WEBVTT - America’s Maternal Mortality Crisis, Part 2 0:00:00.400 --> 0:00:07.000 Hi everyone, I'm Katie Couric, and welcome to Next Question Today, 0:00:07.080 --> 0:00:10.760 part two of our look at America's maternal mortality crisis. 0:00:11.200 --> 0:00:14.360 If you haven't listened to Part one, I highly recommend 0:00:14.560 --> 0:00:18.200 you start there. In it, we heard the devastating story 0:00:18.600 --> 0:00:22.440 of how one mother, Kira Johnson, became a part of 0:00:22.480 --> 0:00:26.840 a shameful statistic that between seven hundred and nine hundred 0:00:26.880 --> 0:00:31.800 American women die every year from pregnancy and childbirth related causes, 0:00:32.440 --> 0:00:37.560 and six of those deaths, including Kira's, could have been prevented. 0:00:38.159 --> 0:00:42.479 Here's Kira's husband, Charles Johnson. What happened to Kira was 0:00:42.560 --> 0:00:46.159 not just a medical tragedy with a medical catastrophe. Everything 0:00:46.200 --> 0:00:49.559 that could have went wrong, in fact did so. Not 0:00:49.680 --> 0:00:52.880 only did that doctor failed Kira, but the hospital, in 0:00:52.920 --> 0:00:57.480 their policies and procedures, failed her. We learned that structural 0:00:57.560 --> 0:01:01.440 issues like racism and sexism, as well as an increase 0:01:01.480 --> 0:01:05.160 in medical interventions during labor, have led to more women 0:01:05.280 --> 0:01:09.560 dying from pregnancy and childbirth today than they did thirty 0:01:09.640 --> 0:01:12.840 years ago, a fact that makes the US the only 0:01:12.920 --> 0:01:16.720 country in the developed world to see its maternal mortality 0:01:16.880 --> 0:01:22.039 rate go up today. In Part two, we tackle my 0:01:22.160 --> 0:01:25.759 next question, what is being done to better protect American 0:01:25.880 --> 0:01:31.480 mothers from becoming a part of that horrifying statistic. She 0:01:31.600 --> 0:01:33.000 was told it was a fluke, And here I was 0:01:33.040 --> 0:01:35.479 looking at these data points and saying she wasn't a fluke. 0:01:35.560 --> 0:01:37.760 She was actually part of a really important trend that 0:01:37.840 --> 0:01:41.679 has not been covered in the US. For investigative reporter 0:01:41.760 --> 0:01:45.600 Nina Martin, this question is a personal one. In two 0:01:45.600 --> 0:01:48.240 thousand and fifteen, when she and her team at Pro 0:01:48.360 --> 0:01:53.240 Publica began reporting their Lost Mother's Project, an investigation into 0:01:53.280 --> 0:01:58.680 maternal mortality, they found an alarming statistic that, in addition 0:01:58.720 --> 0:02:02.600 to the deaths, there are fifty thousand women who nearly 0:02:02.720 --> 0:02:07.680 die every year from pregnancy and childbirth related issues. And 0:02:07.720 --> 0:02:11.040 we're not talking about like they have gestational diabetes and 0:02:11.080 --> 0:02:14.440 then they cut back on you know whatever, um, the 0:02:14.440 --> 0:02:16.280 the amount of sugar, the ice cream that they ate 0:02:16.320 --> 0:02:18.360 in pregnancy and then everything is okay. We're talking about 0:02:18.400 --> 0:02:21.360 women who, you know, go to the hospital and go 0:02:21.440 --> 0:02:25.399 into cardiac arrest. We're talking about women who nearly bleed out. 0:02:25.440 --> 0:02:30.040 We're talking about women who have life threatening um infections 0:02:30.080 --> 0:02:34.720 that keep them hospitalized for weeks. And UM, that was 0:02:34.800 --> 0:02:37.280 really super interesting to me both because of the size 0:02:37.600 --> 0:02:40.640 um again, which really was not what people were talking 0:02:40.680 --> 0:02:44.360 about in the parenting magazine world that I had spent 0:02:44.440 --> 0:02:46.880 some time in. But it also really connected with me 0:02:46.919 --> 0:02:50.919 on a personal level because my sister had um given birth. 