Maternal Health Story Archives - West Virginia Public Broadcasting

New Report Details Poor Infant And Maternal Health In W.Va.

A new report from the March of Dimes shows West Virginia’s already high preterm birth rate is rising.

West Virginia earned an “F” on its March of Dimes report card for infant and maternal health.

The national percentage of preterm births (PTB) is 10.4 percent, while West Virginia’s rate is 13 percent.

The World Health Organization defines PTB as babies born alive before 37 weeks of pregnancy are completed.

Many factors can contribute to PTB including smoking, hypertension, unhealthy weight and diabetes.

The infant mortality rate in West Virginia increased in the last decade. Infant mortality is defined by the CDC as “the death of an infant before his or her first birthday.” In 2021, 117 babies died before their first birthday in West Virginia.

The Medical Director of West Virginia University’s Neonatal ICU, Autumn Kiefer, said the report shows the state has more work to do to improve outcomes.

“I think there is a need for education of the community in general about things like what preterm labor looks like, what can be done in a healthcare setting to help treat and improve outcomes for moms that do experience preterm labor or have a history of preterm birth,” Kiefer said.

Outcomes are even worse for babies born to Black birthing people. The PTB rate for Black babies is 1.4 times higher than the rate among all other babies while the infant mortality rate among babies born to Black birthing people is 1.6 times higher than the state rate.

According to the report, from 2019 to 2021, the leading causes of infant death in West Virginia were birth defects, PTB or low birth weight (LBW) and maternal complications.

“Making sure that folks are aware that if they have that concern that they could be in preterm labor or if they’re not feeling well, and there’s different with the moms with preeclampsia, all kinds of reasons that they may need to deliver preterm,” Kiefer said. “It’s so important to get checked out because there are things that can be done for mom and baby that can improve the chances of a good outcome is born preterm.”

The primary causes of infant mortality include birth defects, preterm birth and low birth weight, sudden infant death syndrome, accidents and injuries, and maternal pregnancy complications, according to both the CDC and March of Dimes.

In West Virginia, unhealthy weight was reported in 42.9 percent of all births and smoking in 17.9 percent of all births.

According to the National Center for Health Statistics, from 2018 to 2021, 25.4 per 100,000 births resulted in the death of the birth giver during the pregnancy or within six weeks after the pregnancy ends.

The March of Dimes also reported that West Virginia also has inadequate prenatal care. According to the report, almost 13 percent of birthing people received care beginning in the fifth month or later, or less than 50 percent of the appropriate number of visits for the infant’s gestational age.

The March of Dimes concludes the report by listing policies and funding that would improve and sustain maternal and infant health care. West Virginia does not have paid family leave or a doula reimbursement policy.

“The March of Dimes has suggestions of some additional legislation that can be helpful, based on current national information, like more options for paid family leave,” Kiefer said. “In general, having a new baby is a stressful experience and so having a family feel like they’re supported and have a means to bond with baby and have time to put things in place to get a good system going can help on the infant mortality side of things.”

The state’s expansion and extension of Medicaid scored well alongside a maternal mortality review committee, fetal and infant mortality review and a federal perinatal quality collaborative.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.

MarchofDimesReportCard-WestVirginia Download

Advocates Discuss Black Infant And Maternal Health With Lawmakers

The Black Infant and Maternal Health Working Group hosted a breakfast and meet and greet with lawmakers Monday at the capitol.

The event brought together advocates, affected community members, health professionals, and policymakers to address Black infant and maternal health outcomes in West Virginia.

Representatives from Black by God, the Black Voter Impact Initiative, the Morgantown/Kingwood NAACP, Morgantown NOW, the West Virginia Center on Budget and Policy and TEAM for WV Children participated in the breakfast.

Attendees heard from experts like Health and Safety Net Policy Analyst Rhonda Rogombe with the West Virginia Center on Budget and Policy.

“The most recent multi-year data showed that Black babies were twice as likely as their white counterparts to die in their first year of life in West Virginia, and that’s an unacceptable statistic,” Rogombe said.

According to the March of Dimes the number of preterm births between 2019 and 2021 in West Virginia was higher for Black infants, at 17.6 percent compared to 12.4 percent for white babies.

Preterm birth is a high indicator of risk, but West Virginia law currently does not allow the mortality review team to interview the family of an infant or mother who dies, which limits the scope of the information they collect, according to Rogombe.

