Arkansas Online

Maternal mortality targeted in state

UAMS professor tells of progress

RYAN ANDERSON

Arkansas fares worse than the national average in terms of maternal mortality and morbidity.

But the state has made positive strides in recent years, and there are several areas where more improvements could be realized.

Those are the conclusions of Dr. Nirvana Manning, chairperson and associate professor in the Department of Obstetrics and Gynecology at the University of Arkansas for Medical Sciences. Manning made a presentation at a meeting of the board of trustees of the University of Arkansas System last week.

The pregnancy-related mortality ratio per 100,000 births in Arkansas was nearly twice as high for women as the national average in 2018, and rural, low-income and Black women generally have higher rates of maternal mortality and morbidity, Manning told trustees on Wednesday at the meeting, which was held at the University of Arkansas at Little Rock. This “is not a small issue, and it [impacts] all corners of our state.”

Teen pregnancies have profound socioeconomic impacts for the state, and 28% of births in the state are to those ages 15-19,

nearly 11% higher than the national rate, she said. Nearly 30% of teen pregnancies in the state are second or even third pregnancies.

The vast preponderance of the state’s 75 counties have zero or only one hospital or birthing center, she said. Only seven counties have two or more hospitals or birthing centers, and it’s paramount to expand access so rural women can have treatment similar to those in urban centers.

The state has taken steps to address maternal mortality, such as establishing the Arkansas Maternal Mortality Review Committee in 2020, which provides critical “real data,” while the Arkansas Maternal and Perinatal Outcomes Quality Review Committee reviews all maternal deaths, she said. Arkansas also joined 48 other states as a member of the Alliance for Innovation in Maternal Health in October 2022.

A $1.2 million, five-year grant from the U.S. Centers for Disease Control and Prevention for UAMS and the Arkansas Department of Health will help develop patient engagement tools for hospitals and educate and support patients and providers, she said. It’ll also allow for data collection that will promote better care and support in rural areas.

ANGELS, a program focused on succoring women with high-risk pregnancies established in 2003 by UAMS, has grown significantly since inception, and its 24/7 consultation call center fields more than 170,000 annual calls, according to the latest data reports, she said. The network of telemedicine has been particularly effective and popular, with more than 2,700 annual telemedicine visits.

The Prenatal Outcomes Workgroup through Education and Research (POWER) at UAMS aims to help the state’s 37 delivering hospitals implement maternal safety bundles to improve patient outcomes through live and virtual sessions, interactive video meetings, workshops and simulations, and telemedicine opportunities, she said. “We take our show on the road” to hospitals throughout the state.

CenteringPregnancy began in Central Arkansas, spread to Northwest Arkansas, and will soon move to the Arkansas Delta with a grant, she said. CenteringPregnancy “empowers women to be actual participants in their health care and develop a cohort of support” through providing evidence-based prenatal care to mothers that includes their regular checkups and additional time for health education and social support.

Participants spend four times as much time with a provider as nonparticipants, she said. There’s been a 12% reduction in chances of low birth weights and a 6% reduction in chances of very low birth weights for participants.

The Remote Patient Monitoring program at UAMS focuses on connecting rural and high-risk patients with providers when there are health concerns, and it’s “become instrumental in our field,” she said. In addition, “I can’t tell you how impactful” community-based programs of UAMS — such as Healthy Start, which serves more than 1,000 families, and Following Baby Back Home, which serves more than 1,500 families — are “to obstetric care.”

A $600,000 grant will allow more work in the area of long-acting reversible contraception, she said. “When patients are in control of their pregnancies, they can make decisions for their health care.”

Expanding access to long-acting reversible contraception in the immediate postpartum period is one of several things the state could do to improve these health outcomes, she said. Arkansas could also expand Medicaid to 12 months postpartum, as 26 other states have already done, and invest in the maternity care workforce for rural areas.

The latter includes obstetric training for family medicine physicians and expanding the certified nurse midwife workforce, she said. Nationally, nearly a third of rural births have a certified nurse midwife as part of the hospital delivery team, but in Arkansas that figure is under 0.5%.

UAMS has also applied for a $16 million, five-year grant to address postpartum care in patients that would expand visits, she said. “If we want to make strides in rural areas, we need to look at this [problem] from all these different aspects.”

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2023-01-29T08:00:00.0000000Z

2023-01-29T08:00:00.0000000Z

https://edition.arkansasonline.com/article/281934547085872

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