0:02:50.919 --> 0:02:57.120 I've I've three sisters, three yeah, and um the oldest 0:02:57.120 --> 0:03:01.480 of five. Nina Martin's sister Meal had given birth to 0:03:01.520 --> 0:03:05.480 a boy named Aiden in Texas in two thousand. She 0:03:05.560 --> 0:03:08.959 and her husband both had good jobs. She was a paralegal, 0:03:09.240 --> 0:03:12.120 he was a lawyer, and they had access to good 0:03:12.160 --> 0:03:17.520 health care. She was very healthy, had a really good pregnancy, 0:03:17.560 --> 0:03:20.600 and she nearly died after in her postpartum period she 0:03:20.639 --> 0:03:25.160 had to very severe infections, one of which was they've 0:03:25.520 --> 0:03:27.639 caught and fixed in the hospital, and the second one 0:03:27.840 --> 0:03:31.880 which nearly killed her. And I remember going and trying 0:03:31.919 --> 0:03:34.120 to help out at the time and how freaked out 0:03:34.120 --> 0:03:36.840 everybody was, and then it was kind of over. People 0:03:36.880 --> 0:03:39.680 said to her, you know, oh, well, you know this 0:03:39.840 --> 0:03:43.480 never happened to anybody. We have no idea that we've 0:03:43.560 --> 0:03:47.400 never seen anything like this before. And and also, um, 0:03:47.480 --> 0:03:49.600 don't worry, you're a little head about it, because you're 0:03:49.640 --> 0:03:52.119 fine now and your baby's fine, and go home and 0:03:52.400 --> 0:03:55.320 live your life and be happy that everything's okay. And 0:03:55.400 --> 0:04:02.520 so her experience was completely erased. Being a professional athlete, 0:04:02.560 --> 0:04:06.000 I just thought that will never happen to me. Olympic 0:04:06.080 --> 0:04:09.720 runner Alison Felix became one of the fifty thousand women 0:04:09.880 --> 0:04:14.880 who nearly died from pregnancy related complications in two thousand eighteen. 0:04:15.520 --> 0:04:20.200 During her pregnancy, she was diagnosed with severe preclampsia, a 0:04:20.279 --> 0:04:24.560 condition characterized by high blood pressure that puts mothers at 0:04:24.680 --> 0:04:28.640 risk for stroke, among other things. The only cure for 0:04:28.680 --> 0:04:32.200 severe cases like Allison's is to get the baby out. 0:04:32.560 --> 0:04:35.479 So it just thirty two weeks she had to deliver 0:04:35.600 --> 0:04:40.800 her daughter, Cameron, via emergency c section. It happened so 0:04:40.920 --> 0:04:44.440 fast she didn't even realize how much danger she was 0:04:44.480 --> 0:04:48.640 in during and after the birth. My family was definitely 0:04:48.760 --> 0:04:51.080 very concerned, and I think that they were even more 0:04:51.160 --> 0:04:55.479 concerned than I was, because obviously all of my attention 0:04:55.600 --> 0:04:57.960 was on Cameron, and I was consumed with how she 0:04:58.160 --> 0:05:00.599 was doing and all of that. Um But I was 0:05:00.640 --> 0:05:03.560 still having issues with my blood pressure and we were 0:05:03.600 --> 0:05:07.239 still trying to get that to be at a manageable level, 0:05:07.279 --> 0:05:10.200 and so I was still in the hospital for several days. 0:05:10.279 --> 0:05:14.559 After both Cameron and I were together, UM and uh 0:05:14.600 --> 0:05:17.279 for several weeks. I was still trying to regulate my 0:05:17.360 --> 0:05:21.040 own blood pressure. Today, both Alison and Cameron are happy 0:05:21.080 --> 0:05:24.320 and healthy, but the six time Olympic gold medalists is 0:05:24.400 --> 0:05:28.680 determined to not let her experience be erased. In May 0:05:28.720 --> 0:05:32.360 of two thousand nineteen, she testified at a House Ways 0:05:32.360 --> 0:05:36.800 and Means committee hearing about racial disparities in the maternal 0:05:36.839 --> 0:05:41.240 mortality crisis. First, let me welcome this Alison Felix, United 0:05:41.240 --> 0:05:44.360 States Track and Field star, nine time Olympic medalists, going 0:05:44.440 --> 0:05:50.400 through this experience, UM, and just feeling so scared as 0:05:50.400 --> 0:05:52.359 I went through it all. That was really the turning 0:05:52.400 --> 0:05:55.720 point from me and talking to girl friends and UM, 0:05:55.760 --> 0:05:58.640 just feeling like my friends are not even educated, you know, 0:05:58.760 --> 0:06:02.839 on this topic. It really pushed me to share my story. 