“What really started the spark to the national conversation around this is that Black and indigenous women were facing mortality rates two to three times more than their white peers in that first year after giving birth,” Rogombe said. “That has only been exacerbated by the COVID-19 pandemic. And so, without that knowledge on the state level, we really don’t know what that looks like, but given the other health indicators that our Black population often faces, we can reasonably assume that the issue is worse for Black West Virginians as well.”

Rogombe said more data collection and the sharing of that data by race in a timely fashion would give a more complete picture of Black infant and maternal health outcomes in West Virginia.

“When controlling for variables like income, education, and other pieces, we still see Black women facing higher rates of mortality than their white peers,” Rogombe said. “All of those things mean that in West Virginia, we really, really need to address this issue and, and just ensure that moms and babies live.”

Attendees had the opportunity to share their stories with lawmakers directly at Monday’s breakfast. Some have lived experience of racial discrimination in maternal health, like Elizabeth Anne Greer Mobley.

“I have a master’s degree plus 42 credits. That still did not save me from suffering horrific miscarriages, from suffering from catastrophic and well catastrophic in the sense that I hemorrhaged, my children ended up in a PICU, NICU,” Mobley said. “It just does not protect you in the state of West Virginia from having horrific and challenging medical situations when there’s Black racism ingrained within the maternal and infant medical industry.”

Mobley moved from Maryland to Martinsburg with her family when she was 14. She calls herself a “Black-alachian.”

“I claim West Virginia, I have been here for 18 years, my babies, I’m giving birth in West Virginia, educated in West Virginia, I stayed in West Virginia, I have a 501(C)3, and an LLC,” Mobley said. “I’m proud to be here. I’ve stayed here, but you don’t want me. You don’t want my children’s or my life, the lives of me or my children are not worthy.”

In addition to being involved in her community in Martinsburg, Mobley is also a foster parent for the state. She said she attended the breakfast at the capitol so that no one else has to go through what she has gone through.

“I don’t know what it’s gonna take or what I’ve had to say or what all I have to give to make the story palpable enough for us to impact and affect will change,” Mobley said. “Because what I went through should never happen again, and yet it did.”

Rogombe said improvements could be made by prioritizing families in the upcoming 2024 legislative session.

“Creating pathways for midwives and doulas to be reimbursed by health insurance companies so that pregnant people have options in terms of what their care looks like,” Rogombe said. “Things like paid family and medical leave so that people can recover, you know, deepening our, the wealth of resources around mental health. There is a broad range of options and the more that we prioritize families, whatever that looks like, the better our outcomes will be.”

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.

DHHR To Distribute Federal Funding For Mental Health And Substance Use Services

In a release, the DHHR outlined seven grant programs that will support various health initiatives across the state.

More than $33 million in federal funding was awarded to the Bureau for Behavioral Health (BBH) to enhance mental health and substance use prevention services for West Virginians.

Federal funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) will support prevention, early intervention, treatment and recovery services across the state.

“BBH and its partners are seizing every opportunity to meet our state’s behavioral health needs,” said Dawn Cottingham-Frohna, commissioner for the West Virginia Department of Health and Human Resources’ (DHHR) Bureau for Behavioral Health. “With this funding, we are not only addressing the immediate needs of our communities but also investing in the long-term well-being of West Virginians.”

In a release, the DHHR outlined seven grant programs that will support various initiatives:

