's multiple factors for that ... some people are driven more by, "I want to get this patient delivered, I want to get home in time." Having coverage in the hospital, 24 hours a day, seven days a week is definitely important to help reduce that risk. 

A recent Consumer Reports investigation ranked St. Mary’s as having the second-lowest C-section rate in the country, for first-time, low-risk mothers. It is 12 percent.

We try to reserve C-sections for when they’re truly indicated. We allow women labor a little bit longer, instead of calling them a “failure to progress” or saying that they failed labor, giving them a little bit more time provided that it’s safe for the mom and the baby. Also, allowing them to push a little bit longer when it’s time to give birth. We also have a team-based, patient-centered approach. We’ve incorporated other health care providers such as midwives, who are experts in managing labor.

What should women know about their own risk?

BABBAR: It’s always important, if you have any pre-existing health conditions, to talk to your doctor about controlling certain medical conditions that could increase your risk of complications during pregnancy. But about 50 percent of pregnancies are unplanned, right? So it’s hard to say exactly when you should see a physician before you plan a pregnancy. But I think it’s just, optimizing their own health before getting pregnant, or even during pregnancy. You can still make changes during pregnancy to reduce your risk of having adverse outcomes, and one of them being maternal mortality.                

This transcript has been edited for length and clarity.

Follow Durrie on Twitter: @durrieB

Follow Brent on Twitter: @brentajones

Editor's note: A previous version of the story misidentified the probability of having a second C-section.