0:06:02.920 --> 0:06:05.880 I'm a person who is, you know, more private, and 0:06:05.920 --> 0:06:09.159 so it was definitely something that was out of my 0:06:09.200 --> 0:06:12.360 comfort zone. My name is Alison Felix, and I am 0:06:12.440 --> 0:06:15.560 Cameron's mom, and I would like to share the story 0:06:15.640 --> 0:06:18.640 of the two most terrifying days of my life. What's 0:06:18.640 --> 0:06:22.320 scary about Allison's story is that she didn't realize anything 0:06:22.440 --> 0:06:27.320 was wrong until everything went very wrong. I had a 0:06:27.400 --> 0:06:30.320 really great pregnancy. I was I knew I wanted to 0:06:30.360 --> 0:06:33.760 come back to compete, so I was training. I was 0:06:33.800 --> 0:06:36.800 pretty much training four or five days a week. I 0:06:36.880 --> 0:06:39.839 was on the track, um, in the gym, in the pool, 0:06:40.320 --> 0:06:43.039 so you know, really intentional with the idea that you know, 0:06:43.080 --> 0:06:45.599 I was going to resume right back onto the track. 0:06:46.279 --> 0:06:49.120 And at thirty two weeks, I went into the doctor 0:06:49.200 --> 0:06:51.760 and I was just going for my routine checkup and 0:06:51.800 --> 0:06:54.279 so went in and immediately when I came in, I 0:06:54.320 --> 0:06:57.760 found out that I was spelling protein. And from there, 0:06:57.760 --> 0:07:01.400 my doctor sent me straight to the hospital or further monitoring, 0:07:01.760 --> 0:07:05.159 and um, it was not going well what they were seeing, 0:07:05.640 --> 0:07:08.279 and so I was admitted right away and I spent 0:07:08.440 --> 0:07:12.119 that night in the hospital. And that's when things really 0:07:12.160 --> 0:07:15.680 started to go downhill. You know, I was diagnosed with 0:07:15.760 --> 0:07:19.800 a severe case of pre clampsia, and um my blood 0:07:19.800 --> 0:07:22.560 pressure was through the roof, and you know, the baby 0:07:22.640 --> 0:07:25.720 was not doing well, and things happened just so quickly, 0:07:26.480 --> 0:07:29.160 and I was trying to wrap my head around what 0:07:29.200 --> 0:07:33.320 was happening and trying to understand what was happening, and UM, 0:07:33.960 --> 0:07:37.680 from there after that evening the next day, it continued 0:07:37.720 --> 0:07:40.400 to get worse, and UM, we realized that it was 0:07:40.720 --> 0:07:44.440 an emergency situation and that the only way out of 0:07:44.440 --> 0:07:48.120 it was to have an emergency c section and to deliver. 0:07:48.800 --> 0:07:52.920 So it was terrifying, you know, it was so far 0:07:53.000 --> 0:07:56.280 from what my birth plan was and UM, just trying 0:07:56.280 --> 0:07:59.720 to understand, you know, what was really going on camera. 0:08:00.280 --> 0:08:03.400 Just three pounds seven ounces when she was born and 0:08:03.560 --> 0:08:06.320 was taken to the Nick you right away, where she 0:08:06.360 --> 0:08:09.480 would stay for a month. But in addition to worrying 0:08:09.480 --> 0:08:13.160 about her PREMI day in and day out, Allison also 0:08:13.280 --> 0:08:17.120 had to heal from her own trauma. It was honestly 0:08:17.240 --> 0:08:20.920 very difficult. UM, all of my energy and all of 0:08:20.920 --> 0:08:23.440 my focus was really trying to be in the Nick 0:08:24.240 --> 0:08:27.400 seven and I was so concerned with everything that was 0:08:27.440 --> 0:08:31.040 happening with Cameron that UM, I felt very low on 0:08:31.080 --> 0:08:34.199 that list. UM. If it wasn't for my support system, 0:08:35.120 --> 0:08:37.840 I don't know, you know what if I would have 0:08:37.880 --> 0:08:40.720 taken so much care for myself. But my family really 0:08:40.760 --> 0:08:43.880 stepped up and UM, you know, made sure that I was, 0:08:44.400 --> 0:08:46.960 you know, going to doctor's appointments, making sure that I 0:08:47.040 --> 0:08:50.120 was taking my medication UM because I was still dealing 0:08:50.160 --> 0:08:53.240 with the blood pressure even well after I was released 0:08:53.240 --> 0:08:57.200 from the hospital. So having um other people helped me 0:08:57.600 --> 0:09:01.440 was um enormous Because as I was spending you know, 0:09:01.640 --> 0:09:03.720 night and day in the nick, you you could see 0:09:03.760 --> 0:09:08.400 how someone without means, without a support system, without good 0:09:08.480 --> 0:09:13.080 doctors or attentive doctors, could really fall through the cracks, 0:09:13.280 --> 0:09:16.840 can't you so easily? I mean, and I didn't deal 0:09:16.880 --> 0:09:20.480 with any postpartum