State's high maternal-death rate gets study; pregnancy-related deaths mostly from violence, substance use, anxiety, depression

UK researchers studying the state's high maternal-mortality rate include (front row, left to right) Anna Chamberlain, Ann Coker, Linda Berry, Heather Bush; (back, left to right) John O'Brien, Cynthia Cockerham, Dana Quesinberry and Josh Bush. (Photo by Jeremy Blackburn, UK Research Communications)

By Lindsay Travis
University of Kentucky

A team of health-care providers and researchers at the University of Kentucky is working with community and government leaders across the state to address a pressing issue facing the state: its high rate of death and illness among women who give birth.

“Kentucky has one of the highest maternal mortality rates in the country. Lowering the proportion of women dying during or after childbirth in our state is not just a goal, but a necessity to safeguard the health and futures of both mothers and their children,” said Dr. John O’Brien, director of the Division of Maternal Fetal Medicine at UK HealthCare. O'Brien is also a professor in the Department of Obstetrics and Gynecology in the UK College of Medicine, and the appointed chair of the Kentucky Maternal Morbidity and Mortality Task Force in the state’s Cabinet for Health and Family Services.

The task force is funded by a $5.2 million, five-year grant from the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

The state has a Maternal Mortality Review Committee that determines the causes of maternal deaths and identify opportunities for preventing future deaths, through policy or practice. The panel has documented that substance use, injury and behavioral-health conditions are all common contributing factors to maternal death or maternal illness, also called maternal morbidity.

“In Kentucky, the study of severe maternal morbidities reveals a stark reality that these outcomes are deeply intertwined with health-care disparities,” O’Brien said. “Rural communities and people of color bear a disproportionate burden, highlighting the urgent need to address systemic inequalities in maternal healthcare access and quality.”

O'Brien's task force will work with hospitals, other health-care providers, community partners and state agencies to implement and promote best practices to make birth safer, improve maternal health outcomes and, ultimately, save lives.

The task force will work with state agencies to develop a scorecard to track severe maternal-health issues, using hospital records. The team will also create a data surveillance system to monitor maternal deaths and injuries, with a goal of making this information publicly available.

“Our team also wants to be able to provide critically important hands-on learning opportunities for smaller hospitals to be prepared to handle pregnancy-related complications,” said O’Brien. “We also want to extend and assist coordination of telehealth services to birthing facilities throughout the state as we have shown reduction of severe morbidity in rural communities is possible through telehealth availability.”

The federal grant will also fund bystander-informed violence intervention and prevention training specifically for obstetric health-care providers to address maternal health related to violence.

“In Kentucky, the majority of pregnancy-associated maternal deaths stem from partner or family violence, substance use and anxiety or depression,” said Dana Quesinberry, associate director of the Kentucky Injury and Prevention Research Center and an assistant professor of health management and policy in the UK College of Public Health. “Our goal is to leverage our collective expertise to share violence intervention and prevention training models statewide to make a targeted effort to reduce these types of death.”

“The majority of violence-related maternal deaths ARE preventable. We are firm in our belief that this proactive approach will offer hope to mothers in our state and make a measurable difference in health outcomes,” said Ann Coker, one of the team leaders on the project. She is the Verizon Wireless Endowed Chair in the Center for Research on Violence Against Women and a professor of epidemiology in the Department of Obstetrics and Gynecology.

O'Brien said, “This task force is a comprehensive project involving multiple stakeholders and a crucial step for Kentucky moving forward. By uniting expertise, resources and advocacy, our goal is to ensure every mother receives care and support.”

In addition to the grant, HRSA provided $170,233 to be used for Medicaid redetermination and postpartum-care coverage navigation for pregnant and postpartum individuals and their families. “We have utilized these funds to establish a Perinatal Community Health Worker Program . . . to provide culturally and linguistically matched services to pregnant and postpartum persons in the state,” said Cynthia Cockerham, community program and research director for UK HealthCare’s Division of Maternal Fetal Medicine.

The study team also includes Linda Berry, a registered nurse and perinatal substance use coordinator at UK HealthCare; Public Health Dean Heather Bush, an endowed professor in the Center for Research on Violence Against Women; and Dr. Barbara Parilla, medical director of the UK HealthCare Perinatal Assistance and Treatment Home (PATHways) program and a professor in the Department of Obstetrics and Gynecology.

To inquire about the task force, email Kentucky_MMM@uky.edu. For more information about the Perinatal Community Health Worker Program, email PerinatalCHW@uky.edu.