The Screening and Treatment for Maternal Mental Health and Substance Use Disorders program will provide $750,000 annually for five years from the Health Resources and Services Administration to expand health care provider’s capacity to screen, assess, treat and refer pregnant and postpartum women for maternal mental health and Substance Use Disorder (SUD). BBH is partnering with the West Virginia Perinatal Partnership’s Drug Free Moms and Babies Project to implement the program.
The Children’s Mental Health Initiative will provide $3,000,000 annually for four years to provide resources to improve the mental health outcomes for children and youth up to age 21, who are at risk for, or have serious emotional disturbance or serious mental illness and their families with connection to mobile crisis response and stabilization teams and other community-based behavioral health services through the 24/7 Children’s Crisis and Referral Line (844-HELP4WV).
The First Responders – Comprehensive Addiction and Recovery Act Grant will provide $800,000 annually for four years to build upon the Police and Peers program implemented by DHHR’s Office of Drug Control Policy. The activities will be administered by the Bluefield Police Department, Fayetteville Police Department, and the Logan County Sheriff’s Office in collaboration with Southern Highlands Community Mental Health Center, Fayette County Health Department and Logan County Health Department.
The Projects for Assistance in Transition from Homelessness grant will distribute $300,000 annually for two years to support the system of care for adults in West Virginia and promote access to permanent housing and referral to mental health, substance abuse treatment and health care services. Grantees are located in areas of the state with the most need, based on the population of individuals experiencing homelessness, including the Greater Wheeling Coalition for the Homeless, Prestera Center, Raleigh County Community Action, the West Virginia Coalition to End Homelessness and Westbrook Health Services.
The Promoting the Integration of Primary and Behavioral Health Care grant will provide $1,678,044 annually over five years to serve adults with serious mental illness who have co-occurring physical health conditions or chronic diseases and adults with SUD. Three provider partner agencies have been identified to work on this project including Seneca Health Services Inc., Southern Highlands Community Behavioral Health Center and United Summit Center, covering 16 counties in the state.
The Cooperative Agreements for States and Territories to Improve Local 988 Capacity will provide $1,251,440 annually for three years to enhance the capacity of West Virginia’s single 988 Suicide & Crisis Lifeline center, which is funded by BBH and operated by First Choice Services, to answer calls, chats and texts initiated in the state. In addition to this award, First Choice Services received $500,000 from Cooperative Agreements for 988 Suicide and Crisis Lifeline Crisis Center Follow-Up Programs and a National Chat and Text Backup Center award from Vibrant Emotional Health to help answer overflow chats and texts from more than 200 local 988 centers nationwide.
The Behavioral Health Partnership for Early Diversion of Adults and Youth will provide $330,000 annually for five years to establish or expand programs that divert youth and young adults up to age 25 with mental illness or a co-occurring disorder from the criminal or juvenile justice system to community-based mental health and SUD services.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.

Meeting Challenges To Improve W.Va. Infant And Maternal Mortality Rates

Addressing the West Virginia Legislative Interim Committee on Health Monday, Dr. Angela Cherry is with the West Virginia Perinatal Partnership Advisory Council, a public private collaborative dedicated to improving health outcomes among pregnant women and babies.

Cherry first laid out the medical and social challenges, beginning with where West Virginia stands on a national scale.

“We have the fourth highest low birth weight, the tenth highest very low birth weight, the fourteenth highest teen birth rate, the eighth highest infant mortality and twentieth highest maternal mortality rate.” Cherry said. “We are having an increase in our maternal deaths according to accidental drug overdoses, which I’m sure everyone knows.”

Cherry pointed out racial disparities with a significantly higher infant mortality rate for Blacks and Hispanics. She also noted the birthing center ‘deserts’ in West Virginia.

“We have 20 birthing hospitals with one free standing birthing center,” she said. “With obstetrical deserts in West Virginia, women are having to travel really far, sometimes up to two hours, to get to these hospitals that are doing these deliveries.”

Cherry listed the many initiatives underway to improve mortality outcomes for infants and mothers, including monitoring a hospital’s levels of care to make sure that they are at the appropriate level of care and treating the patients that they should. There’s a project to reduce the incidence of very low birth weight infants born outside of tertiary care centers and a quit-nicotine-cessation project because of the high risk of smoking and preterm births.

Cherry made special note of the relationship between rampant, statewide substance use disorders and pregnant women.

“Drug Free Moms and Babies is a program that addresses those issues, a program that deals with care coordination including prenatal care, postpartum care and routine OB care,” she said.“ In addition to that, let’s add the care coordination for all the other services that moms may need. They need outreach, for communities to do a needs assessment to see what they actually do need in their communities. They need follow up referrals; home visitation; WIC support, housing; childcare; transportation, all of those things.”

Dr. David Didden, Medical Director of DHHR’s Office of Maternal, Child and Family Health also addressed and took questions from the interim committee.

Following up on a statement from Cherry, Del. Mike Pushkin, D-Kanawha, noted a 2020 report from WVU Medicine that Black infants died at almost twice the rate of white infants in West Virginia.

Didden said the problem is well known and being addressed.

