Focus On Preventive Care As The Long-Term Strategy To Improve Health

There has been a lot of press about the rising maternal mortality rates in the United States in spite of the fact that we spend nearly $30 billion dollars a year caring for mothers and their babies. What is happening? According to the CDC, the top two causes for these devastating outcomes include cardiovascular disease and overwhelming infection.

A contributing factor associated with many of these poor outcomes is obesity. The rising rate of obesity in the United States is affecting our health, and this is reflected in our birth outcomes. In 1962, just 13 percent of Americans were classified as obese. Today, that number is closer to 60 percent. This translates into greater percentages of women entering pregnancy with this complicating health condition. Women who are obese are at greater risk for gestational diabetes, pregnancy associated hypertension, large babies which can result in birth trauma for both mother and baby, abnormally long labors, placental abnormalities, cesarean section and -- in the postpartum period hemorrhage -- blood clots and infections. All of these are potentially life-threatening conditions. The baby also does not escape an increased risk for complications. These babies are at greater risk for diabetes, heart disease and obesity themselves. They also have an increased risk for a number of birth defects including neural tube defects, cardiac defects and cleft lip and palate.

I congratulate the National Partnership for Maternal Safety for working hard on the issue of maternal mortality, in particular, by examining the sentinel events that occur in hospitals leading to such tragedies. This is important work. But until we in the United States learn to put more focus on health promotion and disease prevention, I believe we will continue to struggle with rising maternal morbidity and mortality. We have a tendency to rely on life-saving, last-minute efforts to turn around a person's health. When successful, these strategies can lead to miracles. But these strategies are often unsuccessful and always extremely costly. They usually do not result in a lifetime improvement in health.

What is happening in maternity care is a reflection of what is happening in the entire health care system. We need a change. We need to focus on keeping people healthy. We need accessible health clinics staffed with health care providers such as nurse-midwives, nurse practitioners, physician assistants and family physicians whose goal is health promotion and disease prevention. They should be located in every school, in work places, in stores and on every street corner. The health care providers need to have the time during each visit to do the counseling, teaching and encouragement that can steward effective change and healthy habits.

If women had easy and affordable access to preventive health care, I believe they would take advantage of it. This could result in women entering pregnancy in a healthier state. Women are very motivated to take care of themselves during pregnancy. If we could see them before the pregnancy started, we would have the best chance of giving them the information and help they need to develop a plan to have the best outcome possible. For example, who is there now to tell women about the risks of obesity and pregnancy? Who is there to help women get healthy prior to getting pregnant? If we could devote a fraction of the current costs of health care to this type of wide-spread preventive care, I believe we could start to make some inroads.

Our only strategy cannot be waiting until people are having a health care crisis and then trying to solve it. We have to be proactive in setting up systems of care that can help people remain healthy.

The Affordable Health Care Act has opened the door for hundreds of thousands of people to access health care. This is a step in the right direction. It is now up to us as a society to assure that the right systems are put in place to promote a healthy population.