2017 Edition — Quality of Care: Maternal and Childbirth Health
November 3, 2017
Jen Joynt, Independent Health Care Consultant
Over the last few decades, there has been a significant growth in the measurement and reporting of health care quality outcomes. As health care evolves, it is important to continue to monitor and report on the quality of care delivered to patients in California and across the US. This is the first in a series of measures CHCF is publishing on the quality of care in our state. Topics range from maternal to end-of-life care, and include measures on mental health, cancer care, patient safety, and hospital care.
This set of maternal care measures highlights California’s performance in areas such as maternal mortality and preterm births, and also draws attention to opportunities to improve care, especially for women and infants of color.
In half of California counties, rates of low-risk, first-birth cesarean sections (c-sections) were higher than the 2015 Let’s Get Healthy California target (state-established 10-year improvement targets for 39 health care indicators) of 23.9%. The statewide average was 25.6%. While medically necessary in some cases, c-sections can pose serious risks for baby and mother.
After reaching a high of 16.9 in 2006, California’s maternal mortality rate (MMR) fell to 7.3 in 2013, which was much lower than the national rate of 22.0 that year. Since 2010, California’s MMR has been lower than the federal government’s Healthy People 2020* target of 11.4. Statewide collaborative efforts to address the growing problem of maternal mortality have helped reduce preventable deaths. Such efforts help reduce hemorrhage during childbirth and prevent the adverse effects of preeclampsia.
African American mothers were more likely to deliver low birthweight or preterm babies compared to Asian, Latina, and white mothers. Low birthweight babies and those born preterm are at increased risk for lifelong health problems or even dying before age one.
African American mothers and infants died during childbirth at least two times more often than mothers and infants of other races or ethnicities. Reasons for the disparity may include access to prenatal care, prevalence of maternal chronic conditions, and appropriateness of care delivery.
About 1 in 3 uninsured mothers and 1 in 5 mothers covered by Medi-Cal experienced prenatal depressive symptoms compared to less than 1 in 12 women with private insurance. Left undetected and untreated, these conditions can lead to negative health outcomes for the mother, and can negatively affect the mother-child bond and the child’s long-term physical, emotional, and developmental health.