Maternal Health: Why Is the System Failing?

Part II

The crisis of the maternal care system is rooted in problems embedded within the core of society. Women are lacking good maternal care, not because we lack the medical technology or the ability to provide it, but because no one has drive to fix the problems with the system. Not enough people care. So why is it that so many women die every year in our country and around the globe from maternal health problems? How can a woman in a hospital struggling to breathe after giving birth be ignored for hours until the internal bleeding was too bad to stop? There are a number of reasons the system fails women, including lack of coverage, lack of prenatal and postpartum care, quality of care, limited staffing, restrictive patient involvement, family planning, discrimination and a lack of accountability. Together these problems create a maternal health care system that is in a state of crisis, unable to provide proper care to some of the people in society who need it the most.

Pregnancy is extremely expensive. Even leaving out all of the baby products, medical necessities like prenatal care and delivery can cost thousands and thousands of dollars. About half of all births in the United States are covered by private insurance. But what about the other half? What happens to pregnant women who do not have private insurance? In the past year, 13 million women of reproductive age (15-44) had no health insurance. That’s one in five. Some of those women could be eligible for public assistance like Medicaid, but many are excluded because they are immigrants or earn too much money to be eligible but not enough to afford their own private insurance. Although the system has set up financial assistance programs to try and help the uninsured, the bureaucracy of the system and limited information given to women keeps these programs a dirty little secret that women in need do not know about. So what is a pregnant woman with no insurance supposed to do? She can’t get private insurance because insurance companies classify pregnancy as a “preexisting condition.” As one insurance company representative said, “We don’t insure a house on fire.” One of the only options is to go to low cost clinics like Federally Qualified Health Centers, but these facilities have their own problems. Because they are often underfunded, crowded, slow it is difficult to recieve necessary care. Although they are better than receiving no prenatal or maternal care at all, these facilities cannot provide the proper care to everyone. In fact, low cost clinics are not accessible in most communities that actually need their services, so many women go without any maternal care every year. Lack of coverage is a major factor in the failings of the maternal health care systems. The recent health care reform does address a part of this issue by banning insurance companies from denying women coverage based on preexisting conditions like pregnancies and past c-sections and making young adults insured on their parents’ health care plan until the age of twenty-six. Hopefully both of these measures will help more women be covered by insurance during their pregnancy giving them access to better care and services.

Prenatal care is an essential part of maternal health. Not only is it important for the baby, but proper care during pregnancy is crucial for the mother’s health as well. When women do not receive adequate prenatal care, they are 3-4 times more likely to die of a pregnancy related complication than those who do receive proper prenatal care. Yet only 75% of women receive the recommended amount of care, 13 prenatal visits from the first trimester on. 1 in 4 of all pregnant women are not receiving the prenatal care they need to have a safer and healthier pregnancy. This trend needs to change drastically to try and reduce maternal mortality and other pregnancy complications. A big part of the reason women do not receive prenatal care, however, is because they do not have health insurance that covers these medical visits. Beginning to see the links?

Maternal health is not restricted to care during pregnancy and labor. One of the most important pieces of maternal health care is postpartum care. More than half of all maternal deaths occur during the postpartum period in the 48 days after birth. The standard for postpartum care in the United States is a single visit to a doctor about six weeks after birth, an inadequate amount of care that allows for many complications from pregnancies to be missed. Women are often sent home without proper education about the signs of hemorrhaging and pulmonary embolisms, the main causes of maternal mortality. These are complications that can develop weeks after giving birth and are life threatening if not caught and treated. The lack of adequate postpartum care in the United States is a major contributor to the high maternal mortality rate, but it is in no way impossible to fix. It just requires the will power to want to improve the system and establish new standards to provide better postpartum care

Even if women are able to access maternal care, there are often many factors that lead to poor quality care. In many hospitals and clinics, especially public institutions serving low-income areas, there is a problem with understaffing. There are not enough nurses, physicians or OBGYNs to provide quality care to every patient or to see patients when they display complications. Numerous studies, personal accounts from health care professionals and the United States government all report that inadequate staffing, especially among the nurses, directly correlates with poor quality care, maternal morality, and medical errors. Without the proper staff, it is impossible for health care providers to give the proper care and medical attention to their patients because they are stretched much too thin. For publicly funded institutions this is usually a matter of lacking the money to pay for more staff, but understaffing is also a problem at private institutions that cut back on staffing to save money for profit. Dealing with economic restrictions makes the issue of understaffing extremely complicated, but it is a necessary and crucial issue to try and fix while addressing maternal health.

And the problems go on and on… A system with so many flaws has to be in a crisis! The maternal health system has for years limited the ability of women to make their own informed choices about their maternal health, especially in terms of giving vaginal birth or cesarean birth (c-sections). One third of all births in the United States are done via c-section, even though this is a risky procedure that the World Health Organization recommends only be used in 1 in 6 births. Instead of being a standard, c-sections are supposed to be used when a vaginal birth is dangerous for the mother. Overall, the risk of dying after a c-section is more than three times higher than a vaginal birth. Even though a c-section is a potentially dangerous procedure, care givers often recommend it, or in some cases don’t give the women a choice. In today’s maternal health care system there is a lack of patient education about their options, the risks and signs of complications. Women need to be able to make decisions for themselves about their own health care. The term pro-choice applies perfectly to this problem. The central idea to the pro-choice movement is that a women should have control over her own body, which can be applied outside the context of abortion to include maternal health rights. Only by fully informing women about their choices and allowing them to make their own decisions, does the maternal health system really give women a choice about their own bodies.

Maternal health care is going to be a difficult problem to tackle because of a lack of evidence and a failure to report maternal mortality. Many maternal deaths are not reported as pregnancy related, and most States lack proper systems or procedures for reporting maternal death. Without standard procedure there is difficulty in collecting data about maternal mortality. The CDC has even reported that the number of maternal deaths may actually be double the current estimates. Without a unified system to collect and analysis data about maternal health for governments, it is difficult to address and face the issue. Solidarity among the states is necessary to make progress in improving maternal health because without standard procedure, a system cannot be effective.

The problems with the maternal health system are extensive, complicated, and intertwining, and these are not the only ones. Family planning gaps and discrimination are two other major barriers preventing adequate care and will be addressed in the next posts. Although the problems with the system may seem impossible o solve, there is a manner in which we can succeed in working towards solutions. One of the first steps in that, however, is making sure we know what to fix.