ROBERT PIERCE
• Leader & Times
March is Women’s History Month, a time to honor the contributions, resilience and strength of women throughout history.
The month is also an opportunity to recognize the challenges many women continue to face, including the negative maternal health outcomes that impact mothers, babies and families across Kansas.
For leaders with Blue Cross Blue Shield of Kansas (BCBSKS), in a country with great hospitals and health care providers, many moms still face serious health problems during pregnancy, childbirth and after having a baby.
BCBSKS Health Equity Manager Sonia Jordan said while most pregnancies are healthy with few complications, there are still some when plans do not go as well.
“There are those negative health problems women can face,” she said. “What we find occurring is when these do happen, even though they’re more rare, they are quite serious. This could include something like a hemorrhage, which is uncontrolled bleeding or kidney failure. You could have organ or tissue damage or failure because your body is actively fighting an infection. A lot of these can lead into longer term health issues as well. It can also lead to negative effects during the labor and delivery process.”
Likewise, Jordan said in some worst-case scenarios, health issues can lead to the death of either the mother or the child.
“Mortality is a risk that can occur with some of these pregnancies, and even though our maternal mortality rate is a little lower in Kansas than in other places, it still happens here, and it happens in the United States,” she said. “It really is a critical issue for mothers to consider and think about when they’re going through this journey.”
Along with age, Jordan said pre-existing issues can cause many of the health issues some women experience during pregnancy.
“If you have Type 1 diabetes, that is a huge risk factor for a healthy pregnancy for mothers,” she said. “If you have other chronic conditions like hypertension prior to entering the pregnancy, what we see is you have more risks for that as you go along. There are also other health issues that can be developed during pregnancy.”
Beyond health issues are risk factors Jordan called life issues for pregnant mothers.
“When we think about access to medical care, if you are identified as a high risk pregnancy, it is very important for you to be seeing a doctor on a more regular basis than a non-high risk pregnancy,” she said. “However, if you are in a very rural part of the state, your access is going to be more limited.”
Jordan said this could be compounded in areas such as Southwest Kansas, where somebody may not speak the same language as their doctor, and they may not have the coverage needed to see a doctor as regularly as possible.
So for Jordan, how to fix these problems is the million dollar question, and she said it is a question being explored by many people in the maternal health profession.
“The framework we’ve been trying to take is everyone has a part to play in this,” she said. “We are all working on this together. If you are the woman who is pregnant, some things you should do are to know your warning signs, keep a close eye on yourself, don’t be afraid to speak up. You might have to speak up multiple times. If you feel something is not going well or is wrong, speak up for yourself.”
Jordan also suggested looking into available free resources.
“There’s a National Maternal Health Hotline,” she said. “That is a toll-free number that has free access to nurses you can talk to who might be able to provide you some assistance.”
The number for that hotline is 1-833-852-6262. Jordan said for families, those with a pregnant wife, sister, mother or daughter need to keep an eye on the expectant mother.
“Make sure they have a way to get to their prenatal care appointments,” she said. “Make sure they have a way to engage with the doctor in a way they can speak for themselves and advocate for themselves. Keep an eye on the warning signs. Check in with them regularly. Ask how they’re doing. If they say they’re not doing well, believe what they’re telling you.”
For the system level, Jordan said this includes places like hospitals or BCBSKS itself, and officials with those facilities are looking at what data is telling them as to the extent of the problem is and what interventions and levers can be pulled to see improvement.
Though critical, Jordan said fixing health issues for pregnant women does not have a silver bullet answer.
“It really is going to take a variety of interventions from a variety of levels that hopefully can make some sort of dent, and collectively, we start to see the risk for these instances going down,” she said.
As to what finding solutions for these issues is like, Jordan had one word – challenging.
“That’s definitely the first word that popped into my mind,” she said. “It requires a diligence and a commitment to it. For many women, this is supposed to be a time of extreme joy and transition. You’re adding a new baby. That is supposed to be a time of love and joy and gratitude, and when you have these kind of negative health outcomes occurring, that destroys that in an instant for a lot of families. The recognition that while this is a larger public health issue and a critical issue, this affects individual families, and it can really cause negative effects for those families in the communities where those families are.”
Jordan said offeing support, whether through small acts of kindness or sharing helpful resources, can make a difference, and a successful pregnancy takes many parts.
“It’s about what the individual is doing,” she said. “It’s about what their family is doing. It’s about what the doctors and the providers and the insurance system are all doing to try to get this mother to a happy and healthy pregnancy with a happy and healthy outcome.”
Jordan said BCBSKS officials are trying to make informed decisions as much as possible when it comes to the health issues pregnant women face.
“We are trying to look at the data, look at what it tells us about differences in health outcomes by rural versus urban for example or by distance to a health care center,” she said. “We’re trying to assure that we’re not just blowing in the wind on what interventions or solutions we’re proposing. We really want them to try to be as targeted as possible so we can hopefully see some differences occurring and do our small part to start to make a difference as well.”
For Jordan, in general, the health recommendations for most people work for pregnancy as well.
“Those are things like non-strenuous exercise, making sure you’re eating healthy, if you are smoking still, taking steps to quit smoking,” she said. “Beyond that, the number one thing I would recommend is to work with a health care provider to know what the warning signs are for your control risk levels and working with the providers to identify what is a good path so A, if you see that warning sign, you know what to do, and B, to avoid getting to the level of the warning sign regardless.”
For BCBSKS members, there is a maternal health case management program.
“Blue Cross Blue Shield members can work with a nurse who will guide them through a lot of these healthy recommendations to assure they can have a healthy pregnancy or try to get to as healthy a pregnancy as possible,” Jordan said.
Outside of BCBSKS, many community centers and hospitals have education for expectant moms such as prenatal classes.
“If you’re in a very rural part of Kansas, there may be a telehealth program you can participate in,” Jordan said.
While ultimately the mother is the one experiencing pregnancy, Jordan said much of the pregnancy experience is about community and mothers getting the chance to connect and advocate for themselves and not just with providers and the insurance system, but with other mothers who are going through the same thing.
BCBSKS likewise funds Baby Talk, a free prenatal program offered by the University of Kansas School of Medicine-Wichita. Jordan said the company is exploring other opportunities both currently available and not available, but she added more opportunities are available elsewhere.
As for mortality rates, Jordan said that issue centers more on health risks and life risks.
“Those are extremely risky for mothers, and if they develop preeclampsia and it goes to eclampsia, there is a risk of the mother for mortality from that event,” she said. “What we see happening is mothers are experiencing these negative health outcomes, and they’re either responding too late so they’re going to the hospital quick enough or they’re not getting to the doctor fast enough, or the doctor’s not as responsive as they should be and the issue continues to develop to a point where it cannot be managed medically anymore.”
With a low percentage of pregnant women not being doctors, Jordan said many cannot describe things medically. However, they do know their bodies and when something is wrong.
“The CDC campaign Hear Her has really good resources for this as well, and it’s a really interesting campaign,” she said. “They interview families of people who have experienced this directly.”
Jordan emphasized it is critical for expectant mothers to know their warning signs.
“If you don’t know what you’re at risk for and you don’t know what that looks like for your body and yourself, you’re not going to know if you are experiencing high blood pressure or high blood sugar, low blood sugar related to diabetes,” she said. “Know what those warning signs are for those critical events so you can take the steps you need to take to get that addressed in a timely fashion so you’re not waiting too long to go to the emergency department. You’re not waiting too long to go to the doctor.”
