Introduction: 

For the past few months I have been researching the causes of and solutions to the rising maternal mortality rates in the United States. When I first began this project, I was unsure about a lot of things. I knew it was an important topic but I didn’t realize how important it would be. When I wrote my first introduction to the topic, I was not only introducing my topic to my audience but to myself as well. I had only read a little bit about the topic and honestly it was a little overwhelming. When I started it seemed like the problem was too big for me to find any solution. However, I have since realized that most of the causes have really simple solutions. 

The problem I am tackling is the fact that the US has the highest maternal mortality rates among the developed countries and is the only developed country in which the rates have been rising. By developed countries I mean countries that are doing well structurally, financially, and socially. Maternal mortality is the death of a mother during pregnancy, childbirth, or up to 42 days postpartum. Sometimes deaths after the 42 days are taken into account if the death can be proven to be a result of pregnancy or childbirth.  The problem is that over half of all maternal deaths in the United States in recent years have been preventable. The main sources of the problem are patient knowledge and physician response. Patients are often unaware of the warning signs of major complications, and physicians have delayed diagnosis and response times. For this recommendation report I want to focus on what are the causes and solutions to the maternal mortality rates in the United States.

Purpose:

Maternal mortality is such a big issue with a wide variety of causes, and there is not just one solution that can solve it. However, I think one of the most impactful solutions is knowledge. I want to use this recommendation report as an opportunity to inform my audience. I want to educate them on the causes and solutions of maternal mortality, and present them with attainable solutions. My hope is that expecting mothers will learn something from this report and go to their doctors with questions. I also want doctors to realize the need to better educate their patients about warning signs and be ready with a plan in case of unexpected complications. I also want to educate those that just may not be aware that it is an issue.

I chose this topic without knowing very much about it. What I did know was that in today’s world, maternal deaths should not be as much of an issue, especially with the amount of research and technology we have. When I told people about this issue, I found that most people were like me and did not realize how big of an issue it is. That’s why I think it’s important to talk about. Because the more aware we are of the problem, the more resources we can put forward to fix it.    

Literature Review:

There is a massive amount of information on maternal mortality out there. It was daunting when I first started my research, but once I started reading through all of it, I noticed some similarities among my sources. A lot of sources said the same things, sometimes even in the same words.  For example, reports from the Center for Disease Control and Prevention (CDC) and a Maternal Mortality Review Committee (MMRC) say that women of color are three to four times more likely to die of a pregnancy related death compared to non-hispanic white women. These are not the only sources to have this statistic either. Another fact that most of my sources mentioned was that more than sixty percent of all pregnancy related deaths in recent years have been preventable. Also, the two most common causes of the problem among my sources were patient knowledge and the response to complications from healthcare providers.

Women of color:

Across multiple sources it is stated that black women are three to four times more likely to die from pregnancy related complications than a white woman. This statistic is staggering considering the US already has the highest maternal mortality rate among developed countries. According to the CDC, as of 2015, black women have a maternal mortality rate of 42.4 deaths per 100,000 births versus white women at 13.0. So why is there such a disparity between races? After doing some reading, I have found that the main reason is unconscious or conscious bias among healthcare providers. While socioeconomic status and access to healthcare were also issues, black women who were well off financially and had access to the best healthcare still faced the issue of bias. In a story done by NPR they referenced a survey taken by the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, which said “33 percent of black women said that they personally had been discriminated against because of their race when going to a doctor or health clinic, and 21 percent said they have avoided going to a doctor or seeking health care out of concern they would be racially discriminated against.” Also reported in this story it was said that black mothers frequently stated that their pain was not taken seriously or ignored entirely. Most people think that the disparity between black and white women in terms of maternal health has to do with socioeconomic status, lifestyles, and access to healthcare. While those are part of the problem, the bigger issue is discrimination and that’s something that needs to be fixed.