depression, but I just kept thinking, Wow, 0:09:20.520 --> 0:09:23.720 if that had kicked in as well, UM, how could 0:09:23.720 --> 0:09:26.880 this have been manageable. It's just so much that it 0:09:26.920 --> 0:09:29.840 can feel overwhelming, and so my heart goes out to 0:09:29.920 --> 0:09:32.960 those two women who have to, you know, deal with 0:09:33.520 --> 0:09:36.440 these extra things on top of having a newborn in 0:09:36.600 --> 0:09:40.400 so many changes within your body. One of the biggest 0:09:40.440 --> 0:09:44.280 reasons Alison has turned to advocacy is she wants to 0:09:44.320 --> 0:09:49.000 get the message out her story can be anyone's story. Frankly, 0:09:49.480 --> 0:09:54.000 it's something she wished she had known leading up. I 0:09:54.040 --> 0:09:58.679 think that I was not UM prepared enough. You know, 0:09:58.880 --> 0:10:01.360 I wasn't told what to look out for. I wasn't 0:10:01.400 --> 0:10:04.720 told that I was at risk UM, and so That's 0:10:04.760 --> 0:10:08.000 something that I wish had gone differently. You know. I 0:10:08.040 --> 0:10:13.000 think had I known beforehand what to look out for, um, 0:10:13.080 --> 0:10:15.360 just that I was at risk, then I could have 0:10:15.440 --> 0:10:18.520 wrapped my head more around, you know, a possible stay 0:10:18.559 --> 0:10:20.600 in the Nike You and what that means and kind 0:10:20.640 --> 0:10:22.200 of all of these things. But it was it was 0:10:22.320 --> 0:10:25.400 terrifying to have to go through this ordeal and straight 0:10:25.440 --> 0:10:29.360 into you know, I was still dealing with the symptoms 0:10:29.840 --> 0:10:32.480 UM and the after effects of what I had been through, 0:10:32.600 --> 0:10:34.880 and straight into now my daughters in the nick You 0:10:35.040 --> 0:10:37.960 and what does life there look like? And I'm trying 0:10:38.000 --> 0:10:40.400 to manage all of that as well. And when you 0:10:40.440 --> 0:10:43.000 say you were at risk, what made you at risk 0:10:43.160 --> 0:10:46.240 for this? Just being a black woman? That made me 0:10:46.480 --> 0:10:50.600 at risk? And that is something that I didn't understand before. 0:10:50.920 --> 0:10:53.800 You know, I had heard. But I know, I'm a 0:10:53.800 --> 0:10:57.439 professional athlete, you know, I trained for a living, I'm healthy, 0:10:57.480 --> 0:11:00.440 I know how to eat right. I exercised throughout my ignancy, 0:11:00.480 --> 0:11:04.319 and I was um wanting to have this beautiful natural birth, 0:11:04.960 --> 0:11:07.439 and so I just didn't think it would be me, 0:11:07.559 --> 0:11:12.520 you know, And that is just such a misconception that um, 0:11:12.520 --> 0:11:15.080 that I want to bring awareness to that women of 0:11:15.120 --> 0:11:21.600 color are at risk. According to the Agency for Healthcare Research, 0:11:22.000 --> 0:11:26.080 black women are at least fifty more likely to experience 0:11:26.160 --> 0:11:31.040 preclampsia than white women. The effects are also more severe 0:11:31.400 --> 0:11:35.840 and present earlier than in other races. Did your doctor 0:11:35.920 --> 0:11:41.400 ever even mentioned the term preclampsia? I don't recall, you know, 0:11:41.520 --> 0:11:45.440 having that conversation, and so that's pretty scary looking back, 0:11:45.520 --> 0:11:48.840 you know, I would have loved to know, you know, 0:11:49.200 --> 0:11:51.280 these are the symptoms. These are things that you really 0:11:51.320 --> 0:11:55.160 should pay attention to UM and just be on the 0:11:55.160 --> 0:11:57.920 lookout for. Well, tell us what those are, because I 0:11:57.960 --> 0:12:03.000 feel like people listening can learn from your experience. So 0:12:03.040 --> 0:12:07.000 what are some of the symptoms swelling? Swelling is definitely 0:12:07.040 --> 0:12:08.520 one of the big ones. But I think what makes 0:12:08.559 --> 0:12:11.960 it also scary is that sometimes you don't have any symptoms, 0:12:11.960 --> 0:12:15.679 and so I really feel like I fell into that category. 0:12:15.720 --> 0:12:18.120 I mean, the swelling was one thing, but other than that, 0:12:18.160 --> 0:12:21.280 I felt really good, and so that is really scary. 