NEW BEDFORD — A state Department of Public Health report released this month indicates that instances of severe maternal morbidity (SMM) almost doubled in Massachusetts over a nine-year period, from 52.3 per 10,000 deliveries in 2011, to 100.4 in 2020. Furthermore, it was found that Black non-Hispanic birthing people consistently had the highest SMM rates — up to 2.5 times higher than white non-Hispanic birthing people.
Meanwhile, a head Southcoast Health physician says the local health care system hasn’t been immune to the general rise in SMM, noting that Southcoast Health has observed that the increase has continued since 2020 after dropping slightly that year.
“It’s something we’re very worried about, because every statistic has a face to it,” said Southcoast critical care physician and Chief Clinical Officer Dr. Dani Hackner.
Why the rise in severe maternal morbidity, and its racial discrepancies?
According to Hackner, there are a number of speculatory factors that come into play in discussions within the medical field around why the rise in SMM and the discrepancies therein have materialized.
“We know there are different rates of diabetes, hypertension and pregnancy-associated hemorrhage by group…. We also know there are significant differences in how different groups access health care,” he said, noting historical difficulties for some groups in receiving proper medical care which have led to some being less likely to seek help, or to seek it early enough.
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Hackner said there is also the fact that there’s been a rise in the general population’s average weight and body mass index, pointing to an area of the DPH report highlighting a link between obesity/weight gain and higher rates of SMM.
“So when you combine some of the unknown scientific and medical factors, plus the access issues, plus the known changes in the population as a whole, they appear to be combining to produce these very worrisome outcomes,” Hackner said.
What is being done to combat severe maternal morbidity?
To mitigate the factors thought to be contributing to the troubling data, DPH outlined a number of “actions” in its report, including establishing a statewide Maternity Health Task Force, funding SPEAK UP Against Racism trainings, and launching remote blood pressure monitoring pilot programs. It was also announced that, starting some time later this year, MassHealth — which covers about 40% of births in Mass., including a “disproportionate share of birthing people of color” — will cover doula services for maternity patient members.
“The fact that these rates and the gaps have continued to worsen over time indicates that Black non-Hispanic birthing people have not benefited from improved medical knowledge and care,” said Hafsatou Diop, MD, MPH, Director of the Division of Maternal and Child Health Research and Analysis at DPH. “It has been long recognized that racism — not race — is the risk factor, as it leads to discriminatory beliefs and behaviors toward Black non-Hispanic birthing people.”
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At Southcoast Health, Hackner says measures being taken to address issues related to SMM and its population discrepancies include participating in a number of equity coalitions, such as the Perinatal Neonatal Quality Improvement Network (PNQUIN), and carrying robust language translation services. Then there are other efforts that less directly related to SMM, but issues believed to be adjacent, such as the Southcoast Cares About My Diabetes program, and programming around substance abuse.
“Substance use treatment and support, which affects all communities, is one area where we’ve seen a lot of success,” he said, noting Southcoast’s recently expanded New Beginnings maternity program. “We think it’s something that could make a difference in the perinatal outcomes for families.”
What should birthing people do?
Hackner says the best way maternity patients can ensure preparedness for any birthing difficulties is to access care at an early point.
“Pregnancy typically is uneventful, and many individuals who see themselves as healthy don’t seek care early,” he said. “There are some individuals who show up on our doorstep who haven’t received prenatal care, or perhaps it was fragmented — it wasn’t at our organization or it wasn’t continuous, things weren’t communicated to us — so that is a challenge.”
For medical professionals, Hackner says the important thing to remember is that regardless of race, pre-existing conditions or other factors, “each population, each individual is different.”
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“Our challenge is to better understand and to speak to people in a way that gives them confidence in the health system to access care early. That’s so important,” he said. “This is one of the important areas that we will be continuing to work on in the coming years.”
