Making childbirth safer for rural Minnesota moms

Researchers just last week produced the first hard evidence that rural childbirths carry higher risks of maternal deaths and complications, but policymakers and researchers have already been working on the problem.

U.S. Sen. Tina Smith, D-Minn., has co-authored the Rural MOMS Act, which would award grants to rural communities that come up with new ways to support expecting mothers and improve their birth outcomes.

"Nearly 60% of maternal mortality is preventable," Smith said last week in a letter seeking Senate committee action on her bill.

"Hemorrhage, mental health conditions and hypertension are some of the leading causes of maternal mortality, and they can all be prevented."

While rural mothers might always face some higher risk, simply because they have to travel farther for care, the disparity shouldn't amount to the 9% increase in risk of deaths or near-death complications that was reported on Wednesday, said Katy Kozhimannil, the University of Minnesota researchers who led the study.

One solution is comparing hospitals by their maternal outcomes data so they have incentives to improve. The California Maternal Care Quality Collaborative has provided this incentive since 2006, and its efforts have coincided with a dramatic decline in the state's rate of maternal mortality — even as the national rate has increased.

"We need to start with the data," Kozhimannil said. "If we don't measure the differences, we don't know" they exist.

One national model for improving maternal outcomes has emerged in Bemidji, where Sanford Health used a grant to work with community organizations to support mothers addicted to opioids during and after births.

With many small hospitals closing their obstetric units and no longer scheduling deliveries, Kozhimannil said solutions must involve community organizations who can support local mothers and not just hospital providers.

Smith's legislation also would improve maternal outcomes data nationally, expand telehealth so that small hospital providers could receive support from specialists, and fund investments in small hospitals' obstetrics technology.

Jeremy Olson • 612-673-7744