“We’re working with organizations that historically have reached out into the African American community in West Virginia. Based on experiences in the pandemic and working with the Dunbar School Foundation in Fairmont, we are hoping to get more information, qualitative data from the minority communities, and to be able to find out just what services are needed,” Didden said. “One of the promising practices we’re looking at is establishing through our home visiting program, a Doula Network. Doulas are birth attendants; birth assistants, knowledgeable in prenatal care, knowledgeable in labor and delivery. At least, we can step up and create a demonstration project in some of our hardest hit communities. We’re aware of the disparities, working with our academic partners, who are also studying this and moving forward.”

Sen. Hannah Geffert, D-Berkeley, asked Didden about the challenge in recruiting doctors following the state’s abortion ban.

“One of the one of the problems we’re having in our area is we can’t get OBGYN’s to move into our state because they have fear of what this body might do to doctors who are performing abortions. For example, lose their medical license for doing that,” Geffert said. “I’m not quite sure why people assume that, that’s exactly what’s going to happen, but they can’t even get hired headhunters to get OBGYN’s to come to our community.”

Didden said West Virginia has suffered a medical provider shortage for years, especially with OBGYN’s.

“If we’re able to activate our nurse midwives, and successfully recruit more obstetricians to the state, I think that partnering with local organizations that like the Perinatal Partnership, we can send the message that we are in support of reproductive health for women, and that this is a promising place to come and practice medicine,” Didden said. “It’s a tough sell. We’re going to continue to try to establish best practices and standards of care, and I hope we’ll be able to convince some more providers that this is a good place to practice medicine. The distance to a birthing hospital is a major issue. So we’re going to continue to work with with the perinatal partnership to try to solve some of these problems and come up with some structural changes that I’m hopeful we’ll activate more local resources, get nurses and other members of the care team practicing at the top of their license, so that rather than having to transport someone, two hours to get an evaluation done, we may be able to provide those resources more closer to home.”

W.Va. to Receive 6 Million for Maternal, Child Home Visiting Program

The U.S. Department of Health and Human Services announced today that West Virginia will receive approximately 6 million dollars for the Maternal, Infant,…

The U.S. Department of Health and Human Services announced today that West Virginia will receive approximately 6 million dollars for the Maternal, Infant, and Early Childhood Home Visiting Program.

The project originally launched in 2010. It currently serves every state in the union, as well as some territories and the District of Columbia. The goal is to help at-risk parents and families improve child and maternal health, prevent child abuse and neglect, and promote school readiness.

The program is voluntary. Participants opt to receive home visits from nurses, social workers and child development professionals who provide things like breastfeeding support. They also work with moms who want to continue education, help find childcare solutions and support preventative health practices.

In 2018, the program served more than 150,000 families nationwide. Of those, 71 percent lived below the federal poverty line.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.

W.Va. Bucks Rising U.S. Maternal Mortality Trend

The United States has some of the highest maternal mortality rates in the developed world — and unlike most other first-world countries, our rates are…

The United States has some of the highest maternal mortality rates in the developed world — and unlike most other first-world countries, our rates are going in the wrong direction.

American women are three times more likely to die during or after birth than women in Great Britain and eight times more likely than women in Scandinavian countries.

But despite the prevalence of major risk factors such as low access to prenatal care, a high poverty rate and a largely rural population, West Virginia, is bucking the maternal mortality trend. Maternal deaths are not only low, they’re also stable.

Part of that may be due to statewide initiatives to improve outcomes.

Lauren Headley

When Lauren Headley was 35, she got pregnant. Her age categorizes her as high-risk, but she is a nonsmoker and was a Zumba teacher at a healthy weight at the time she conceived.

Headley in the hospital shortly before the birth of her daughter

About six months into her pregnancy, though, Headley was diagnosed with gestational diabetes. Her obstetrician was concerned that, as a result, her baby would be born large and wouldn’t fit through her birth canal. So at around 39 weeks, doctors induced labor. The baby girl was born healthy and neither mother or infant had any complications.

Then on the 10th day after she gave birth, Headley woke up bleeding.

“But this was like gushing and red clots of Jell-O,” she said.

She called her doctor’s office and her doctor told her that some bleeding was normal but, if it continued, to go to the emergency department or to call back. So she got into the shower to see if that would calm things down.

“As I’m in the shower, the blood just pours out,” she said. “I mean cups of red Jell-O is what it looks like and it’s just pouring out. And I get really weak and I sit down in the shower and yell for my husband, and he comes in and he looks in there and he’s like ‘Oh dear God, you need to call your doctor back. There’s no way this is normal.’”