0:12:21.360 --> 0:12:25.080 But UM headaches can be a symptom along you know, 0:12:25.120 --> 0:12:31.559 the swelling. UM also rapid weight gain, UM, vomiting. So 0:12:31.640 --> 0:12:34.559 there are some things to be on the lookout for, 0:12:35.280 --> 0:12:39.760 but really more than anything consistent, your consistent healthcare. Because 0:12:40.040 --> 0:12:42.600 once you go in to have your appointment and you 0:12:42.640 --> 0:12:45.839 see that you're spelling protein, that is an indicator, um, 0:12:45.960 --> 0:12:48.720 right there, that something is not right. Spelling protein means 0:12:49.120 --> 0:12:52.080 protein in your urine, so there's successive amounts of it 0:12:52.240 --> 0:12:56.440 and your urine. It's interesting, do they understand why Black 0:12:56.480 --> 0:12:59.760 women are at higher risk other than just the sheer 0:12:59.800 --> 0:13:03.320 no bursts of women who experienced preclampsia. Yes, I mean, 0:13:03.360 --> 0:13:06.160 I'm far from an expert on this, but from my understanding, 0:13:06.240 --> 0:13:09.640 that is what we need more research to be done, 0:13:09.840 --> 0:13:12.480 um and to be able to understand because some of 0:13:12.480 --> 0:13:15.800 the contributing factors that we know about, you know, not 0:13:15.880 --> 0:13:19.720 having as high of healthcare, we're seeing this happen in 0:13:19.800 --> 0:13:23.839 really privileged black women. Beyonce reveals for the first time 0:13:24.080 --> 0:13:27.360 the harrowing emergency she had while pregnant with twins in 0:13:27.400 --> 0:13:33.079 two thousand seventeen. Beyonce also suffered preclampsia during her pregnancy 0:13:33.160 --> 0:13:36.840 and had to deliver her twins via emergency C section. 0:13:37.840 --> 0:13:42.160 Tenn's great Serena Williams with baby Alexis Olympia shares her 0:13:42.240 --> 0:13:46.760 harrowing ordeal for Serena Williams, it was something else Entirely 0:13:47.200 --> 0:13:51.160 after giving birth via emergency C section, Serena had to 0:13:51.200 --> 0:13:54.040 beg staff to take her pain and her understanding of 0:13:54.080 --> 0:13:58.640 her own body seriously. She nearly died first of a 0:13:58.679 --> 0:14:03.439 blood clot and then a hemorrhage. If Serena Williams struggles 0:14:03.480 --> 0:14:06.520 to be heard, it's clear this isn't just a matter 0:14:06.720 --> 0:14:11.000 of access to good care. I think a big factor 0:14:11.040 --> 0:14:13.439 in it, as well as having to advocate for your 0:14:13.440 --> 0:14:17.840 own for yourself UM. For some reason, either the tolerance 0:14:17.840 --> 0:14:21.320 of pain or black women's pain in general is not believed, 0:14:21.400 --> 0:14:25.160 and that is something that has to change. Do you 0:14:25.160 --> 0:14:29.840 think racism played a role in your your experience looking back, 0:14:30.000 --> 0:14:35.160 I it's really hard to pinpoint, but I think that 0:14:35.200 --> 0:14:38.480 there might have been some of that implicit uh bye 0:14:38.520 --> 0:14:43.000 is going on in my UM doctor's appointments previously. Really 0:14:43.200 --> 0:14:46.880 why you know, do you think that that the doctor 0:14:46.880 --> 0:14:51.560 whoever your doctor was, was educating, say, a white patient. 0:14:51.760 --> 0:14:55.120 More about this, I think when when I look back, 0:14:55.360 --> 0:14:59.080 I guess it definitely wasn't outright, that was not my 0:14:59.160 --> 0:15:02.280 situation at all. But the fact that I that this 0:15:02.360 --> 0:15:05.680 wasn't a conversation that I wasn't discussed, especially as you said, 0:15:05.720 --> 0:15:08.840 since you were at greater risk. Yes, I feel like 0:15:09.080 --> 0:15:13.160 every woman of color you know immediately that you should 0:15:13.160 --> 0:15:17.040 be sat down and explained that you know, this is 0:15:17.040 --> 0:15:19.520 something you're at risk for. Do you think had you 0:15:19.640 --> 0:15:23.520 not had the resources that you have, had you not 0:15:23.760 --> 0:15:27.560 been an Olympic athlete, had you not been able to 0:15:27.600 --> 0:15:31.240 get the best medical care possible, that there's a chance 0:15:31.280 --> 0:15:33.600 that you might not be here. I think it's a 0:15:33.640 --> 0:15:37.840 possibility for sure. And that is