Duke Health Referring Physicians

Practice Management

Guidelines Promote Productive Maternal Care

The United States has the highest maternal mortality rate among developed nations

Women getting an ultrasound

Nearly 700 women die each year in the United States as a result of pregnancy or delivery complications, according to the CDC. The United States has the highest maternal mortality rate among developed nations, despite the gains made in protecting infants’ lives (the country’s infant mortality rate has recently fallen to its lowest point in history).

Leading physician groups have issued new guidelines designed to encourage providers to address the needs of their pregnant and postpartum patients. For example, the American Medical Association adopted new policies in 2017 to implement routine anxiety and depression screenings among pregnant and postpartum women during prenatal, postnatal, pediatric, and emergency department visits. Additionally, the American College of Obstetricians and Gynecologists (ACOG) helped develop the Alliance for Innovation on Maternal Health to eliminate preventable maternal mortality and severe morbidity in the United States through the implementation of consistent best practices.

Financial inequality and barriers to accessing health care are some of the factors that have contributed to the increase in deaths of pregnant and postpartum women, explains Barbara Levy, MD, vice president for health policy at ACOG. Maternal mortality is more common among African American women, women with low incomes, and women living in rural areas. “We need to reduce the disparities in outcomes,” Levy says.

Levy also advises providers to create an environment in which patients feel comfortable advocating for their needs. That can mean inviting a supportive partner, friend, or family member to prenatal visits. “When we have someone with us, it helps us express ourselves better—it gives us more power and more voice,” Levy says.

Jennifer Lang, MD, a gynecologic oncologist and ob-gyn based in Los Angeles, recommends that health care providers seek appropriate referrals for their pregnant patients and provide them with appropriate resources. “Direct your patients toward high-quality, supportive information that you know to be medically and scientifically accurate,” Lang says. Additionally, complementary care providers, such as prenatal chiropractors, acupuncturists, nutritionists, and clinical psychologists, can help clinicians address the spectrum of a pregnant or postpartum woman’s physical and emotional needs. “A doctor’s role is to ask, ‘What issues are you having? Where can I refer you to have these issues fully explored and cared for?’” Lang says.

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