Tip Sheets

In maternity care, hospitals know what to do, but most fail to do it

By Joseph Burns

“Hospitals know how to protect mothers.
They just aren’t doing it.”

That’s the headline from a series, "Deadly Deliveries," that USA Today began publishing in July. The ongoing series is the result of a four-year investigation by Alison Young, an investigative reporter for USA Today's investigative team.

If you cover hospitals in your town and read just the first four paragraphs of the first article in Young’s series, then you’ll know you have a big story worth pursuing:

“Every year, thousands of women suffer life-altering injuries or die during childbirth because hospitals and medical workers skip safety practices known to head off disaster, a USA TODAY investigation has found,” Young writes.

“Doctors and nurses should be weighing bloody pads to track blood loss so they recognize the danger sooner. They should be giving medication within an hour of spotting dangerously high blood pressure to fend off strokes.

“These are not complicated procedures requiring expensive technology,” she adds. “They are among basic tasks that experts have recommended for years because they can save mothers’ lives.

“Yet hospitals, doctors and nurses across the country continue to ignore them, USA TODAY found.”

For health care journalists, there’s the state and local angle involving how the hospitals you cover are doing in providing care to mothers during pregnancy and childbirth. For NorthJersey.com, for example Lindy Washburn covered the angle of racial disparities during pregnancy and childbirth. In her story, “Helping black babies survive: New Jersey gives $4.3 million to address infant mortality,” she reported black babies in the Garden State are more than three times as likely to die before their first birthday as white babies and black moms are more than four times more likely than white mothers to die of pregnancy-related complications. Earlier Washburn wrote about infant mortality among African-American babies.

Annie Waldman covered this angle for ProPublica, writing about how New York was starting a program to eliminate racial disparities in maternity care.

Last year, ProPublica reported that most of the 700 or so deaths in the United States each year from pregnancy- and childbirth-related complications are preventable. For their work, ProPublica reporter Nina Martin, engagement reporter Adriana Gallardo and NPR special correspondent Renee Montagne were finalists earlier this year in the Pulitzer Prize Explanatory Reporting category for their series, “Lost Mothers, Maternal Care and Preventable Death.”

Adding to ProPublica’s work, Young ranked the states in terms of each one’s maternal death rate. In some states, such as California, Massachusetts and Nevada, hospitals are doing relatively well in keeping mothers safe from harm. But in other states, such as Louisiana, Georgia and Indiana, they are not. She noted that Vermont, New Hampshire and Alaska had no data available on maternal death rates.

For its story on Young’s work, “USA Today investigation ranks states with the highest maternal death rates.” CBS News highlighted the state rankings, and noted that while 700 women die each year, many more are injured. "We're not just talking about the women who die, we're talking about 50,000 U.S. women who are suffering life-altering harms,” Young said. As ProPublica and NPR reported, most of the deaths of women from childbirth-related causes could be prevented, a shocking fact considering  that the United States spends much more on medical care than most developed countries.

On Aug. 1, the federal departments of Health and Human Services, Labor and Treasury issued a final rule on short-term, limited-duration insurance plans that the departments say give consumers more flexibility and choices for more affordable health coverage. In reporting on these short-term plans for Bloomberg, “Short-Term Health Plans Backed by Trump Are Cheap for a Reason,” Zachary Tracer  and Emma Ockerman explained that such plans can charge higher rates based on enrollee’s health status, and usually do not cover maternity care or prescription drugs.

For years, U.S. employers, who cover 150 million workers, retirees and family members, have been demanding that hospitals and physicians improve the quality and safety of care they deliver to new mothers. We covered this topic in a recent webinar with Suzanne F. Delbanco, PhD, executive director of Catalyst for Payment Reform (CPR). The webinar is available to watch on demand.

Given that employers spend 7 percent to 10 percent of their total medical costs on maternity care, CPR wants health plans and health care providers to work to minimize complications during labor and delivery by suggesting options to reform payment for maternity care.

On its website, CPR offers links to articles about initiatives in South Carolina from 2013 and California from 2017 that are aimed at improving maternity care.

Other employer groups working to improve maternity care include the Midwest Business Group on Health, the Northeast Business Group on Health and the Florida Health Care Coalition.

In April, Maria Castellucci reported for Modern Healthcare on Humana's Maternity Episode-Based Model, a bundled-payment program that began in January. In the program, physicians will receive payments based on their costs and quality performance for Humana members who have low- to moderate-risk pregnancies, she wrote.

One month later, Castellucci covered the news from a report by the Leapfrog Group and Castlight Health that the likelihood a woman giving birth will receive a Cesarean section or an episiotomy (an incision in the birth canal) depends greatly on the hospital involved. In Los Angeles, rates of episiotomies range from a low of 0.5 percent to as high as 47.3 percent, depending on the hospital, she wrote. Leapfrog’s panel of experts recommends that the episiotomy rate should be 5 percent or lower.

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