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New U.S. Maternal Mortality Rate Fails to Capture Many Deaths

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by Nina Martin for ProPublica

Since 2007, the government had held off on releasing an official estimate of expectant and new mothers who died from causes related to pregnancy and childbirth. It waited for the data to get better. But the new, long-anticipated number falls short.

Late last month, maternal health experts from around Illinois were videoconferencing in Chicago and Springfield, poring over the files of expectant and new mothers who’d died in the state in 2017. Many of the deaths could have been prevented if only medical and other providers had understood the special risks that women face during this critically vulnerable time.

Then, someone’s phone buzzed: The Centers for Disease Control and Prevention had just released its new, long-awaited U.S. maternal mortality rate, a number that had not been updated since 2007, when the federal government decided states weren’t doing a good enough job of capturing all of the deaths related to pregnancy and childbirth. It had taken more than a decade for states to implement new procedures, like adding a checkbox to death certificates, to flag pregnant women and new mothers who had died.

Now, here it is, from the CDC’s National Vital Statistics System: 17.4 maternal deaths per 100,000 live births in 2018 — an estimated 658 lives lost. It was worse than the last official calculation, 12.7 deaths per 100,000 births, and it placed American maternal health outcomes where experts suspected they would land, worst among wealthy nations, and 55th among all countries, ahead of Ukraine but just behind Russia.

The new U.S. rate was widely assumed to reflect the cutting edge of maternal mortality research. But as the Illinois experts quickly discovered, there were gaping holes. The rate didn’t include the types of cases they had been reviewing that day — suicides and drug overdoses, which may not seem like it at first but are often linked to pregnancy and childbirth. It didn’t include new mothers who had died more than 42 days after giving birth, missing a huge chunk of relevant deaths. It underestimated the deaths of women 45 and older as well as those whose pregnancies had been overlooked by doctors and coroners.

“I don’t think it represents the full story of maternal mortality in this state,” said Shannon Lightner, deputy director of the Illinois Department of Public Health’s Office of Women’s Health and Family Services. “It’s not a complete and accurate picture of what’s going on.”

Bob Anderson, chief of the mortality statistics branch at the CDC’s National Center for Health Statistics, agrees: “That particular indicator by itself is certainly not enough on which to make decisions about programs and policy… It’s one indicator. It’s not the end-all and be-all in describing maternal mortality by any stretch.”

There was a reason the rate was so limited. In order to come up with a number that allows the United States to be compared with other countries, the National Vital Statistics System was required to use the World Health Organization’s definition of maternal mortality: “the death of a woman while pregnant or within 42 days of termination of pregnancy … from any cause related to or aggravated by the pregnancy or its management.” The global standard encompasses the traditional, acute, obstetric causes of maternal death — hemorrhage, infection, blood clots, strokes — but excludes “accidental or incidental” causes, such as overdoses. It’s an old-fashioned definition that ignores some of the most important recent findings about why so many American mothers die.

That means that the new rate, while capturing just how poorly the U.S. ranks among other countries, is actually a significant underestimate of the problem. The 42-day cutoff “might be appropriate for other countries,” said Dr. Joia Crear-Perry, whose National Birth Equity Collaborative is part of the Black Mamas Matter Alliance. But in the U.S., “the science is showing we really should [consider deaths] out to a year postpartum and not limit our definition to things that happen in the hospital.” Indeed, a study co-authored by Crear-Perry shows that in Louisiana, homicides were the leading cause of death for pregnant and postpartum women from 2016-17.

The irony is that the CDC is one of the major drivers of that science. And in virtually all of its efforts, the agency tracks maternal deaths up to a year after the end of pregnancy. The CDC also encourages states to conduct robust maternal mortality reviews of deaths up to a year postpartum, both to understand what’s happening to women in different parts of the country and to pool the results to create a national picture of what causes mothers to die and how to protect them. Deaths that are found to be “related” to pregnancy are distinguished from those “associated” with pregnancy — though in many instances, especially for postpartum women, that’s a difficult distinction to make.

It was this expansive approach that identified just how dangerous the late postpartum period can be for American mothers. In the U.S., as many as 24% of pregnancy-related deaths are happening from 43 days to 365 days after delivery, according to a CDC report last fall. In Texas, the proportion is closer to 40%. Even the new NVSS data confirms an enormous number of such deaths.

Hidden in its report is a calculation for late maternal mortality for 2018: an additional 277 deaths. That brings the CDC estimate for maternal deaths up to a year postpartum to a much higher figure than it reported in the official U.S. rate: a total of 935 lives lost.

