Governor Cuomo’s call for municipal governments to cut hundreds of millions of dollars from their annual Medicaid spending to help balance the state’s budget has local officials looking for ways to reduce costs while improving patient outcomes.
City Council Member Carlina Rivera, who chairs the Council’s Committee on Hospitals, believes she has identified a strategy that will also address a national mortality crisis that is most pronounced when it comes to mothers and newborns of color.
‘More Than Doubled’
“The U.S. maternal mortality rate has more than doubled from 10.3 per 100,000 live births in 1991 to 23.8 in 2014,” according to the Harvard Business Review. “Black women are three to four times more likely to die in childbirth than white women—regardless of education, income, or any other socio-economic factors. This is the primary reason the United States lags so far behind other affluent countries.”
“Data suggests Black people in NYC are 12 times more likely to die from pregnancy-related causes than White people,” according to a research paper prepared by Ms. Rivera’s committee staff. “Of the 15 deaths in 2016 [in New York City], six were of people who were Black and six were people who were Latina, accounting for nearly every pregnancy death.”
It continued, “African American infants are 3.2 times more likely than non-Hispanic White infants to die from complications related to low birth weight. Babies born with low birth weight may also be more likely to have certain chronic health conditions later in life, including diabetes, heart disease, high blood pressure, intellectual and developmental disabilities, and obesity.”
At a Jan. 21 Council hearing, Ms. Rivera heard several panels of women’s health experts testify that the most-effective way for the city to respond was to increase the use of community-based doulas and midwives from pregnancy to child delivery and through post-natal care.
Effective But Costly
“A doula is a trained professional who provides continuous physical, emotional and informational support to a pregnant person and the family before, during, and shortly after childbirth,” according to the Health Committee’s research paper.
The Council staff analysis continued, “A recent report found that women who had a doula were 39 percent less likely to have a caesarean. In a survey of NYC mothers who accessed the service of a doula, over 80 percent made their labor and birth experience ‘much better’ than if they had not opted to use a doula. Yet, 88 percent reported that cost was an issue when weighing whether or not to use a doula.”
According to the witnesses, this more-holistic approach is widely embraced throughout much of the world and produces better health outcomes and reduces over-reliance on surgical procedures like caesareans, that cost significantly more and can pose their own set of risks.
“In many other countries, including Great Britain, Canada, New Zealand, and Sweden, all of which have much lower rates of maternal and infant mortality than the United States, midwives oversee many, if not most pregnancies,” according to the committee’s analysis.
‘Should Be Leading’
“We have models we have taken from other countries who are serving pregnant women better than we are as a state and a nation,” Ms. Rivera said after the hearing. “Today we got recommendations on expanding doula and midwifery service…We are the largest health-care system in the country, and we should be leading on this issue when it comes to maternal morbidity.”
Maternal morbidity refers to adverse health results experienced during pregnancy or during childbirth, or within 42 days of the termination of a pregnancy.
Ms. Rivera said that while the city’s Health + Hospitals network was working with doulas and midwives, she hoped the system “would adopt a more-universal model, because there’s no reason they cannot be in every one of our acute-care facilities.”
“This morning I am asking for a set of specific protocols, actions, policies and procedures that are uniquely tied to the women and babies who are black and brown,” testified Shawnee Benton Gibson, whose daughter, Shamony Makeba Gibson, died at 30 from a pulmonary embolism, just two weeks after giving birth. “It is our sisters who are dying or having near-death experiences while doing the most natural thing that any woman can do: bring life into the world.”
In 2018, 103,000 babies were born in New York City hospitals, with 57 percent being Medicaid recipients, 40 percent using private insurance and two percent uninsured, according to the Greater New York Hospital Association.
Katy McFadden, a certified Nurse Midwife and activist, testified that the vast racial disparity in maternal health outcomes was linked to the fact that Medicaid reimburses at “half the rate of private [insurance] for obstetrics care.”
“Racist, inequitable health financing culminates in insurmountable challenges to provide safe and appropriate care at predominately black-serving institutions,” she said. “The subsequent substandard care creates population-level disparities.”
In 2017, the City Council passed the Maternal Mortality Reporting Law, which mandates that the NYC Department of Health and Mental Hygiene issue an annual report on maternal mortality.
We depend on the support of readers like you to help keep our publication strong and independent. Join us.