Maternal Mortality Becomes An Issue For Population Health

By Katie Moriarty, PhD, CNMF, CAFCI, RN

The Detroit News article on maternal mortality (“Detroit’s Maternal Death Rate Triples the Nation” July 10) highlights the disturbing statistics regarding maternal mortality in Michigan, particularly the City of Detroit.  The article states that experts attribute the increased maternal death rates to uncontrolled chronic health conditions and issues surrounding poverty and access to care.

While the United States spends much more on health care, its performance lags far behind other developed nations on quality indicators.  Research documents that care of childbearing women and their newborns is by far the most common reason for hospitalization and its care is the most costly hospital conditions for both Medicaid and private insurers.  The overuse of many interventions puts women and babies at risk and increases cost.  We are doing more and paying more and yet we are accomplishing less – it is termed the “Perinatal Paradox”.  Wide variations exist within health care practice across different providers, hospitals, and even geographic areas. There is an evidence-practice gap in our maternity care in the United States.  In order to close that gap it will entail active roles from policy makers, health systems, clinicians, payers, consumers and the media.  We need to address the overuse of harmful interventions and increase the use of many underused maternity practices which have been shown to be effective, such as in-home nurse counseling.  We need to ensure that all mothers and babies receive evidence-based care that is safe, effective, and satisfying.

The Coalition for Evidence-Based Policy, a non-profit, non-partisan organization, identifies the Nurse-Family Partnership (NFP) as the only prenatal or early childhood program that meets its “Top Tier” evidence standard, which is used by the U.S. Congress and the executive branch to distinguish research-proven programs.   The Detroit Wayne County Health Authority implements the NFP program in Detroit.

NFP is a home visiting program for low-income women having their first time babies.  Each woman is paired with a bachelors-prepared nurse who provides clients with home visits throughout their pregnancy, until the child’s second birthday.  The program has three main goals to improve pregnancy outcomes:

• Help women engage in good preventive health practices, including thorough prenatal care from their healthcare providers, improving their diets, and reducing their use of cigarettes, alcohol and illegal substances.
• Improve child health and development by helping parents provide responsible and competent care.
• Improve the economic self-sufficiency of the family by helping parents develop a vision for their own future, plan future pregnancies, continue their education and find work.

NFP evaluates the client’s health status on their intake into the program and continues the evaluation throughout the program. The program addresses personal health, environmental health, needs for health and human services, relationships with family and friends along with their maternal role, and life course development.

As an evidence-based, community health program, NFP helps transform the lives of vulnerable first time mothers with over 37 years of research from a series of randomized, clinical trials of the NFP program, including research published in the June 2014 edition of the Journal of American Medical Association – Pediatrics.

NFP is client centered meaning that it is adapted to be relevant and valued by the woman and the family.  The program is based on adult learning and behavior change theory—and the belief that changes are most successful when building on your own knowledge, strengths and successes.  The program is multidimensional with a holistic view to different and varied aspects of their lives.   With approximately 2,400 first-time mothers enrolled in the Healthy Michigan and traditional Medicaid health plans in Detroit, and the startling mortality statistics that were noted in the Detroit News article, we need to make evidence-based programs like NFP more accessible.

Katie Moriarty, PhD, CNM, CAFCI, RN, is a certified nurse midwife and director of the Nurse-Family Partnership in Detroit. She can be reached at kmoriarty-nfp@dwcha.org.