The death of Lauren Bloomstein, a neonatal nurse, in the hospital where she worked illustrates a profound disparity: the health care system focuses on babies but often ignores their mothers.

The leading medical cause of such deaths is heart-related conditions, which may not be diagnosed for months after childbirth. “If you cut off the rate at 42 days, you’re going to miss those,” said Judette Louis, chair of the OB-GYN department at the University of South Florida and president of the Society for Maternal-Fetal Medicine. “We need to be studying these cases because that is what will tell us what kind of interventions the moms need after they go home.”

Another important way that the U.S. data diverges from international data is when it comes to accidental overdoses and suicides; the later postpartum period — when women are often stressed out, lonely, broke and depressed, with little access to mental health services and drug treatment programs — may be particularly high-risk. “For a woman who has reduced the amount she’s taking [during pregnancy], when she goes back to using the same amount she was using before, the chances of overdose is very high,” said Dr. Ann Borders, a Chicago-area OB-GYN who heads the Illinois Perinatal Quality Collaborative and sits on the statewide maternal mortality review panel that analyzes these deaths.

In Illinois, one-fifth of all deaths of pregnant women and new mothers in 2014-16 were suicides and overdoses — and medical providers have an important role to play in helping identify at-risk women and getting them help before it’s too late. But first they have to see those deaths as just as real a form of maternal mortality as those from hemorrhage or sepsis. “If we’re not counting those deaths, we can’t prevent them,” Borders said. “How we measure maternal mortality will compel us to act or not act.”


Nina Martin is a reporter who covers sex and gender issues. She joined ProPublica in 2013 and is based in Berkeley, California.

ProPublica is an independent, nonprofit newsroom that produces investigative journalism with moral force. We dig deep into important issues, shining a light on abuses of power and betrayals of public trust. Follow on Twitter at @ProPublica 

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Health

County Hospitals Receive 300 iPads for Patients to See Family

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LOS ANGELES – 300 iPads have been donated to Los Angeles County hospitals to facilitate patient-family communication during the COVID-19 pandemic. The gift is through a partnership with the Annenberg Foundation, Brilliant Corners, and the Los Angeles County Center for Strategic Partnerships.

“The engagement of loved ones during hospitalization has been shown to improve clinical outcomes,” said DHS Director, Dr. Christina Ghaly. “Clinical staff identified a role for virtual visiting through technology in order to facilitate this family involvement. The generous donations by the Annenberg Foundation and MobileDemand will help support this critical element of our patients’ care.” 

Due to the COVID-19 pandemic, patient visitation by family and loved ones is limited at facilities in order to prevent exposure and the spread of disease. While there are some exceptions, such as the birth of a child or death of a patient, visitation is not permitted for the vast majority of patients and not allowed at all for COVID-19 patients. 

The donation provides 300 iPads to ensure patients and their families are able to connect, despite restrictions in access to the hospital. A second donation, by MobileDemand, provides rugged, protective healthcare iPad cases to protect against damage and loss. The rugged case also has an adjustable easel attached, providing effortless viewing for patients who are too weak to hold a tablet. Additionally, it frees health care staff from having to hold the device for patients.

“This is a wonderful example of how philanthropic organizations, nonprofits, government, and businesses can collaborate and meet an immediate need in our community,” said Wallis Annenberg, Chairman, President and CEO of the Annenberg Foundation. “Being able to offer an opportunity for comfort and connection to those suffering and to alleviate some of the stress from our frontline caregivers is of utmost importance.”

While social distancing has been successful in flattening the curve of the COVID-19 surge in Los Angeles County, it is anticipated that it will continue for several months. With this gift, physicians and nurses will be able to place an iPad in the room of COVID and other critically-ill patients for the duration of the admission and reduce potential exposure and use of personal protective equipment going in and out of the room. Having a stationary iPad helps relieve medical staff who would otherwise have to hold the phone for a patient or search for the person’s personal phone. It also will allow patients who do not have a personal mobile device to communicate and “visit” with their family.

The Los Angeles County Department of Health Services (DHS) is the second largest municipal health system in the nation. Through its integrated system of 26 health centers and four hospitals – LAC+USC Medical Center, Harbor-UCLA Medical Center, Olive View-UCLA Medical Center, and Rancho Los Amigos National Rehabilitation Center – and expanded network of community partner clinics, DHS annually provides direct care for 600,000 unique patients, employs over 22,000 staff, and has an annual budget of over $6 billion.

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Processions to Cedars Will Salute Healthcare Workers on National Nurses Day

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The coronavirus (COVID-19) outbreak is putting a strain on essential workers such as first responders and healthcare workers who are on the frontlines in the effort to care for coronavirus patients so the City of West Hollywood is setting out to recognize them in a special way on May 6.

