What are the interventions to reduce fetal mortality rates in North Carolina?

Interventions to Reduce Fetal Mortality Rates in North Carolina

The most effective interventions to reduce fetal mortality in North Carolina include implementing the Pregnancy Medical Home (PMH) model, standardizing obstetric emergency protocols, addressing racial disparities, improving rural healthcare access, and extending comprehensive postpartum care.

Pregnancy Medical Home (PMH) Program

• North Carolina's Division of Public Health developed the PMH program for the Medicaid population with dual targets: reducing primary cesarean delivery rates and decreasing very-low-birthweight and low-birthweight babies 1
• The program has extensive reach with over 1,600 providers participating across North Carolina 1
• Key features include nurse/social work care managers providing case management services to high-risk patients, milestone-based provider payments, and higher physician reimbursement for vaginal deliveries 1

Addressing Racial and Geographic Disparities

• Non-Hispanic Black women face significantly higher pregnancy-related mortality ratios (3.2 times higher than non-Hispanic White women), contributing to higher fetal mortality 2
• Rural North Carolina residents have approximately 9% higher probability of severe maternal morbidity during childbirth hospitalizations compared to urban residents 2
• Implementation of implicit bias training for healthcare providers and culturally responsive care practices are essential to reduce these disparities 1
• Extending Medicaid coverage to 12 months postpartum can improve maternal health outcomes and reduce fetal mortality 1

Standardized Obstetric Emergency Protocols

• Implementation of maternal safety bundles and standardized protocols for obstetric emergencies such as hemorrhage, severe hypertension, and venous thromboembolism 2
• The Alliance for Innovation on Maternal Health (AIM) program assists state-based teams in implementing maternal safety bundles, which are evidence-based practices for maternity care 1
• Continual reassessment of patient risk status using validated tools and prompt addressing of any changes can prevent adverse outcomes 1

Early Risk Identification and Management

• Identifying women at greatest risk and initiating appropriate interventions early in the reproductive life course is crucial 1
• Risk factors requiring attention include:
  • Pre-existing health conditions that may qualify as high-risk 1
  • Socioeconomic, geographic, and other non-medical factors that modify risk 1
  • History of previous pregnancy complications, particularly hypertensive disorders 1

Improving Rural Healthcare Access

• Expansion of telehealth services to increase access to care for high-risk pregnant women, especially in rural and medically underserved areas 2
• Eliminating "care deserts" through telemedicine and innovative referral networks 1
• Addressing transportation barriers that limit access to specialized care 2

Comprehensive Postpartum Care

• Extending comprehensive care beyond delivery through the "fourth trimester" with multiple customized postpartum visits 2
• More than half of all pregnancy-related deaths occur after birth, including nearly 12% occurring 43-365 days postpartum 2
• Improved care transition communication between providers is essential for continuity of care 1

Enhanced Data Collection and Surveillance

• Enhanced surveillance and data collection systems to better identify contributory factors to fetal mortality 2
• The Maternal Mortality Review Committee process is part of the required approach to prevent maternal and fetal deaths 3
• Continuous monitoring of risk factors such as maternal age, race/ethnicity, birth weight, gestational age, and socioeconomic factors 4, 5

Addressing Modifiable Risk Factors

• Targeted interventions for substance use disorders, as deliveries associated with maternal opioid abuse have more than 4 times the odds of maternal death 2
• Providing effective patient education resources on signs and symptoms of common complications and strategies for minimizing risk 1
• Connecting patients in need of safe and affordable housing, transportation, and food with appropriate social services 1

Pitfalls and Caveats

• Focusing solely on medical interventions without addressing social determinants of health will limit effectiveness 1, 2
• Failure to recognize the impact of systemic racism and discrimination on maternal and fetal outcomes 1, 2
• Inadequate attention to the postpartum period, when many complications can still arise 2
• Overlooking the importance of standardized approaches to emergency obstetric care 2