Part 2 – Dear ACOG, Moms Have Been Speaking Up.
You Just Don’t Believe Us.
In part 1 of this series, I wrote about how moms have been speaking up to their doctors — oftentimes to save their lives — and being ignored. As a result, many moms are dying of preventable complications, which makes the United States one of the most dangerous places in the developed world to give birth.
To address this issue, the American College of Obstetricians and Gynecologists (ACOG) launched a “Preventable Maternal Mortality” initiative. Here’s what they’ll focus on.
ACOG’s 4 Pillars to Combat Maternal Mortality
ACOG is a member of the Alliance for Innovation on Maternal Health (AIM). The voluntary initiative is “a national data-driven maternal safety and quality improvement initiative based on proven implementation approaches to improving maternal safety and outcomes in the U.S.” But because it’s not mandatory, the program has only been implemented in 26 states. In order to enroll in the program, a state must: 1) have a Maternal Mortality Review Committee and 2) be willing to submit data.
As of this writing, 29 states have a Maternal Mortality Review Committee.
At the core of “Every Mom. Every Time.” are four pillars ACOG claims will help eliminate preventable maternal mortality. They are:
Optimizing Postpartum Care: “You’ve had your baby. See you in six weeks.” That’s the standard approach to postpartum care for most providers in this country. Now, however, ACOG recommends postpartum care should be spread among several visits instead of just one six weeks after birth. These visits should have services and support tailored to each woman’s needs, begin at 3 weeks postpartum, and conclude with a comprehensive visit 12 weeks after birth. At this “comprehensive visit,” a woman should have a full assessment of her physical, social, and psychological well-being.
In theory, this approach sounds much better than the postpartum care we are currently receiving. But the fact remains most providers are woefully uneducated on postpartum mood disorders, the pelvic floor dysfunction that is common post birth, and even breastfeeding issues. No one is stopping to ask, #IsMomOK? If they did, they might find the person needs mental health assistance, some pelvic floor physical therapy, just some encouragement, or something more.
In my experience, I was asked two questions that both centered on feelings of depression at my six-week checkup. I wasn’t feeling classic depression symptoms, but I was angry. Really angry. And that, I later learned from a therapist, is symptom of postpartum depression. Postpartum mood disorders extend way beyond depression. How many postpartum people can’t get the help they need because providers don’t know or bother to screen for other symptoms outside of depression?
Improving Access to Care: Using the Levels of Maternal Care guidance, ACOG suggests facilities receive “uniform designations for levels of maternal care related to a facility’s capabilities and resources, to promote collaboration among facilities and health care providers within a region, so that pregnant women can receive care at a facility that best meets their needs.” The organization also notes that maternal mortality and severe maternal morbidity can be decreased if pregnant people can easily receive risk-appropriate maternal care.
Again, that sounds nice. But any pregnant person who wants a VBAC or doesn’t want excessive interventions can tell you it doesn’t matter how many facilities and providers are collaborating. They still may have to drive hours just to find a provider who won’t immediately give them an unnecessary surgery (which increases maternal death risk) just because they have had one or two c-sections.
Standardizing National Data: There is not a centralized database that collects and stores clinical data on labor and delivery and maternal health outcomes. ACOG’s birth registry, which was introduced in 2014, will reportedly serve as a “national outcomes registry for maternity care that is centered around labor and delivery.” It will be piloted at 10 locations this year.
While this registry is a step in the right direction, it’s not a mandatory requirement. Currently, it requires already overworked medical staff to enter additional data into the system, which may, depending on a physician’s workload, fall by the wayside.
Advocating for State and Federal Legislation: “ACOG works to pass evidence-based, actionable legislation to eliminate preventable maternal mortality, reduce racial health disparities and improve maternal health outcomes,” the organization writes.
Like the rest of this list, it’s a step in the right direction. But how and where exactly is the organization focusing its advocacy efforts? Here is where the advocacy work of groups like ImprovingBirth can really make a difference. Because we’re the largest consumer-based advocacy based organization, we have the experiences of birthing people throughout the country to guide us.
And Last But Not Least: It’s not officially included with the four pillars to combat maternal mortality, but at the bottom of the page about this initiative (and what got me so angry in the first place) is a section called “What Patients Should Know,” which states: “Help empower yourself, your friends, and your family members to speak up when something might be wrong by educating yourself about maternal mortality, the leading causes of maternal death and warning signs that shouldn’t be ignored.” Are. You. Serious?
We know our bodies. We know when something is wrong. You know those little sheets you give us after we’re discharged from the hospital that list things to watch for? We read those. And when we experience the things listed there or other complications and speak up, you don’t believe us. We are telling you we are not ok, and it’s time to believe us. It’s time to stop and ask #IsMomOK. Every Mom. Every Time.
. . . .
We Need You
This blog post is part of the #IsMomOK initiative. The time is now to share our stories and appeal to the medical community to take pause and listen, really listen.
To have the impact that we envision, we need your participation. Here’s how:
DONATE: By donating, you are insuring that your voice is represented as a consumer, as a mother, as a birthing person. If you have ever felt dismissed please donate.
GET A SHIRT: See yourself as an ambassador of improving birth. Help us expand and grow this message. that we deserve better, by wearing your t-shirt with pride.
SHARE YOUR STORY: The effect you have on others is the most valuable currency there is. Sharing your story can inspire others and quite possibly, drive real change.
GET INVOLVED: All of us have important work to do – each with something to contribute, because if we don’t, the work will not be done. We need your drive and dedication
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Part 2 of a 2-Part Series
About the author: Casey Newman is on the board of ImprovingBirth and a PR/marketing professional with a passion for maternal issues. She enjoys spending time with her family, supporting various causes, and angrily tweeting about baseball @caseybnewman.