what really is scary 0:15:37.880 --> 0:15:41.480 to me. And that's what really wanted me to open 0:15:41.960 --> 0:15:45.040 up and to share my experience in my story, because 0:15:45.080 --> 0:15:46.960 I felt like, you know, I had the best of 0:15:47.000 --> 0:15:49.680 the best, you know, and I still ended up in 0:15:49.720 --> 0:15:51.920 a situation that was really scary and that we weren't 0:15:51.960 --> 0:15:55.880 sure about. And if I'm experiencing this, someone who might 0:15:55.920 --> 0:15:58.880 not have the best of health care, or might not 0:15:59.040 --> 0:16:01.840 have even been heard to the level that I was, 0:16:02.560 --> 0:16:07.120 might not have made it. When we come back how 0:16:07.200 --> 0:16:11.160 some states are managing to turn their maternal mortality rates around. 0:16:23.320 --> 0:16:26.640 In Part one, we met Deborah Bingham, a registered nurse 0:16:26.680 --> 0:16:29.640 with a doctorate in public health who spent her career 0:16:29.720 --> 0:16:33.160 focusing on improving the health of moms and babies. In 0:16:33.200 --> 0:16:36.200 two thousand and six, as the founding executive director of 0:16:36.280 --> 0:16:42.040 California's first Maternal Quality Care Collaborative, Deborah learned that California's 0:16:42.120 --> 0:16:46.440 maternal mortality rate had actually been going up. We then 0:16:46.960 --> 0:16:50.960 sought permission to talk about this in small groups. As 0:16:51.000 --> 0:16:55.520 we went around organizing the California Maternal Quality Care Collaborative, 0:16:55.840 --> 0:16:59.840 I would hear gaps in the room from the clinicians 0:17:00.040 --> 0:17:03.840 in that space, so that would be physicians, registered nurses, 0:17:03.880 --> 0:17:08.240 and midwives who were running hospitals leading uh and also 0:17:08.440 --> 0:17:14.080 public health leaders literally gasping at this was brandon news. 0:17:14.200 --> 0:17:18.080 Nobody had expected this. We did not think that it 0:17:18.119 --> 0:17:20.879 would be on our watch that we would see this rise. 0:17:21.680 --> 0:17:24.760 Deborah and her committee of experts reviewed three years of 0:17:24.800 --> 0:17:27.960 maternal deaths that occurred in the state, and one of 0:17:28.000 --> 0:17:31.800 the things they found was that death by hemorrhage could 0:17:31.840 --> 0:17:35.359 often be prevented. We found that there was quite a 0:17:35.359 --> 0:17:38.480 bit of denial and delay had led to these deaths, 0:17:38.800 --> 0:17:42.639 meaning that women were not um the severity of the 0:17:42.680 --> 0:17:47.879 hemorrhage was not recognized early enough. They We're not getting 0:17:47.920 --> 0:17:53.760 blood early enough, which is life saving. Obviously and um 0:17:53.840 --> 0:17:57.000 and so a lot of our efforts became around how 0:17:57.119 --> 0:18:03.399 to eliminate this denial and delay, how to better recognize hemorrhages, 0:18:03.440 --> 0:18:07.159 how to better prepare. What Debora ultimately did was to 0:18:07.240 --> 0:18:11.720 help create a standardized action plan to help tackle potentially 0:18:11.800 --> 0:18:16.720 fatal complications like hemorrhage. Debora refers to these plans as 0:18:16.800 --> 0:18:21.439 quality improvement toolkits or safety bundles. They can be implemented 0:18:21.440 --> 0:18:24.760 in hospitals in different ways, but they typically include a 0:18:24.840 --> 0:18:31.200 checklist of the four rs or steps to improve readiness, recognition, response, 0:18:31.280 --> 0:18:35.239 and reporting so that women receive life saving medications and 0:18:35.280 --> 0:18:39.199 treatments in time. In addition to the hemorrhage safety Bundle, 0:18:39.520 --> 0:18:43.879 there's also one for preclampsia and reduction of C sections. 