The past few weeks have seen lots of interesting news and tidbits that impact (or have the potential to impact) birthing families both in the United States and on a global level.  Here are just a few snippets that caught my eye.  What have you been reading in the news lately about maternal-infant health?

Birth rates down and age of birthing parent up

The Centers for Disease Control: National Center for Health Statistics released the newest birth statistics and some of their findings concluded what many of us are probably already seeing - people are having fewer children and waiting longer to have them.  There are fewer teen parents, which influences the age of the birthing population. Fewer children being born is a trend that is being observed globally, and in the United States, this is evident in both rural and urban populations, with a more significant drop in urban centers. You can read more about the just-released birth rate report in Data Brief, No. 323. Trends in Fertility and Mother’s Age at First Birth Among Rural and Metropolitan Counties: United States, 2007–2017.

Pregnancy discrimination causing miscarriages

The New York Times reported late last week that pregnant people required to complete physically challenging tasks as part of their work responsibilities are not receiving appropriate accomodations, resulting in miscarriages. In Miscarrying at Work: The Physical Toll of Pregnancy Discrimination, journalists Jessica Silver-Greenberg and Natalie Kitroeff reported that requests for light duty were denied by employers across many business segments, including at a hospital, a post office, an airport, a grocery store, a prison, a fire department, a restaurant, a pharmaceutical company, and several hotels. In many cases, there was an official request for light duty and workplace accommodations accompanied by a health care provider's prescription/recommendation. 

Unfortunately, companies who refuse to accommodate a pregnancy are perfectly legal in their actions. Current federal laws are outdated and very brief in their discussion of who is protected and when.  The people most affected by this refusal to modify work tasks are often blue-collar employees, those on the lower end of the pay scale and families of color.  This population is least able to weather a period of unemployment or change employers in their effort to protect their pregnancy and their baby.

Health care providers often misinterpret risk when reviewing test results

A fascinating perspective piece was published in The Washington Post earlier this month by Daniel Morgan is an associate professor of epidemiology, public health and infectious diseases at the University of Maryland School of Medicine and chief of hospital epidemiology at the Baltimore VA Medical Center.  Dr. Morgan stated in his article that "many physicians misunderstand test results or think tests are more accurate than they are. Doctors especially fail to grasp how false positives work, which means they make crucial medical decisions — sometimes life-or-death calls — based on incorrect assumptions that patients have ailments that they probably don’t."

After reading "What the Tests Don't Show", I could not help but think of how often this comes up in obstetrical care and how health care providers rely on test results or screenings with a known high false positive rate to make decisions on when babies need to be born and how- vaginally or by cesarean surgery.  Electronic fetal monitoring is one such example that comes to mind.  Another example is low amniotic fluid at term in the absence of any other issues. Both of these issues are consistently relied on to make "calls" about how to proceed that can have a significant impact.  Certainly, the fact that there is both a parent and baby who are experiencing the pregnancy and any adverse outcomes that may sometimes occur makes it doubly tricky.  When clinicians are relying on screenings and tests that have been proven to be less than reliable and have a known high false positive rate, and false positive rates are poorly understood by the health care provider, many interventions are occurring that could have been avoided with a better grasp of what the test results really mean.

Mommies Act making its way through the Senate

The new bill "Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES) Act" was introduced into the US Senate by several senators including Cory Booker (D-NJ), Kirsten Gillibrand (D-NY), Tammy Baldwin (D-WI), Ben Cardin (DMD), Richard Blumenthal (D-CT) and Kamala Harris (D-CA).  The purpose of this bill is to reduce the United States’ rising maternal mortality rates, improve maternal and infant health outcomes, and close the disparities that continue to put parents and children of color at risk. The services this bill would provide will impact those pregnant families who are covered by Medicaid.  Medicaid (federal funds) supports almost half of the births occurring in the USA today.  The Mommies Act bill calls for extending coverage for many people to a full year after childbirth, increasing access to primary care providers and ob/gyn health providers, establishing a maternity care home demonstration project, and taking action to expand access to doula care.  Currently, the United States has the highest maternal mortality rate in the developed world.

The MOMMIES Act can impact maternal mortality rates by:

• Extending Medicaid coverage for postpartum women to a full year after giving birth, rather than the current limit of 60 days that many women face
• Ensuring that all pregnant and postpartum women have full Medicaid coverage, rather than coverage that can be limited to pregnancy-related services
• Establishing a maternity care home demonstration project to study this innovative model of care in several states
• Extending the Affordable Care Act’s primary care bump to ensure that Medicaid beneficiaries have access to primary care providers, including women’s health providers
• Encouraging increased access to doula care to provide pregnant women on Medicaid with emotional, physical, and informational supportStudying telemedicine and its effectiveness and potential to improve Medicaid beneficiaries’ access to maternity care

The MOMMIES Act is endorsed by many maternal-infant health organizations, including many who work with families of color, who are most likely to experience poor parent and baby outcomes.  Some of those who have stepped to support this important bill include:

• Association of Maternal & Child Health Programs
• Black Mamas Matter Alliance
• Black Women's Health Imperative
• Center for Reproductive Rights
• Every Mother Counts
• In Our Own Voice
• March of Dimes
• MomsRising
• National Asian Pacific American Women's Forum
• National Health Law Program
• National Latina Institute for Reproductive Health
• National Partnership for Women & Families
• National Women's Law Center

Published: October 23, 2018

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