OB Hospitalist Group has released data indicating disparities in maternal care because patient race is reduced by care from obstetric hospitalists.
Maternal outcomes differ significantly based on patient race but can be improved by obstetric (OB) hospitalist-based care, according to recent data by OB Hospitalist Group (OBHG).
The United States has the highest maternal death rate of any developed country, with 1205 deaths from pregnancy and delivery complications reported in 2021, according to the CDC. About 60% of pregnancy-related deaths have been estimated as preventable.
According to the CDC, maternal death rates were 2.6 times greater in Black women than White women in 2021, at 69.9 deaths per 100,000 live births in Black women compared to 26.6 deaths per 100,000 live births in White women. Research has indicated worse health care quality in Black women than White women, increasing maternal mortality risk.
A lower standard of care may be seen in pregnant women when they are sent to a labor and delivery unit without a physician. This issue is avoided in programs with an Obstetrics Emergency Department, which ensure an expert provides care to every woman in labor or with antepartum or postpartum concerns.
OB hospitalists are OB/GYN clinicians specializing in acute and emergency care. A recent study found decreased levels of severe maternal morbidity in hospitals with constant OB hospitalist coverage, making OB hospitalists a potential method of reducing racial disparities during childbirth.
From August 2022 to February 2023, OBHG analyzed racial disparities by collecting patient reported racial identification. Data was gathered from over 31,000 deliveries with an OBHG clinician, along with additional data from over 319,413 patient encounters.
Cesarean sections, which have been reported in 36% of US Black women and 31% of US White women, were examined by OBHG. Outcomes of cesarean sections were significantly below the national goal of 23.6% for all races in OBHG data. On average, OBHG had a cesarean section rate of 19.5% compared to the CDC’s reported average of 26.3%.
White OBHG patients had a cesarean section rate of 15% compared to a rate of 18.2% in Black OBHG patients. In CDC reports, these rates were 25.2% and 31.2%, respectively, showing reductions in cesarean section rates from OBHG implementations.
Lacerations and episiotomies, which can cause long-term complications in patients, were also evaluated. The national goals are 5% for episiotomy, 11.7% for third- and fourth-degree lacerations with instrumentations, and 1.7% for third- and fourth-degree laceration without instrumentations.
OBHG results were all below these goals for all races, except for Pacific Islander which was slightly higher in episiotomies and third- and fourth-degree lacerations with instrumentations, and Asian which was slightly higher in third- and fourth-degree laceration without instrumentations.
There are multiple factors which might explain improved maternal health disparities from OBHG which could be adapted by OB hospitalists. The first of these is workplace diversity, as maintaining a diverse clinical workforce benefits both patients and hospitals.
Training to address bias may also improve maternal health disparities. This can reduce cultural bias and encourage an inclusive culture. A 24/7 program also ensures readiness for emergency care at any time.
Evidence-based practices should also be implemented to ensure equal care. Standardized protocols encourage physicians to be agnostic to patient race, reducing maternal disparities. A data-driven approach can also lead to new opportunities to address inequality and improve maternal outcomes.
Disparities in maternal outcomes remain an issue among OB hospitalists, but methods implemented by OBHG show steps which can be taken to improve these disparities. Further research may lead to new approaches which can reduce maternal mortality.
Reference
Racial disparities in maternal outcomes: An analysis of the impact of OB hospitalist involved care on implicit bias. OB Hospitalist Group. Accessed May 8, 2023.
Expert consensus sheds light on diagnosis and management of vasa previa
December 5th 2024A recent review established guidelines for prenatal diagnosis and care of vasa previa, outlining its definition, screening and diagnosis, management, and timing of delivery in asymptomatic patients.
Read More
S4E1: New RNA platform can predict pregnancy complications
February 11th 2022In this episode of Pap Talk, Contemporary OB/GYN® sat down with Maneesh Jain, CEO of Mirvie, and Michal Elovitz, MD, chief medical advisor at Mirvie, a new RNA platform that is able to predict pregnancy complications by revealing the biology of each pregnancy. They discussed recently published data regarding the platform's ability to predict preeclampsia and preterm birth.
Listen
Cesarean delivery reduces mortality risk in preterm breech births
December 2nd 2024In a recent study, infants born very preterm or extremely preterm had reduced odds of mortality when cesarean delivery was chosen as the mode of delivery, without a notable increase in any morbidity risk.
Read More
Maternal sFLT1 and EDN1 linked to late-onset preeclampsia
November 25th 2024A new study highlights the association of maternal soluble Fms-like tyrosine kinase 1 and endothelin 1 with preeclampsia severity, offering insights into the pathogenesis of early- and late-onset forms of the condition.
Read More
Chemoattractants in fetal membranes enhance leukocyte migration near term pregnancy
November 22nd 2024A recent study highlights the release of chemoattractants from human fetal membranes at term, driving leukocyte activation and migration, with implications for labor and postpartum recovery.
Read More