Patients’ lack of knowledge:

When I began my research I wanted to know why the United States’ maternal mortality rates were so high and continuing to rise. In my search I found there are a number of issues that contribute to maternal deaths. First off is the patients’ lack of knowledge when it comes to symptoms of major issues. According to Elizabeth Howell, professor of obstetrics and gynecology at the Icahn School of Medicine at Mount Sinai Hospital in New York City, in a story by NPR, “we do not give women enough information for them to manage their health postpartum. The focus had always been on babies and not on mothers.” Women often don’t recognise symptoms during and after pregnancy that are warning signs of major complications. For example, a swollen leg could signal a blood clot, while a fever may warn of infection, and after pregnancy any sign of chest pain should be taken seriously as giving birth puts strain on your body, especially your heart. Women are often sent home with a great deal of information on how to take care of their baby; however, they are given little to no information about how to take care of themselves or warning signs to look out for. This is one of the causes of the maternal mortality issue that has a simple solution. Giving women the information they need to take care of themselves could save thousands of lives. 

Healthcare providers:

Another major issue that I came across quite a bit during my research was clinician, facility, and system failure. According to an issue of the Journal of the American Medical Association (JAMA), these failures include things such as poor training, missed or delayed diagnoses, delayed and/or ineffective treatment of complications, and poor communication among health care providers. In an article by the World Health Organization (WHO), these issues stem from a lack of standardized care. Hospitals across the country do not have a standard method of care for mothers after they give birth. This issue leads to not getting tests ordered and not looking for the common complications following childbirth. Insufficient care from medical staff is more well known and therefore more efforts are put in to fix those problems. In the MMRC report from 2018, they made suggestions to fix the issues caused by healthcare providers and facilities. They suggested solutions such as improved training, enforcement of policies already in place, better access to healthcare, and multiple other things. The problem in the United States does not seem to be that we do not have solutions but we are not doing what is necessary to implement them. 

The U.S. vs the U.K:

Another one of the questions I had while doing my research was what are other countries doing better than the United States? I read reports from both the United States and the United Kingdom. MMRCs, and the differences were interesting. Some of the first numbers that stood out to me were 259 and 700. 259 is the number of women that died due to pregnancy related issues in the UK over the course of two years; 700 is the number of women that die of the same issues in the US every year. I wanted to believe that this disparity was caused by the significant population difference. However, as I read more, I realized the difference in population was not the only cause for the discrepancy. In the UK the maternal mortality rate as of 2015 was 9.78 versus the US at 17.2. These rates are based on the number of maternal deaths per 100,000 maternities, and that is not dependent on population size. All of this is to say that other countries are doing better than us and I want to know why. 

One of the big differences I noticed between the two reports were the causes of death. In both countries hemorrhage and sepsis (infection) were the leading causes of death, but after that the causes vary greatly. The US has a much higher rate of deaths due to cardiovascular issues than the UK and the UK has much higher rates of deaths due to mental health conditions. These facts lead me to believe that some of the discrepancy in rates between the two nations is due to lifestyle habits. However, another difference I noticed seems to be in the implementation of solutions. According to the UK report they seemed to have had more success in implementing changes that are making a difference. Whereas in the US, while they might be suggesting the same solutions, the application seems to be where the issue lies. Another big factor may be access to healthcare. Many of the women that suffer complications from pregnancy and childbirth are of low socioeconomic status and do not have access to adequate healthcare. However, I am sure that fixing the American healthcare system is not the only way to solve the maternal mortality issue. 

