New York’s maternal mortality rate should have dropped drastically between 2019 and the end of this year, but pandemic-era complications turned that lofty goal into an impossible dream, USA TODAY Network has learned.
Despite efforts to improve maternal mortality rates, they’ve barely budged the past few years — as some mothers died due to COVID-19 while medical worker shortages and financial upheaval plagued hospital systems.
Before COVID-19 hit in 2020, state health officials aimed to reduce the maternal mortality rate by 22% to 16 deaths per 100,000 live births by the end of 2024, according to a key state plan launched in 2019.
Instead, New York’s rate was about 22 maternal deaths per 100,000 live births from 2018 to 2022, ranking 17th nationally, the most recent federal data show, and state health officials conceded they will miss the pre-pandemic goal of bringing that level down much further by the end of 2024.
“We had a break in the momentum, but we’re not allowing the momentum to dissipate,” state Family Health Director Kirsten Siegenthaler said recently in an exclusive interview with USA TODAY Network.
- Could Medicaid plan help fix what’s wrong with pregnancy care in NY?
- How New York ranks in U.S. racial health disparities
That same pre-pandemic plan also pushed to reduce racial and ethnic disparities in maternal mortality by 34%. Missing that goal would mean, in part, Black women remain nearly five times more likely to die from pregnancy-related causes than white women.
At the same time, doulas told USA TODAY Network efforts to grow their role in saving the lives of more mothers — in particular those of color — have struggled amid delays in making long-overdue Medicaid coverage changes and frustration with the government program’s reimbursement rates for doula care.
Still, Siegenthaler asserted New York had to fight hard to hold its maternal death rate relatively steady since 2020, while many other states suffered through drastic spikes of more than 50%.
How NY’s maternal death rate compares to other states
Overall, New York’s national ranking of 17 has improved dramatically from a low point of 46th in 2010.
New York leaders in government and hospitals, Siegenthaler noted, also pushed in the past two years to re-prioritize maternal health, spanning from expansions of Medicaid coverage for doulas and postpartum care to health equity surveys and investments.
Some recent measures, however, are expected to take at least a couple years before translating into mortality rate reductions, said Dr. Peter Bernstein, co-chair of the American College of Obstetricians and Gynecologists, or ACOG, Safe Motherhood Initiative in the New York region.
Changes to Medicaid — and new efforts to reduce cesarean deliveries among low-risk mothers and limit cardiac-related maternal deaths — could prove key to catching up with top-performing states, added Bernstein, who is also Mt. Sinai Health System’s obstetrics’ director.
California’s nation-leading maternal mortality rate of about 10 deaths per 100,000 live births stemmed, in part, from using high-level data analysis to identify and better treat high-risk pregnancies, said Bernstein.
New York’s efforts to reduce maternal mortality, he added, remain about three to four years behind the California model.
“Some of these are difficult patient populations to engage,” Bernstein said, noting mental health issues have emerged as a top preventable cause driving maternal mortality.
“For someone who is sleep-deprived — or may have depression related to being postpartum — and has a crying newborn in the other room and may have a substance use disorder, it is really hard to take care of themselves,” he said.
What is working to lower maternal mortality?
To explore this crucial issue, the USA TODAY Network interviewed top experts and analyzed a key report issued in March by the state maternal mortality review board, which was established by state law in 2019.
Among the maternal health solutions that are working and those that could be improved:
- Nearly 95% of hospitals in New York had implemented recommended safety bundles for massive blood transfusions, while 86% used the evidence-based standards for quantifying blood loss.
- Those statistics — recorded in 2023 surveys — suggested widespread adoption of solutions highlighted in a 2019 USA TODAY Network investigation of preventable maternal deaths and injuries.
- In contrast, about 75% of hospitals in New York had implemented screening for venous thromboembolism and chemoprophylaxis, despite safety bundles being available to limit those risks.
At the same time, the state Health Department provides data analysis to help hospitals in New York identify, assess, and reduce maternal health threats.
But that approach is less effective than the California model, which provides real-time data analysis through an online maternal data center affiliated with Stanford University.
While it remains unclear if New York could join other states in gaining access to California’s data center, the service is pushing to add hospitals nationally through a membership fee.
With the state review board revealing discrimination was a probable or definite circumstance surrounding about 47% of pregnancy-related deaths in New York, efforts to survey patients about racism and bias in medicine have also been crucial, experts said.
