Maternal mortality is rising. So paramedics are visiting high-risk moms at home
More moms in Michigan are dying of preventable causes, and Black women have nearly three times the risk of maternal mortality than white women in the state. The leading cause of pregnancy-related deaths in Michigan? Hypertension.
But Dr. D’Angela Pitts thinks some of those lives could be saved with a simple, at-home visit from a paramedic in the week after a mom gives birth - the time period in which 19% of all postpartum deaths occur.
“Living in Detroit and serving the community in Detroit, we know that this is our patient population, and we want to help reduce those preventable complications,” says Pitts, the director of maternal health equity at Henry Ford Health. “When we look at preventable maternal mortality and morbidity, hypertension is the most common in African-American and Hispanic women.”
Women who give birth in the health system can now be screened for risk factors, including a diagnosis of gestational hypertension, chronic hypertension or preeclampsia, and one of the following: fewer than four prenatal care visits, and transportation issues that make it hard for them to come back for an in-office blood-pressure screening within the week.
If they qualify, Pitts’ program would set up a time for a paramedic to come by their home and take their blood pressure there.
“If you are on medication, they can adjust medication at that same time,” she says. “So it's not saying ‘Your blood pressure is high, now you have to come into the hospital.’ Sometimes you can make adjustments at that time. If it is severely high and you're symptomatic, the recommendation would be coming to the hospital for further care.” The paramedic can also help moms learn to recognize symptoms that could mean they need immediate care, including severe headaches, changes in vision, and nausea and vomiting. And return visits will be made to moms whose blood pressure remains high.
The pilot program is still small so far, but it’s expanding to more hospitals: four moms have already received the paramedic visits, and another five have been referred to the program. The feedback’s been good, Pitts says, and thus far none of the patients have been readmitted. One mom said the home visit was “convenient for her, having a newborn at the house and having other toddlers at her house. Her blood pressure was normal. So that also gave her reassurance, because she has seen in the media how women are passing away that look like her. So it did provide a little anxiety [relief.]”
There’s growing evidence that remote monitoring for postpartum hypertension can be effective, with hospitals increasingly sending moms home with blood pressure cuffs and follow-up instructions. Caring for moms where they are, Pitts says, will be crucial to reducing maternal mortality - whether that’s home blood pressure checks, postpartum doula care, or community birth centers.
“The reason for death is a delay in recognizing a diagnosis, and a delay in treatment, so we can decrease both of those,” she says. “Then we're going to decrease our mortality rate, and have our moms live longer and be there for their families, to take care of their kids.”