Discussion and Recommendations:

So, I’ve talked a lot about all the problems in the United States that have led to it’s high maternal mortality rates. Now I want to talk about what we can do to fix it. I feel like I should mention that some places are doing some great things in ways of solving the issue. I think the most promising article I read was about an effort in California that had amazing results. Between the years 2006 and 2013, California’s maternal mortality rates dropped 55 percent from 16.9 to 7.3. These amazing outcomes are the result of focusing on problems that arise during labor and delivery, collecting data to quickly identify deficiencies, and training hospital staff on how to overcome them. In the article they quote Stephanie Teleki, who leads maternity care initiatives at the California Health Care Foundation, “There are free [instruction manuals] to help hospitals address the major drivers of maternal mortality and morbidity. And we have a data center in California that can be replicated in other states that is low-burden and low-cost to hospitals.” Changes like the ones made in California are easy to implement and highly impactful. They require only a will and some funding from the state. The article says that systems like the one in California could be implemented for as little as 95,000 dollars a year, which is a drop in the bucket compared to other things the states spend their money on.

The system in California is just one part of the solution. I also think that getting more information out to mothers is another important factor. Most often, life-saving efforts focus more on the baby rather than the mother. Women are often sent home with a list of symptoms to look for in the baby and little to none to look for in themselves. By simply giving women the knowledge they need, diagnoses could be made and treated much sooner saving hundreds of women.

Most of the solutions to the maternal mortality issue in the United States are simple. The problems are not because of a lack of money or technology, but simply a lack of effort. By implementing any number of simple changes, the maternal mortality rate in the US would plummet. 

Conclusion: 

When I first learned about the maternal mortality issue in the United States, I couldn’t believe it was still a problem.  Modern science has led to some amazing medical marvels and yet we haven’t figured out a way to keep women from dying during childbirth; a thing that’s been happening as long as humans have been around. I was even more confused to find out that it was such a big issue in the United States but not other countries who were just as well-off as ours. Why was our country failing at something that seemed so important? 

When I got into my research I realized that most of the issue seemed to be that we just are not putting forward the resources that we should be. A lack of training and preparedness among medical personnel and a lack of information given to mothers are the biggest issues. These issues are easily solved by improving training and awareness among healthcare providers and simply giving women the information they need to take care of themselves. Taking care of children is very important but that starts with taking care of their mother first.

In my previous writings I focused on the issue of maternal mortality rates in the US and what things were being done to fix it on a broad scale. I wanted to use my photo essay as a way to show expecting mothers what role they play in the solution to the maternal mortality issue. The reason this essay deviates slightly from my main argument is because I wanted to tell a story that would appeal to the emotions of expecting mothers. My main topic is more about me presenting the problem of the maternal death rate in America rather than making a specific argument, so I decided to make my photo essay an argument about a specific aspect of my topic. 

I used photos that, by themselves, seem happy but juxtaposed them with captions that would impact the reader emotionally. In addition to pathos, I used logos by presenting the reader with devastating possibilities and then explaining a logical solution to the problems. I arranged my photos in a specific way so that it would flow somewhat like a story. I opened with my main point then I went to some worst case scenarios and then brought it back to my main point. I made the first and last pictures similar because I wanted to start the essay with my argument and then after scaring people a little, I wanted to bring the essay back to my main argument so it would have more of an impact. 

The middle portion of the essay can be broken down into two sections. First is the image of the parents with their new baby and the image of the mother seeing her baby for the first time. I chose these images because when I think of the special moments right after having a baby, those types of images are what come to mind. I felt these images would contribute to my pathos because an expecting mother would typically look forward to those moments. My hope was that by using those happy images and then having such contrasting captions would make my argument more impactful to expecting mothers. The second section of the middle portion included the image of the dad holding the baby and the image of the grandfather with his granddaughter. I chose these images because I wanted to point out situations that people don’t typically think they will have to deal with after having a baby. These images pointed out that not only would a child lose their mother, but also, the other people in that child’s life are thrown into a situation they were not prepared for. I included these images to encourage people to see the logic in my argument. Because my pictures and captions were so poignant, it made my simple solution seem that much more reasonable. 