National Nurses Day is a day of recognition to celebrate and honor the contributions that nurses have made and continue to make in our communities and throughout the nation. National Nurses Day is celebrated annually on May 6, which marks the beginning of National Nurses Week, a week-long celebration to raise awareness of the value of nursing and educate the public on the role nurses play in meeting the healthcare needs of Americans. National Nurses Week concludes on May 12, the birthday of Florence Nightingale, or as she was more commonly known, “The Lady of the Lamp” and founder of modern nursing.

The West Hollywood Sheriff’s Station of the Los Angeles County Sheriff’s Department is coordinating two motorcades to honor healthcare workers on Wednesday, May 6, 2020, which is nationally recognized as National Nurses Day. The processions will begin at 9:45 a.m. and at 7:15 p.m. on Santa Monica Boulevard at La Cienega Boulevard and the motorcades will head west and then travel southbound on N. San Vicente Boulevard passing multiple medical center locations in West Hollywood en route to a destination outside the emergency room entrance of Cedars-Sinai Medical Center on Gracie Allen Drive. First responders will briefly stop, exit their vehicles and applaud healthcare workers while wearing face coverings and practicing appropriate social distancing.

“Our nurses and healthcare workers are nothing short of heroes,” said City of West Hollywood Mayor Pro Tempore Lindsey P. Horvath. “The coronavirus pandemic has reminded us just how critical their work is to our everyday health and safety. This National Nurses Day means so much more to all of us — the City of West Hollywood and our LA County Sheriff’s West Hollywood Station and LA County Fire Stations; the City of Beverly Hills and Beverly Hills Police and Fire; the City of Los Angeles and LAPD and LAFD; the California Highway Patrol, and more — and we will honor these heroes in a special way for the care that they provide, which often goes unseen and unrecognized, in carrying us through this crisis.”

“As the worldwide response to the novel coronavirus (COVID-19) continues, the critical importance of nurses in our society has been brought sharply into focus,” said City of West Hollywood Councilmember John Heilman. “More often than not, when a coronavirus patient ends up in a hospital, it is the nurses at the frontlines who are responsible for their care and treatment, putting themselves at risk in the process. We can’t say ‘thank you’ strongly enough.”

The City of West Hollywood encourages residents and community members to participate during this day of celebration while still adhering to LA County Safer At Home Orders and social distancing requirements. Suggested forms of participation include amplifying posts on social media channels, making yard or window signs and banners, participating in a coordinated daily applause or shout out for nurses and healthcare workers, and donating to organizations that are addressing the emerging needs of nurses and healthcare workers during the coronavirus (COVID-19) health pandemic.

According to the American Nursing Association, nursing is the nation’s largest healthcare profession, with more than four million registered nurses in the United States. Registered nurses comprise one of the largest segments of the U.S. workforce and are the primary providers of hospital patient care, delivering most of the nation’s long-term care. In nursing, where workers are on the front lines of patient interactions, women make up more than 85 percent of the workforce. This year, with the onset of coronavirus, nurses have stepped up and shown the incredible impact they have on our healthcare system. It is more important than ever that we recognize National Nurses Day and celebrate the significance of nurses every day.

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Texas & California Wet Markets Show Full Extent of Vile Conditions

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Texas & California Wet Markets Show Full Extent of Vile Conditions

(TMZ) — It’s becoming more clear by the day that wet markets are NOT just a China problem — it’s an American problem too … just take a look at these latest clips from Texas and California.

TMZ has gotten a hold of even more graphic videos of two different live animal shops in TX and CA — where people pick out the animal, have it slaughtered on the spot and then sold to them right then and there — and you see the mixed-in livestock runs the gamut.

There are pigs in pens, goats and sheep hoarded together … and, of course, as we’ve seen in New York and elsewhere — chicken and rabbits cooped up in cages — all in the same area within earshot of each other, and all getting butchered.

Ya got pigs hanging from hooks out in the open, chicken beaks, feathers and guts all over the floor and in an exposed trash can — this while customers (including kids) come in and browse the freezer for whatever cuts of meat they want. It’s downright dirty and gross.

As we’ve been told by the experts, these one-stop-shop slaughterhouses/storefronts can be breeding grounds for disease — including new viruses, like COVID-19, which supposedly got started at a wet market in China.

We already know of lawmakers in Cali and New York working to get these things shut down, but it’s pretty apparent there needs to be federal legislation rolled out to address this. Can’t call the kettle black when we’re swimming in the freakin’ pot.

Tune in to TMZ on TV weekdays Monday through Friday (check syndicated/local listings)

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