0:18:44.200 --> 0:18:46.840 And I think my years of being in a frontline 0:18:46.840 --> 0:18:51.280 position in the hospitals and actually running hospitals and knowing 0:18:51.320 --> 0:18:55.280 how busy you are in those in those roles, helped 0:18:55.320 --> 0:18:59.080 me put together a model that would be very practical, 0:18:59.800 --> 0:19:02.200 uh and also just kind of cut through a lot 0:19:02.240 --> 0:19:05.720 of cripheral information and what would it take to actually 0:19:05.760 --> 0:19:08.760 really save lives and what did people really need to do? 0:19:09.240 --> 0:19:14.560 Safety bundles also include preparation protocols like running simulation drills 0:19:14.640 --> 0:19:17.720 and huddling with staff and family as the mother is 0:19:17.760 --> 0:19:21.840 being admitted to the hospital to assess possible risks she 0:19:21.880 --> 0:19:27.200 may have. California is one of the only states that 0:19:27.520 --> 0:19:30.560 has seen a rise in maternal mortality and also a 0:19:30.640 --> 0:19:34.600 decrease in fact um. Their data shows that in a 0:19:34.640 --> 0:19:39.439 five year period UH that there was about a fifty 0:19:40.280 --> 0:19:46.359 decrease in pregnant in maternal mortality, and that was unbelievably 0:19:46.480 --> 0:19:52.000 unexpected that we would see that decrease so quickly. Back 0:19:52.000 --> 0:19:56.399 in two thousand and six, California's maternal mortality rate was 0:19:56.520 --> 0:20:01.760 just shy of seventeen deaths per one thousand live births. Today, 0:20:01.800 --> 0:20:05.760 that number, according to an investigation by USA Today, has 0:20:05.840 --> 0:20:09.320 dropped to four deaths in one hundred thousand. That's the 0:20:09.359 --> 0:20:12.840 lowest maternal mortality rate in the country, and now other 0:20:12.960 --> 0:20:16.360 states are trying to follow suit. New Jersey has one 0:20:16.359 --> 0:20:19.680 of the highest national rates, at thirty six point two 0:20:19.680 --> 0:20:23.920 deaths per one hundred thousand live births. Deborah Bingham has 0:20:24.000 --> 0:20:26.440 joined a team in New Jersey to turn that around. 0:20:26.920 --> 0:20:31.280 The initiative, launched in two thousand nineteen is called Nurture 0:20:31.480 --> 0:20:35.520 New Jersey. New Jersey is the medicine cabinet of America 0:20:35.680 --> 0:20:39.320 and has some of the finest hospital systems in the 0:20:39.400 --> 0:20:43.399 United States. First Lady Tammy Murphy is the driving force 0:20:43.520 --> 0:20:49.720 behind this new initiative. So my naive assumption was that 0:20:49.880 --> 0:20:55.719 this all centered around access to prenatal care. And you know, 0:20:55.880 --> 0:21:00.520 it became immediately clear after going on a listening to 0:21:00.560 --> 0:21:03.520 her all around the state and speaking with all stakeholders, 0:21:03.520 --> 0:21:08.280 whether they be the hospital systems, foundations, nurses, dulas, midwives, 0:21:08.320 --> 0:21:13.239 any stakeholders who were out there, that the problem was 0:21:13.800 --> 0:21:19.040 much more complicated than I had assumed. Um, the problem 0:21:19.280 --> 0:21:21.400 is truly if you're going to look at this, it's 0:21:21.440 --> 0:21:27.680 systemic racism and implicit bias, and it brings in all 0:21:27.720 --> 0:21:32.280 the social determinants of health. And so our goal is 0:21:32.320 --> 0:21:39.159 to uh not only reduce maternal mortality by over five years, 0:21:39.200 --> 0:21:43.120 but it's also to eliminate racial disparities and birth outcomes. 0:21:43.480 --> 0:21:46.560 Tammy Murphy says, despite the new challenges posed by the 0:21:46.560 --> 0:21:51.239 coronavirus pandemic, the work of Nurture New Jersey continues, and 0:21:51.320 --> 0:21:54.880 considering the fact that racial health disparities have only been 0:21:54.920 --> 0:21:58.639 exacerbated by the spread of COVID nineteen. She says this 0:21:58.720 --> 0:22:04.119 work is more relevant and necessary than ever. There's good 0:22:04.119 --> 0:22:07.520 news for pregnant women and mothers all over the country. 