Mary Norine Walsh, MD, immediate past president of the American College of Cardiology, discusses the cause of the recent increase in maternal mortality, and the importance of team-based care to address it.
The United States has seen an increase in maternal deaths. Some attribute this to better reporting, others say it indicates a rise in comorbidities and a lack of equal access to care. Can better approaches to team-based care close these gaps?
Well, the rise in maternal mortality is really concerning because we don't see this worldwide. In fact, maternal mortality is declining worldwide, but not in the United States. I do think it's multifactorial— we certainly cannot simply say that we're counting patients more accurately than we did in the past, that's absolutely not the sole issue that we're dealing with.
The age of first birth has risen in the United States year on year recently. With that we do see an increase in comorbid conditions such as high blood pressure, diabetes, even coronary artery disease and valvular disease. Assessing women in advance of pregnancy, if possible, is very important. But the thing we really need to focus on is a team— a cardio-obstetric team that if a woman does develop hypertension, preeclampsia, signs and symptoms during pregnancy, or soon after delivery. We have to have a team in place that is knowledgeable about these diseases and conditions in pregnant and postpartum women so that we can rapidly take care of a patient as a team.
That team would involve maternal fetal medicine physicians, nurses, OB/GYN's, cardiologists, midwives, nurse practitioners, the whole team working together to make sure that the woman is cared for very well.