Oklahoma mothers are experiencing fewer unexpected complications during their hospitalization for delivery. But those mothers and infants are still dying at higher rates than the national average, a new March of Dimes report found.
Oklahoma received a preterm birth grade of D in the nonprofit’s report, which found the state's rate remains at 11% of births. Babies born before 37 weeks may have more health problems or need to stay in the hospital longer than those born later. The state also received low marks in infant mortality, with more babies dying before their first birthday in this year’s report.
But some outcomes are improving. Although its maternal mortality rate is still higher than the national average of 23.5 per 100,000 births, it did lower from 29.6 in last year’s report to 27.3 per 100,000 births.
Oklahoma also ranked among the top 20 states with the lowest rates of severe maternal morbidity, which refers to unexpected outcomes of labor and delivery that can result in significant short- or long-term health consequences. Those can include increased medical costs and longer hospital stays. Oklahoma was 12th nationally.
“Some of those numbers for maternal data are actually promising for Oklahoma,” said Barbara O'Brien, director of the Oklahoma Perinatal Quality Improvement Collaborative. “We don't have very many health rankings that are not in the bottom 10.”
The collaborative, which works with birthing hospitals and perinatal providers to improve care for Oklahoma mothers and babies, held its annual summit this week. There, they covered the landscape of perinatal quality, new guidelines for neonatal stabilization and celebrated the state’s progress.
“We're really trying to ensure that, throughout Oklahoma, we have a culture of safety and excellence and equity in perinatal care,” O'Brien said. “So, no matter where someone gives birth, they receive high-quality care that is safe and equitable.”
O’Brien said she thinks these outcomes will get better through initiatives adopted by health professionals in Oklahoma’s 42 birthing hospitals.
Oklahoma hospitals have been working to implement safety bundles, which are structured ways of improving care processes and patient outcomes through evidence-based practices. They help providers better address conditions like hypertension and hemorrhaging.
They are working to bring on additional ones related to substance use in pregnancy and perinatal mental health conditions, which she said are leading drivers of maternal deaths.
Oklahoma is also the only state in the U.S. that has implemented the TEAM Birth process statewide, O’Brien said. The communication method, which exists in almost all of Oklahoma’s birthing hospitals, encourages open conversations among patients, their support systems and clinicians during birth.
O’Brien said this results in shared decision-making, which is associated with increased patient trust and autonomy.
But there are still significant challenges, O’Brien said. Infant mortality, for example, can often be determined by social drivers of health like smoking and hypertension. There are also barriers to breastfeeding and educating Oklahoma mothers on safe-sleep practices – both of which can help reduce infant mortality rates.
“If someone has to go back to work two weeks after giving birth, for example, it's hard for them to continue breastfeeding,” O’Brien said.
Oklahoma is also facing the threat of federal Medicaid cuts. About half of births in the state are covered by Medicaid. O’Brien said the collaborative is working on ways to support hospitals so they don’t lose additional labor units in a state where over 50% of counties are considered maternity care deserts.
“I'm confident we'll work together and do what we need to do. It might be challenging, though," O’Brien said. “We will just have to see how things actually work out. And hopefully we'll be able to have some of the support from the Rural Health Transformation funding.”
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