HJAR Mar/Apr 2024

Q&A 20 MAR / APR 2024 I  HEALTHCARE JOURNAL OF ARKANSAS   that maternal morbidity piece cannot be for- gotten, and we really need to look at ways we can help those moms have better long-term health consequences. Speaking of winning, Arkansas seems to be winning at ranking first for maternal death. Why do you think that is? We bounce around at the bottom. I don't know that being last is much different than being second to last or being third to last. All of it could be improved. When we look at these maternal deaths, and you can see this in the report, they self-categorize them- selves into three buckets. The first bucket, about 30% of maternal deaths, happens in that immediate hospital stay.Those are things Do they have access? Do they have provid- ers? Do they have subspecialists? Are there things that we can do on a small patient edu- cation level or on a huge education piece and community outreach piece? Every piece of that offers preventability. When I first looked at this — and you can't help but think, "Goodness, we could do ..." — it hurt my heart because this is the world that I live in, the world that I work in and have committedmy career to. But it's not just that. It's somuch bigger and far-reaching, and that's where theArkansasMaternityMortality Review Committee gives those recommen- dations in their annual report. It's online. The most recent iteration added some other ele- ments that I think are really interesting in that it added a map to the report. We don't ever want this to be punitive. This is not pointing fingers and saying, "You are doing this so poorly,” and, “You could do this differently." It is, "How can we figure out ways to support these communities differ- ently?" It does not say where that maternal death occurred but shows the zip code of last known residency of that mom. It starts to quantify health concerns in certain areas, maybe rural aspects in certain areas, but it does not say, "The death occurred at this hos- pital or at this ...”We don't ever want that to be the case. How do you define maternal death and maternal morbidity? Maternal death, by definition, is the death of a mother from delivery to 365 days. It hasn’t even been 15 years since we've had that on our death certificates — birth to 365 days. It started in certain states, and it's now pretty universal.TheArkansas Department of Health has an abstracter that looks at every one of those cases. If it was a motor vehi- cle accident or accident that was completely unrelated to pregnancy, that's not something that we discuss. We usually have between 32 and 40 maternal deaths [per 100,000 live births] that we discuss with regard to preg- nancy-associated, pregnancy-related, preg- nancy-related but not associated categories. Now, morbidity is a little harder. Morbid- ity is defined as an outcome that now has significant healthcare consequences for that mom for either the duration of her life or for a significant period of her life — something that has changed the course of her health in a detrimental way. That's really harder to quantify, and there have been some studies that show that, potentially, for everymaternal death, there are 10 to 15 additional moms that suffer severe maternal morbidity as a result of delivery like chronic hypertension that causes end organ damage. They're luckily still alive, but there are health consequences that will require a different level of care for the duration of their life. That's the part that we can't quantify as well, but we can suspect. Obviously, we want there to be zeromaternal deaths in our state; then we are winning. But Pregnancy-Related Deaths by Geographic Location The followingmap represents the last known residence of the deceased, not the location of their death. Source: Arkansas Maternal Mortality Review Committee, Arkansas Department of Health. “Arkansas Maternal Mortality Review Committee Legislative Report December 2023: 2018- 2020 Data and Recommendations.” December 2023. https://www.arkleg.state.ar.us/Home/ FTPDocument?path=%2FAssembly%2FMeeting+Attachments%2F000%2F26326%2F Exhibit+H.06.a+-+ADH+MMRC+Legislative+Report+2023+12-19-2023.pdf