Rising rates of maternal mortality and associated disparities in the city of Philadelphia and across the US reflect a national crisis.
The 2020 Improving Outcomes: Maternal Mortality in Philadelphia report found that while non-Hispanic Black women made up 43 percent of births in Philadelphia from 2013 to 2018 they accounted for 73 percent of the pregnancy-related deaths.
In Philadelphia, non-Hispanic Black women are about four times more likely to die of pregnancy-related causes than non-Hispanic White women. Local statistics align with national data.
In January 2020, the National Center for Health Statistics noted wide racial and ethnic gaps among women nationwide. Non-Hispanic Black women died during 37.1 per 100,000 live births; non-Hispanic white, 14.7; and Hispanic, 11.8. The nationwide average is 17.4 maternal deaths per 100,000 live births.
How Penn Medicine is Addressing Black Maternal Mortality
Penn Medicine’s Department of Obstetrics and Gynecology is alarmed by the data. As a national leader in obstetrical care, we are highly engaged in city-wide efforts to address this crisis. We are taking a multi-step approach to address Black maternal mortality, including:
Education
Education plays an important role in helping to reduce disparities and improve the quality of care. Penn Medicine now has the following trainings and programs for its faculty and staff:
- Mandatory implicit bias training
- Access Matters Implicit Bias in Birthing Care trainings sponsored by the City of Philadelphia
- Departmental, multidisciplinary anti-racism book clubs
Clinical
Penn Medicine’s team goal for fiscal year 2021 is the reduction in maternal morbidity and mortality for Black women. This would mean fewer severe pregnancy-related illnesses, injuries, and deaths. Efforts have focused on:
- Reducing extremely heavy bleeding after birth (postpartum hemorrhage), which is a rare but serious condition. Black women are at a higher risk for severe complication and death from postpartum hemorrhage than women of other races. There are hemorrhage carts across the health system , providers must complete mandatory hemorrhage management training, and we use a standardized postpartum hemorrhage risk assessment in Penn Chart, our electronic medical record system.
- Standardizing clinical care, including labor induction, high blood pressure (hypertension), heavy bleeding (hemorrhage), and anemia management. Our research has shown standardizing clinical care reduces racial disparities.
- Postpartum Hypertension management (Heart Safe Motherhood). All patients diagnosed with high-blood pressure in pregnancy are enrolled in our Heart Safe Motherhood program. Heart Safe Motherhood uses text messages between the patient and provider to monitor blood pressure. Readings are taken twice daily in the first 10 days after leaving the hospital, which is the highest risk time for blood pressure elevation and complications. This program has served more than 3,000 women and has eliminated the disparities noted in postpartum hypertension care. This program has been implemented at all Penn Medicine delivery hospitals.
- Supporting parents with Healing at Home, which provides vital care after birth. Services include two-way texting where parents can ask questions about their own or their baby’s needs, lactation support, and depression screening.
- Regular assessment of quality metrics by race and ethnicity, including studying the factors that lead to severe complications and death in pregnancy.
Research
Research to identify and understand the disparities in complications and death during pregnancy is key in improving outcomes. Our research includes:
- A three-phase study to better identify Black and Latina women most at risk for poor outcomes after delivery and the problems they experience. This information will be used to create an intervention based on data that aims to improve quality of care for high-risk women.
- Interventions to decrease biases that may drive disparate outcomes.
- Translational research focused on revealing microbial-immune pathways that affect the reproductive health of Black women, including infertility, pregnancy loss, preterm birth, and maternal morbidity.
- Clinical research evaluating the use of a standard index to measure health issues to decrease maternal morbidity and associated disparities.
We are confident that this comprehensive approach will improve maternal health outcomes for Black women across Penn Medicine. Additionally, we are working with the Philadelphia Health Department to bring our programs like Heart Safe Motherhood and Healing at Home to birthing hospitals across the city.
We hope that our leadership will lead to a reduction in maternal morbidity, mortality and disparities across Philadelphia and serve as a model for the rest of the nation.