Addressing the Disparity in Maternal Healthcare Helps Moms and Babies

As a child growing up in Milwaukee, Wisconsin, Dr. Meredith Cruz watched her two uncles use their position as doctors to help others. Her uncles’ unflagging willingness to serve both community and family factored strongly in her eventual decision to become an obstetrician — and to help prevent birth defects.

“They were so generous and helpful,” says Dr. Cruz. “The power they had as physicians to make change in people's lives made a huge impact on me.”

Today, Dr. Cruz follows her uncles’ example while forging her own path. As Medical College of Wisconsin’s Maternal Fetal Medicine Fellowship Director in the Department of Obstetrics & Gynecology, she helps prevent birth complications and defects by addressing problems before they start.

Congenital malformations (i.e., birth defects) were the leading cause of infant mortality in the U.S. in 2020.[1] Many of these birth defects can be traced directly to the mother’s health, diet, environment, and the prenatal care she receives — or doesn’t, as is the case for far too many women of color and lower socioeconomic levels. The U.S. Centers for Disease (CDC) Control and Prevention National Center for Health Statistics reported a 2018 Maternal Mortality rate of 37.3 deaths per 100,000 live births for Black women; a major gap from both non-Hispanic white (14.9) and Hispanic women (11.8).[2] Additionally, one study looking at 13.5 million live births found American Indians/Alaska Natives had 50% or greater prevalence for seven major birth defects while there was a significantly lower prevalence with non-Hispanic white women.[3] These risks, along with increased risk for preterm delivery, low birth weight, and stillbirth, for women of color can be attributed in large part to disparities in care before, during and following pregnancy.

“Many times, Black mothers aren’t getting proper care even before they get pregnant, so their health is not optimized for pregnancy,” says Dr. Cruz. “Then they receive poor healthcare while pregnant, which leads to poor birth outcomes.”

A variety of factors contribute to the racial and ethnic health disparities for women, including racism and implicit biases. In addition, Dr. Cruz notes the lack of access to quality healthcare. Fears about costs and an inability to secure transportation can be barriers to accessing care. “Many don’t have primary care doctors to begin with and don’t know how to go about finding an obstetrician or where to reach out for help,” says Dr. Cruz.

Dr. Cruz recalled one patient with a prenatal history of heart attacks who lived about 45 minutes from Milwaukee and didn’t have access to a doctor who specialized in high-risk pregnancies. The physician at the hospital initially didn’t realize how sick the patient was, so her heart continued to deteriorate as the pregnancy progressed. The patient eventually had to be transferred to Dr. Cruz’s care.  

“They realized she needed to be treated at a big center with the appropriate resources,” Dr. Cruz says. “Sometimes, doctors in small communities delay transferring patients because they don’t have the experience with high-risk patients.”

Dr. Cruz decided a controlled delivery in the ICU gave the mother the best chance for a successful delivery. She induced labor early to prevent continuing deterioration of the woman’s heart — and her fetus. After several weeks in the neonatal intensive care unit, the baby was discharged. Unfortunately, the mother never returned for any of her postpartum appointments.

“A lot of times, these patients can't just drive for 45 minutes each way to see a specialist,” Dr. Cruz says.

Social reasons also play a part in the disparity. Single mothers and women juggling multiple jobs can find it difficult to schedule doctor’s appointments — or can end up skipping the visit. If they miss a payment, some patients think they can’t go back to the doctor. Even the cost of a healthy diet can trip up low-income women, says Dr. Cruz.

“You’re supposed to eat a balanced diet when you’re pregnant,” she says. “But that's not something that's always feasible for minority populations in our society because of the cost.”

High incidences of comorbidities, such as obesity, diabetes, and high blood pressure, put extra pressure on women’s bodies when they get pregnant and can lead to complications. One of Dr. Cruz’s patients with a very high body mass index delivered a baby with a heart defect that had been missed because of the mother’s weight. The fetus couldn’t be visualized clearly because the ultrasound waves could not penetrate her abdomen.

Some of the tools Dr. Cruz uses to proactively monitor her patients and their babies are GE Healthcare’s ultrasound solutions including Voluson and the Corometrics Fetal Monitor[4]. Both include features designed with high-risk pregnancies in mind, like Dr. Cruz’s patient with a high BMI.

Monitoring during antepartum, intrapartum and postpartum care provides physicians like Dr. Cruz the data needed to confidently and efficiently care for their patients.

When designing products and services that assist physicians in caring for women and babies, GE Healthcare considers various levels of acuity, says Lucas Delaney, General Manager for Maternal Infant Care at GE Healthcare’s Life Care Solutions business.

“Disparities in care could mean disparities in outcomes,” Delaney says. “We work directly with clinicians when creating new solutions to solve unmet needs and assist them in achieving better outcomes – while helping to empower women in their healthcare choices.

There’s no single solution that will ensure all pregnant women receive equal, high-quality healthcare before, during and after their pregnancies. Good first steps are bringing physicians and the tools they need to provide care into underserved communities.

“Education is key to promoting good pregnancy outcomes,” says Delaney. “In recognizing that disparities persist, providers can work to eliminate unconscious biases that may prevent women from receiving the care they need.”

A recent study found that participants who attended a childbirth class during pregnancy had higher rates of normal vaginal delivery and had a lower rate of vacuum extraction.[5] In addition, fewer patients underwent Cesarean delivery due to a failed induction when they attended a childbirth class in comparison to the group that did not (1.9% vs 8.2%).

Dr. Cruz sees the need for earlier education as well.

“As a society, we should better educate children, particularly those in zip codes where the community has poorer health, about health and wellness in general and we should start at a young age,” Dr. Cruz says.

Organizations like the CDC recommend patients get healthy before pregnancy by taking folic acid, seeing a healthcare professional regularly, avoiding harmful substances and making healthy lifestyle choices to prevent birth defects.[6]  

In addition to her role with the Medical College of Wisconsin, Dr. Cruz also serves on the Milwaukee March of Dimes Board as a member and chair of Mission Impact. During the past 15 years, teams from GE Healthcare have raised hundreds of thousands of dollars for the March of Dimes through March for Babies events, and GE Healthcare donates in support of the March of Dimes mission.

 

REFERENCES