I used my photo essay to make the argument that women should talk to their doctors and make plans and ask questions. By doing this simple thing, expecting mothers can contribute to the solution of my main issue which is the maternal mortality rate in America. I used pathos and logos to persuade my audience to follow my advice. I think my use of happy photos anchored by such emotional captions gave my photo essay more impact than if I had just used statistics. I didn’t want to add statistics to this essay because I already talked about them  in my previous writings. I wanted this essay to focus more on the personal side of the issue rather than facts and figures. I think my photo essay presents an impactful argument and does a good job of convincing my audience to follow my recommendation.

I have mentioned in previous posts that most of the maternal deaths in the United States are preventable. What I want to focus on now is what expecting mothers can do to aid in that prevention and why they should. One of the easiest things you can do as an expecting mother is talk to your doctor. Ask them questions about their protocols in delivery emergencies and if there are any risks in your pregnancy you should know about. Aside from hemorrhaging, heart issues are the next leading cause of death to new mothers. Talking to your doctor and asking questions can eliminate a lot of risks. I want to use these photos to highlight some of the reasons patients should reach out to there doctors with questions or concerns.

What should be one of the happiest times for a family can quickly become one of the saddest and most difficult of times for those left behind. I am not going to tell you that just talking to your doctor and making a plan is going to prevent anything bad from happening, but it might just save you or a loved one’s life. I’m not trying to scare people into not having children. I only want to inform people of the risks so that less families have to experience a devastating loss. By simply setting up a plan with your doctor or asking them about the protocols they have in place, you can be more prepared for and aware of complications that could happen. Preparedness and awareness are the best solutions to the maternal mortality problems in the United States, and this small step is a part of that solution.

Sources:

1. Woman talking to doctor
2. Parents looking at baby
3. Mother seeing baby 
4. Dad holding baby
5. Grandfather with granddaughter 
6. Pregnant woman talking to doctor

In my last post I told you about a issue I was interested in researching and what I hoped to do about it. In this post I want to let you know where my interest began and what I’ve found so far…

When I was told that I was going to spend a whole semester researching and writing about a topic of my choice, I have to say that I was a little nervous. I thought about the last time I had to write a research paper and how stressful and time-consuming it was. But the idea of researching maternal mortality rates came to me fairly easily. I knew I wanted to research something in the medical field and the maternal mortality rates in the United States has bothered me ever since I learned it was a problem. The way I discovered this problem was a little unorthodox. I discovered the maternal mortality issue while watching a medical drama on television. Knowing that it probably wasn’t a reliable source, I googled it to see if it was true. I was distraught when I discovered that it was a real problem. I didn’t look further into it because there wasn’t really anything I could do to fix it.I was excited to be able to research this topic because I could finally see a way I could help people. Getting information out to people is one of my main priorities for this project and I hope that sharing the things I learn will be able to help at least one person.

Like most people, when I began to research my topic, I didn’t know a lot about it. The only thing I knew was that the United States had the highest rate of maternal deaths among developed countries, and I wanted to know why. Despite our access to medicine and research, the rates in the U.S. were still higher than in other countries who had the same if not less access. I wanted to learn about the flaws in our system early on, so I could have the knowledge to recognise and prevent issues from happening when I am a doctor in the future.  So, I began my search in a broad area and just googled my topic to see what I could find. I have to tell you the results were baffling. Even after only reading a few of the top articles on google, I discovered so much about my topic. The amount of information available about maternal mortality just in the U.S. is a little daunting. Even now, I could do a quick google search and find ten more articles that I have never seen before.

Despite the fact that there is more research than I know what to do with, a lot of them seemed to be saying similar things. The United States not only has the highest maternal mortality rate among developed countries, but it is also the only one in which the rate is increasing. However, the cause of maternal deaths is where some sources disagree. Some sources say that the increase in the number is due to better record keeping of maternal deaths. Others say that the deaths are caused by racial and socioeconomic factors due to biases among health care professionals. Many sources say that women of color are three times as likely to die from pregnancy related deaths than white women. Although these sources may disagree on the causes of maternal deaths, many agree that most of the deaths are preventable. During my research, I found a study done by the CDC, centers for disease control and prevention, in which they found that sixty percent of maternal deaths were preventable.