Headley was taken by ambulance to the emergency department at Thomas Health, where she was diagnosed with a severe postpartum hemorrhage — which is one of the leading complications that causes maternal mortality in the United States.

Postpartum hemorrhage 10 days after birth is admittedly pretty rare, but how well a hospital is prepared to deal with obstetric emergencies can mean the difference between life and death for someone like Headley.

Which may be part of why West Virginia’s rates are so low.

West Virginia’s rates are low — but why?

West Virginia actually ranks 5th in the country — tied with Hawaii — for least number of maternal mortality deaths in the nation — behind California, Massachusetts, Colorado and Nevada, according to data from the Centers for Disease Control and Prevention.

Headley with her daughter shortly after giving birth. Headley badly hemorrhaged 10 days later, but the bleeding was stopped at the hospital. Postpartum hemorrhage is one of the leading causes of maternal death in the U.S.

Maternal deaths in West Virginia related to pregnancy and childbirth have bounced between 1 to 4 deaths a year during the past 11 years. Even though West Virginia is a small state and has few births annually, this is a pretty low rate and surprising because West Virginia is poor, rural and has higher rates of comorbidities, which are all risk factors.

But when you try to dig into the numbers, “it’s hard to know exactly why our rates are lower,” said Amy Tolliver, director of the West Virginia Perinatal Partnership. She said over the last 10 years, they’ve been working closely with all of the hospitals in the state that deliver babies to improve the care they offer to moms.

“We have been implementing different training programs specifically around maternal hemorrhage — that is one of the bigger drivers that we see in regard to maternal morbidity and nationally in terms of maternal mortality,” Tolliver said.

Tolliver said every hospital in the state that delivers babies has a specific set of protocols they are supposed adhere to in the event of complications like uncontrolled postpartum bleeding.

“To have the crash carts available with all of the equipment necessary, to have trainings in place, and to continue doing those staff trainings — we think that’s one of the biggest factors in improving care is practicing for the high-risk patient.”

“I think we also do a good job in this state of accepting the fact that we have a lot of the risk factors that increase the risk for maternal mortality,” said Dr. Ally Roy, an obstetrician at Marshall Health.

Roy delivers babies at Cabell Huntington Hospital. When a patient is admitted there, she says there is a checklist the staff goes through with the patient. If they meet the criteria for moderate or high risk for a postpartum hemorrhage, they receive interventions at delivery time aimed at reducing their risk. Anecdotally, she said, the protocols have greatly improved outcomes for patients with postpartum hemorrhage.

“When you have an emergency, you want people to be able to react smoothly and seamlessly,” said Tolliver. “There should be no downtime in trying to figure out what they need to do next. It needs to be very quick, very regimented, getting the process in place.”

In an email exchange with Thomas Health, the hospital Headley was taken to, a representative said that Thomas has protocols in place for how to deal with hemorrhage that were developed in conjunction with the statewide initiatives.

But experts working in this field in West Virginia say there’s still work to be done.

In 2008, West Virginia established a maternal mortality review committee made up of experts from across the state that basically looks at all of the data around deaths linked to pregnancy and childbirth and sees what happened. They then make recommendations based on the findings. About half of U.S. states currently have such committees.

“One of the first things that we did find was that some of our women who were postpartum may have presented in an emergency room with a severe headache and other symptoms, but they weren’t caught quickly enough in regard to understanding that that was preeclampsia, for example, that they may have been experiencing,” said Tolliver. “So there were some efforts put together to do some education with our emergency room staffing.”

Preeclampsia is a pregnancy complication that is usually characterized by high blood pressure and, if untreated, can cause organ damage and even death.

Last year, the committee recommended a renewal of those education efforts, so the Perinatal Partnership is getting ready to go out around the state to do more trainings.

Tolliver said the objective is to have caregivers “be prepared to be looking at the patient just a little bit differently [and] to ask the question, ‘Has she given birth recently?’ Those answers to those questions may drive the care in a different direction and get to the bottom of what is going on with her much more quickly,” she said.

So is there anything women could do to protect themselves against dying in childbirth? First, say experts, understand that women can experience life-threatening complications during childbirth, thus they recommend that women listen to their bodies, advocate for themselves, and talk about risk with their care team.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.