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Reducing Maternal Mortality

A comprehensive program at Norton Healthcare is addressing maternal health

LOUISVILLE Kentucky’s most recent Maternal Mortality Review reports alarming statistics about pregnancy-related deaths. Nearly 90% of these deaths are preventable, and substance use is linked to death in more than 50% of cases. In more urban areas, pregnancy-related deaths of Black women are more frequent than deaths of white women. In Kentucky, many women have hypertension or it is acquired during pregnancy or the postpartum period, causing significant morbidity. These statistics should be a call to action for all healthcare workers caring for women of childbearing age.

At Norton Healthcare, we are using innovative programs to respond to many maternal mortality issues. We have chosen to tackle this challenge using a comprehensive approach to patient-centered care. Highlights of our current efforts include improving care for pregnant patients with hypertension or those at risk for preeclampsia; implementing a doula program for underserved patients; continuing our Maternal Opiate and Substance Treatment (MOST) Program; and increasing our work in health equity.

 

Hypertension: Common and Treatable

One of the largest preventable causes of maternal mortality is hypertension, which accounts for 16% of maternal deaths in the United States. In addition to increasing the risk for preeclampsia, eclampsia, and stroke during pregnancy, many patients also deliver preterm due to these complications. We also know that having preeclampsia increases the likelihood of developing heart disease, diabetes, renal disease, and hypertension — all of which are rampant in Kentucky.

Lyndsey D. Neece, MD, MMM, CPE, FACOG

In 2021, we began a comprehensive program for hypertension and preeclampsia prevention. The program involves providers and patients receiving education on the benefits of low-dose aspirin to prevent preeclampsia. The previous year, we collected our prescribing rate for low-dose aspirin therapy for our patients. After education, we have seen a fourfold increase in the prescribing rate.

The program also includes using doulas to support prenatal care for our underserved patients with hypertension to encourage follow-up care and decrease barriers to care. Patients receiving support from doulas had a decrease in preeclampsia rates and an increase in postpartum follow-up visits.

The doula program provides another level of care thanks to donations through the Norton Healthcare Foundation, Norton Children’s Hospital Foundation from donors such as Aetna Better Health of Kentucky and Edie Nixon. Our doulas are trained professionals who provide physical and emotional support before, during, and immediately after childbirth. Their patient focus is on populations considered underserved. This kind of intervention is evidence-based, with a broad range of positive outcomes, including but not limited to shorter labor, increased satisfaction with the birthing process, and reduced cesarean section rates.

Treating Substance Abuse

In 2023, we began a cardio-obstetrics program that offers integrative care by cardiologists, maternal-fetal medicine physicians, and obstetricians for patients with heart disease and hypertension. Last year, we added a virtual hospital program for postpartum patients with hypertension.

We know that more than 50% of maternal deaths in Kentucky are attributed to substance use disorder. Many schools of thought exist on how to address it, but we know that patients with substance use disorder can thrive with help and support. By offering medical stabilization and outpatient treatment through the Norton MOST Program, in less than 10 years we have helped more than 1,400 patients and their families on the road to recovery. These are patients who have unique needs, and many other treatment programs do not care for pregnant patients.

A survey conducted by Norton Healthcare assessed healthcare needs in West Louisville — a nine-neighborhood community where 65,000 residents are mostly African American. The survey revealed that 36% of respondents

“We must recognize and find solutions to the fact that Black women experience higher maternal mortality rates in Kentucky.” — Lyndsey Neese, MD

felt they had difficulty finding a specialist. Of those, 46.9% said they were looking for women’s healthcare. Transportation, childcare, and office hours were all issues.

We must recognize and find solutions to the fact that Black women experience higher maternal mortality rates in Kentucky. A new women’s health office will offer services at Norton West Louisville Hospital and is scheduled to open this fall. At this location, women’s healthcare providers will offer outpatient gynecological care, outpatient gynecological surgery, prenatal care, and ultrasounds. We believe that this increased access to care will improve maternal outcomes for our community.

Bringing Care to the Community

The Louisville Metro Public Health and Wellness health equity data website states that “one major root cause of infant mortality, preterm birth, and low birth weight is the access and availability to adequate healthcare and health insurance, specifically for preventative, prenatal and/or other maternal health related services.”

If we are going to make a difference, we must recognize that even our locations matter. I am proud to be part of an organization that sees this as important. The goal: provide life-enhancing programs and services to one of Kentucky’s most underserved communities.

Norton West Louisville Hospital is under construction on the Norton Healthcare Goodwill Opportunity Campus at 28th Street and Broadway in Louisville. This unique concept was born out of a partnership between Goodwill Industries of Kentucky and Norton Healthcare to offer social services with various community partners as well as health care in a single location.

The vision includes women’s services as well as adult and pediatric primary care, cardiology, orthopedics, diabetes care, and behavioral health services. The hospital will feature a 24/7 emergency department; inpatient treatment; operating rooms; imaging services, including X-ray, CT, and MRI; and a retail pharmacy.

By offering greater access to prenatal, postpartum, and overall women’s care, we hope that we can contribute to the success of families and improve health moving into the future. Our community depends on it.