0:22:07.640 --> 0:22:11.240 At the end of two thousand eighteen, Congress passed groundbreaking 0:22:11.320 --> 0:22:16.200 legislation called the Preventing Maternal Deaths Act. The law addresses 0:22:16.280 --> 0:22:18.880 one of the fundamental problems at the heart of the crisis, 0:22:19.240 --> 0:22:23.399 the severe lack of reliable data about what actually kills 0:22:23.600 --> 0:22:28.000 American mothers. That was a very important piece of legislation 0:22:28.000 --> 0:22:32.200 that Congress passed. Again, Nina Martin, the set aside a 0:22:32.280 --> 0:22:37.320 lot of money for states to create maternal mortality review committees, 0:22:37.359 --> 0:22:41.760 to standardize them UM, to make them much more robust, 0:22:42.080 --> 0:22:45.919 much more helpful, um much more efficient than they have 0:22:46.000 --> 0:22:49.960 been in the past. That's really incredibly important. A lot 0:22:50.000 --> 0:22:53.320 of states when we started this process didn't even have 0:22:53.440 --> 0:22:56.920 maternal mortality committees, and now almost all of them do. 0:22:57.440 --> 0:23:01.920 The ones that did have them have UM improved to them, 0:23:02.960 --> 0:23:05.320 and so that's a that's a huge change. We're learning 0:23:05.400 --> 0:23:09.120 so much from that process. Some states are also trying 0:23:09.119 --> 0:23:13.359 to tackle the issue of insurance Medicaid finances. Nearly half 0:23:13.400 --> 0:23:16.880 of all births in the United States, Yet new mothers 0:23:16.920 --> 0:23:21.320 on Medicaid are only guaranteed care for two months after 0:23:21.440 --> 0:23:24.840 they deliver. What states are trying to do is to 0:23:25.280 --> 0:23:28.760 change the rules that allow women to continue to have 0:23:28.840 --> 0:23:33.000 Medicaid for the full year along with their babies postpartum. 0:23:33.080 --> 0:23:36.000 And so that means, you know, a lot of support 0:23:36.040 --> 0:23:41.520 for mental health, for substance use disorders, for cardiac problems, 0:23:41.600 --> 0:23:44.239 all the things that we know are killing women in 0:23:44.240 --> 0:23:47.359 that first year. What we know from the from the 0:23:47.480 --> 0:23:53.399 data is that most maternal deaths don't happen during pregnancy. 0:23:53.480 --> 0:23:57.520 They don't happen in the hospital. They happen um when 0:23:57.600 --> 0:24:01.160 women go home, they go They happen in the postpartum period. Um, 0:24:01.200 --> 0:24:04.440 they happen, you know, sometimes it's a week, sometimes it's 0:24:04.480 --> 0:24:06.919 two weeks, Sometimes it's a month, Sometimes it's up to 0:24:06.960 --> 0:24:12.080 a year. So it's incredibly important for women to understand 0:24:14.240 --> 0:24:18.000 that and for doctors and nurses and midwives and everybody 0:24:18.000 --> 0:24:23.800 to understand how risky the postpartum period is, and also 0:24:24.119 --> 0:24:27.520 to give women the information that they need to be 0:24:27.600 --> 0:24:36.480 able to recognize concerning symptoms. According to the c d C, 0:24:37.119 --> 0:24:40.359 thirty six percent of pregnancy related deaths occur up to 0:24:40.440 --> 0:24:45.399 one week after giving birth, and then another thirty happen 0:24:45.520 --> 0:24:49.359 up to a year postpartum, and it's impossible to predict 0:24:49.440 --> 0:24:53.200 which women will suffer such fatal complications, which is why 0:24:53.280 --> 0:24:56.040 Deppa being Him says it's important that all women are 0:24:56.160 --> 0:25:02.200 educated on symptoms. Her organization, the Institute for Perinatal Quality Improvement, 0:25:02.720 --> 0:25:06.520 is helping hospitals do just that. We actually made one 0:25:06.600 --> 0:25:09.600 hand out called Savior Life hand Out, which it outlines 0:25:09.640 --> 0:25:12.680 all of those post birth warning signs. So that's to 0:25:12.800 --> 0:25:18.440 help empower women to know when to seek care. Warning warning. 0:25:19.119 --> 0:25:21.560 My name is Stephanie. I'm going to be your discharged 0:25:21.600 --> 0:25:25.320 that I needs to meet you. Congratulation. N y U 0:25:25.560 --> 0:25:27.920 Land Gone in New York City is just one hospital 0:25:28.040 --> 0:25:30.760 that has put Deborah Savior Life hand out to use 0:25:31.280 --> 0:25:35.720 as part of its postpartum discharge education. But sometimes it's 0:25:35.760 --> 0:25:39.879 hard for overwhelmed new moms to absorb critical information about 0:25:39.920 --> 0:25:43.840 life threatening health issues. So n YU now sends families 0:25:43.920 --> 0:25:47.600 home with a Savior Life Magnet, which reminds moms so 0:25:47.720 --> 0:25:50.280 the symptoms they need to be aware of. I have 0:25:50.400 --> 0:25:54.159 this really helpful acronym here, it's post birth. So p 0:25:55.040 --> 0:25:58.080 IS stands for a painting your chest, OH stands for 0:25:58.200 --> 0:26:02.560