On a more positive note, I also found that there are protocols and committees being put in place to help solve this issue. The CDC has a surveillance system in place to “better understand the risk factors for and causes of pregnancy-related deaths in the United States;” they also support maternal mortality review committees (MMRC) and perinatal quality collaboratives (PQC). It was a nice surprise when I found that there is a serious effort being put in to try and solve this issue.

Over the course of my research I have been able to find so many sources about my topic. Although some of the sources I have found may have biases, I am to recognize them and still gain valuable information from those sources. Not only have I found online articles from news outlets and organizations, I have also found multiple academic articles written about maternal mortality. These academic articles range from information about maternal mortality to prevention plans to legislation being passed to monitor and lower maternal deaths. Many of the academic articles I found are peer reviewed articles and journals that I was able to access through my university’s library research sources. I have found out that there is a lot of information out there about my topic and I am excited to dive into it and see what more I could learn.As I have learned, there is a lot of information out there and it can be pretty daunting. I want to present it in a way that somebody who maybe does not have time to look through or does not understand all the research is able to read my blog and make an informed decision about their health.

An Introduction to the Topic:

I intend to research the causes and solutions to the rising maternal mortality rates in the United States. America has the highest maternal mortality rate of the developed countries and is the only developed country in which the deaths are increasing. Between the years 2000 to 2014 there was a 26 percent increase in maternal deaths in America, and women of color are three to four times more likely to die compared to white women. Many of these deaths are preventable but there are not proper protocols or staff to handle the situations. This problem is distressing because as advanced as medicine and technology are, there should be far fewer deaths and the number should definitely not be going up.

Project Objectives:

By the end of this project, I want my audience to be made aware of and understand the problem that is maternal deaths. Many doctors are already aware of this problem and my plan is not to make them aware of the problem but rather tell them about possible solutions. I want to find out what America is doing wrong and what other countries are doing to lower their maternal deaths. I want to find out if what other developed countries are doing could work in America. Are their protocols, technology, or skills that are not being utilized in the United States? What can health care professionals do help lower the number of deaths? What can expectant mothers learn from this information? And what can they do once they have this information?

Project Implementation Plans:

To accomplish these goals, I plan on looking into what could actually be causing the rise in maternal deaths. I want to find out what, if any, plans have been put into place to try to lower this number. Also, why is there such a staggering difference between women of color and white women when it comes to maternal mortality. I have already found some sources that contain statistics from 1987-2015. I hope to find some medical journals that may have been written about this subject, and I hope to be able to talk to a health professional about their experience with this issue. Dr. Nielsen mentioned a professor that is actually researching this topic and may be able to help, so I hope to be able to talk to them as well.

Audience Analysis:

My ideal audience would be doctors and other health care professionals. I think this group of people would be able to do the most with the information I give them. This group also has a close connection with the mothers and families being affected by this issue. Doctors and health care professionals care about the people they are responsible for, and I think because of that relationship, they would be the most willing group to try and fix this issue. Not only could doctors benefit from this information, but expectant mothers that may not even be aware this is an issue could benefit as well. I want to make sure that women who are pregnant or just thinking of getting pregnant are aware of this problem. These women should know the risks and what questions they may want to ask their doctor so as to avoid or prepare for a dangerous situation after giving birth. Also, while my focus is on the maternal mortality rates in America, people from other countries, especially those less developed than America, might also benefit from this information. The people from other countries would make up my tertiary audience, so while it is not written for them, they may find the research useful.

Sources Used in this post:

• AGOC: Maternal Mortality
• Report from Nine MMRCs
• CDC: Pregnancy Mortality Surveillance System

Other Useful Sources:

• The Rising U.S. Maternal Mortality Rate Demands Action from Employers
• The Last Person You’d Expect To Die In Childbirth
• Report From Maternal Mortality Review Committees: A View Into Their Critical Role
• U.S. Maternal Mortality Trends