Black mothers die at more than two and half times the rate of other mothers in Ohio (Ohio Department of Health, 2020) regardless of their socio-economic status or health behaviors. Multiple factors contribute to these disparities, such as variations in quality healthcare, underlying chronic conditions, structural racism, and implicit bias.

Health disparities are preventable disparate outcomes to optimal health experienced by populations disadvantaged by their social or economic status, geographic location, and environment. Joint Commission Standards state that reducing health care disparities is a quality and safety priority and emphasizes the importance of collecting patient demographic data on race and ethnicity in order to identify health care disparities.

The Center for Medicare & Medicaid Services has identified this measure as a key area to improve maternal and infant health. By providing care to pregnant individuals that follows best practices that advance health care quality, safety, and equity, hospitals and doctors can improve chances for a safe delivery and a healthy baby.

Guidelines developed by doctors and researchers say it’s best to wait until the 39th completed week of pregnancy to deliver the baby because important fetal development takes place in the baby’s brain and lungs during the last few weeks of pregnancy.

The national average rate of elective deliveries in 2022 is 2%.

The Ohio average rate of elective deliveries in 2022 is 2%.

Cesarean deliveries place birthing individuals and infants at higher risk for adverse outcomes. Reducing the rate of cesarean births for individuals at low risk from a vaginal birth provides an opportunity to improve both maternal and infant health.

In the United States in 2022, 26.3% of live births were low-risk cesarean deliveries.

In Ohio in 2022, 25.8% of live births were low-risk cesarean deliveries.

Ohio rates were highest for Asian/Pacific Islander infants (30.0%) followed by Black infants (29.5%), American Indian/Alaskan Native infants (25.6%), White infants (25.4%) Hispanic infants (23.9%).

The Healthy People 2030 target for the low-risk cesarean rate is 23.6%.

The Center for Medicare & Medicaid Services has identified this measure as a key area to improve maternal and infant health. Perinatal Quality Improvement Collaborative programs can help reduce racial disparities in maternal health outcomes by promoting access to evidence-based practices, providing education and training on racial disparities and health disparities, and engaging with communities to create culturally sensitive care models.

Severe complications during labor and delivery can lead to serious and lasting health problems for women, like stroke or kidney problems. Rates of severe maternal complications have increased in recent years, and there are disparities by race/ethnicity. Making sure women get high-quality health care both before and during pregnancy can help reduce severe maternal complications.

Reducing severe maternal morbidity is a priority of the 2022 State Health Improvement Plan for Ohio, with a target of 100.9 hospitalizations caused by severe maternal morbidity, per 100,000 live births.

The Healthy People 2030 target is 64.4 per 10,000 delivery hospitalizations.

Smoking cessation or nicotine withdrawl is important to maternal health because smoking can cause serious health risks for pregnant people and their babies. Smoking during pregnancy increases the risk of premature birth, low birth weight, stillbirth, and birth defects.

Additionally, smoking can lead to a host of other health problems including increased risk of miscarriage, increased risk of ectopic pregnancy, and increased risk of placenta previa. Quitting smoking before or during pregnancy can help reduce these risks and ensure a healthier pregnancy.

The Healthy People 2030 target for increasing successful quit attempts in pregnant women who smoke is 24.4%

Perinatal depression, which includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery, is one of the most common medical complications during pregnancy and the postpartum period, affecting one in seven women. The American College of Obstetricians and Gynecologists recommends that obstetrician–gynecologists and other obstetric care providers screen patients at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool.

Postpartum depression (PPD) affects one in eight women; however, the risk is 1.6 times higher for Black women than White women. Black women are less likely to receive help due to factors such as financial barriers, stigma associated with mental health struggles, structural racism and a historical mistrust of the health care system. Maternal mental health symptoms and issues among Black women are often overlooked and under-addressed.

Postpartum family planning is the process of planning for the future of a family after the birth of a child. This includes discussing and deciding on contraception, spacing of pregnancies, and other family planning options.

This planning is important for maternal health, as it reduces the risk of unintended pregnancies, which are linked to outcomes like preterm birth and postpartum depression. Effective postpartum family planning ensures that women have the necessary time and resources to recover from childbirth and bond with their newborns. Furthermore, it can lower the risk of maternal mortality and morbidity, ultimately enhancing the health of mothers and their families.

Access to birth control and family planning services also promotes longer intervals between pregnancies, leading to better health outcomes for both women and their infants.

Healthy People 2030 aims to increase the proportion of women who get needed publicly funded birth control services and reduce the proportion of unintended pregnancies.

This outcome corresponds with the 2030 Healthy People initiative Healthy People Maternal, Infant, and Child Health (MICH 08) to increase the proportion of pregnant women who receive early and adequate prenatal care.

Early prenatal care can reduce risks for complications related to pregnancy or birth. Early identification can ensure that women with complex problems, chronic illnesses, or other risks are connected to appropriate specialists. Early high-quality prenatal care is critical to improving pregnancy outcomes.

Healthy People 2030 aims for 80.5% of women to receive prenatal care in their first trimester.

In the United States in 2022, the rate of early prenatal care for the 47 states and the District of Columbia using the revised certificates (96% of all births) was 77.7%.

In Ohio, 77.7% of infants were born to women receiving early prenatal care in 2022.

By collecting patient feedback, hospitals can identify areas of improvement and make necessary changes to ensure the delivery experience is as positive as possible.

Collecting patient satisfaction related to the experience of care during labor and delivery can help reduce racial disparities by providing insights into the quality of care received by people from different racial backgrounds, allowing hospitals to identify and address disparities. By understanding the unique challenges faced by different racial groups, hospitals can better tailor their services and create a more equitable healthcare system.