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On the day that my first grandchild was born three years ago, the New York hospital room was heavy with anticipation as we all imagined his future—from his first breath to his first steps to his first day of school. The new baby’s health, well-being, and life ahead of him consumed our minds. The same feelings and thoughts occurred once more with the arrival of my granddaughter, just a few short months ago.

The health of their mother, my daughter, was collectively an afterthought, which is sadly and dangerously the case for many expectant families. Globally and across the United States, maternal health is de-prioritized once the baby is safely delivered, despite the highest-risk period being 6 weeks after childbirth. Moreover, maternal mortality, which is the death of a woman from complications during and after pregnancy or childbirth, is on the rise in the United States.

Every 10 minutes, a woman in the U.S. nearly dies from complications of pregnancy or childbirth. This is incredibly unsettling considering the recent statistics released by the World Health Organization, celebrating a 44% decrease in the global maternal mortality rate since 1990.

If the number of women who die from complications during pregnancy continues to decrease worldwide, yet the number of women dying in the U.S. continues to rise, we need to understand why and work toward ending this silent killer.

Luckily, my daughter did not experience postpartum complications and she did not become a statistic. However, this is not the case for all women. As a physician, father, grandfather, and leader of Merck for Mothers, Merck’s 10-year, $500M initiative to reduce maternal mortality globally, I am on a mission to increase awareness and access to quality maternal healthcare, so more women can experience a safe and joyful childbirth.

 

A look at potential causes of maternal mortality

While it’s difficult to pinpoint a single cause behind the rise of maternal mortality in the U.S., there are a few things we know for sure. For one, women are entering pregnancy sicker. As chronic conditions, such as obesity, high blood pressure, and diabetes, continue to plague American women, the risk of life-threatening complications during pregnancy also rises. Together, with our partners in more than 3 states, we are engaging community health workers to develop new models of care for pregnant women with chronic conditions.

It’s also very important for women to be aware of the common causes of maternal deaths, so they can look out for potential warning signs and speak up if something doesn’t feel right. Three of the most common causes of maternal deaths are:

Expecting mothers and their families are encouraged to have regular check-ups with their healthcare professional to ask key questions, including the possibility of potential complications. We call this conversation a “PEP Talk”—a helpful way to remember these three common causes: preeclampsia, embolism, and post-partum hemorrhage.

In addition to empowering women to become their own health advocates, we must also look at the role of the provider and the healthcare system. Unfortunately, as it stands, more than half of the U.S. states do not investigate the reason for a maternal death. In order to find solutions to improve maternal health, it’s critical that we document and examine each and every death when they occur.

Currently, Merck for Mothers and its partners are working to build the capacity of states and hospitals to collect stronger data and review patient cases in order to better understand the reasons why maternal deaths are occurring. So far, we’ve strengthened 12 review boards and 302 hospitals, allowing them to provide better care to families in need.

Another issue we face is the lack of standardized national protocols for managing childbirth emergencies. Unlike what happens in other common health conditions, such as heart attacks, there is no “code blue” in the case of an obstetric emergency. Merck for Mothers, in partnership with the California Maternal Quality Care Collaborative (CMQCC), is working with over 120 hospitals in California to help them develop standardized protocols for handling obstetric emergencies. Through our partnership with the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN), we are also working to standardize the education that nurses receive and the information they communicate to new mothers on postpartum complications.

 

Hope is on the horizon

As Merck for Mothers continues making strides toward our goal to create a world where no woman dies giving life, we understand the importance of engaging the communities that are impacted by maternal mortality.

Education, awareness, and access to quality maternal healthcare is key in reducing the country’s maternal mortality rate. In collaboration with key partners in more than 16 states, we are working with state officials, hospitals, and local health organizations to make pregnancy and childbirth safer.

However, the largest and most significant aspect of the movement is that women feel empowered to speak up and consult their healthcare specialist. You can help by encouraging expectant loved ones to start a “PEPTalk” at their next visit. Maternal mortality is preventable, and hope is on the horizon.

The bottom line: By working together, we can #EndMaternalMortality.

Naveen Rao, MD
Dr. Naveen Rao leads Merck for Mothers, Merck's 10-year, $500 million initiative to reduce maternal mortality around the world. In this capacity, Dr. Rao is responsible for leveraging the company's science and business expertise to accelerate progress in reaching the Sustainable Development Goals and advancing Merck & Co., Inc. mission to improve and save lives. Dr. Rao is Board Certified in Internal Medicine and is a Fellow of the American College of Physicians. He was Associate Director of the Department of Medicine at Beekman Downtown Hospital and practiced Internal Medicine in New York City for 10 years prior to joining Merck in 1993. Dr. Rao is a member of the Board of Overseers of Columbia University's Mailman School of Public Health, a member of the Board of Directors of GBC Health, and chairs the Maternal Health Pillar of the MDG Health Alliance, an effort supporting UN agencies to improve the health of women and children.

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