Some of the anti-bias efforts stemmed from the state Birth Equity Improvement Project launched in 2021, and Siegenthaler asserted health officials expect to soon release data showing positive gains in reducing race and ethnic disparities.
State officials also continued to work with hospitals to remove any barriers to implementing safety bundles, which are key to limiting health risks that disproportionately impact women of color, according to Siegenthaler.
Many hospitals have already begun training staff based on the equity survey findings, while pushing programs aimed at addressing social needs — such as transportation, housing and economic factors — driving disparities, said Dr. Camille Clare, a member of state and ACOG maternal health programs.
“This is how we connect our patients to resources in the community,” said Clare, who works at SUNY Downstate Hospital in Brooklyn.
Why Medicaid expansion, doula care is crucial
Breonna Orum couldn’t afford doula care during her first pregnancy — a health equity gap that she believes contributed to the potentially avoidable cesarean delivery of her son at a Rochester-area hospital.
Her third pregnancy, however, involved a doula who she said helped vastly improve the entire childbirth experience.
The medical saga — including concerns of implicit bias against her as a young Black single mother during the first pregnancy — also inspired Orum to become a doula.
Now, the 33-year-old Rochester native has spent the past six months fielding hundreds of emails from women looking to benefit from the state expansion of Medicaid coverage for doula care.
That expansion took effect January 1 but required other measures, including the state health commissioner’s standing order issued last month, before coverage fully kicked in for prenatal and postnatal doula care.
While Orum has now fully booked Medicaid clients through February, she struggles with the fact countless other women lacked access to doulas previously.
During mommy walks and summer barbecues, Orum has heard tales of untold mothers nearly bleeding to death due to unaddressed high blood-pressure risks or suffering life-altering injuries during avoidable C-section deliveries.
At times, Orum shut off her phone and went to sleep early after shouldering the pain and suffering of neighbors harmed by the systemic flaws within maternal health care. She would awaken some nights and frantically write down notes for saving the next women at risk.
“It’s definitely heavy, but I do realize in those stories is where our corrections are,” Orum said.
Those corrections include her working now with other doulas to form a nonprofit that provides additional postnatal care, as Medicaid covers four postnatal visits for up to year.
While state measures recently expanded that postpartum Medicaid coverage period to one year from 60 days, the number of doula visits covered remained at four. Orum described it as a step in the right direction, noting doulas, hospitals and state health officials are committed to solving this decades-long crisis.
“We all have the same goal,” she said: “To have a healthy mom and baby.”
What doulas say they need
At the same time, Vicky Deutsch, a 34-year-old doula based in Rockland County, has urged state health officials to increase how much Medicaid pays out for doula care.
While her business, Vicky’s Doula Services, has now started taking on Medicaid clients, it must maintain a mix of other clients who pay out-of-pocket or have private health insurance to make the economics work, she said.
Her non-Medicaid clients pay up to $3,000 for doula care, while the Medicaid reimbursement rate is up to $1,350 outside New York City, which gets up to $1,500.
The payment gap has left some doulas reluctant to take on Medicaid patients, Deutsch said, noting she gets about 15 calls per day from women seeking Medicaid-funded doula care.
“Those are the ones who really need this — the single moms and the women struggling financially,” Deutsch said. Her company has four doulas total who are booked up through November, she added, noting they plan to take limited additional clients facing emergencies.
“It does pain me,” she said, “because I wish I could help everyone.”
Because of the inherent emotional and mental strains of doula work, Tamara Wrenn, a 57-year-old doula in Orange County, also voiced concerns about burnout as the profession takes on the new Medicaid patients.
“We have to be careful that we don’t overextend the doula population,” she said.
Amid the expansion rollout, state health officials held monthly town hall sessions with doulas across the state to gather feedback and address concerns, Siegenthaler noted.
The program will regularly be re-assessed to remove any barriers to access, she added, noting the Health Department also recently announced a $250,000 investment aimed at adding more doulas to meet rising demands.
David Robinson has been an investigative reporter for more than 15 years. He has awards for coverage of the opioid epidemic, hospital and nursing home abuses, health inequality, COVID-19 and emergency response failures. Reach him at Drobinson@lohud.com.
You must be logged in to post a comment.