More than a dozen hospitals in Louisiana have earned a new designation for high-quality pregnancy care, as part of a push by the state health department to decrease Louisiana’s high maternal mortality rate and disparities in care that put Black women’s health most at risk.
The Birth Ready Designation was developed by the Louisiana Perinatal Quality Collaborative, a group of physicians, researchers and advocates tasked by the state with investigating and addressing complications and deaths among pregnant and postpartum women in Louisiana, especially Black women.
Dr. Veronica Gillipsie-Bell, the collaborative’s medical director, said the designation was, to her knowledge, the first of its kind focused on maternal care in the U.S.
“We want to honor our hospitals that are putting in the hard work to improve maternal outcomes,” Gillispie-Bell said. “It also is a way for us to encourage all of our hospitals to continue doing the work.”
Eleven hospitals earned the Birth Ready Designation, including some in Shreveport, Monroe, Lake Charles, New Orleans and Baton Rouge. Five earned the higher standard of the Birth Ready Plus Designation. Both are renewed annually and based on performance in a range of areas, including improving health disparities and involving patient feedback, implementing policies and procedures to prepare for and respond to emergencies, monitoring care and collaborating across disciplines.
The collaborative works with 42 of the state’s 46 birthing facilities, and participation is voluntary. Of the 42 hospitals working with the state, 38% qualified for the distinction.
“It shows the community that work is happening,” Gillespie-Bell said. “Quite often we hear about the poor outcomes in Louisiana and how we compare to other states in the South, and not a lot on what efforts are being put into place to improve those outcomes.”
Louisiana’s maternal mortality rate — the number of deaths during pregnancy, at birth, or within 42 days of birth — is higher than the national average, and the United States itself has a rate above those of comparable countries. In both cases, Black women are far more likely to die than white or Hispanic women.
According to an estimate by the Centers for Disease Control and Prevention, Louisiana's rate was 25.2 deaths per 100,000 live births in 2018, compared to a national rate that year of 17.2. The CDC released data for 2019 that found the national rate had risen to 20.1, but did not publish state-specific data.
Data released by the Louisiana Department of Health in 2018 found that Black women are four times more likely to die than white women during pregnancy or within 42 days of giving birth.
A separate review published last year found that for deaths directly related to pregnancy, Black women were actually five times more likely to die. Of those fatalities, 80 percent were preventable. The most common causes of death were cardiovascular and coronary conditions.
Specifically, hemorrhaging and high blood pressure are two of the leading complications in pregnancy, and Paula Adamcewicz, the director of woman and newborn services at East Jefferson General Hospital, one of the new Birth Ready facilities. She said hospitals that participate in the Perinatal Quality Collaborative are able to share best-practices with other facilities.
East Jefferson General Hospital has increased training and improved treatment plans for pregnant people with hypertensive disorder.
“When we can identify that a mom is having some blood pressure issues, we can get them in to see a high-risk specialist. And that results in a better outcome if they're being managed appropriately during their pregnancy, and we can put together a good plan of care,” Adamcewicz said.
Staff now run practice drills for emergencies — including hemorrhages — and every pregnancy is reviewed by a perinatal quality nurse.
Gillispie-Bell said the designation is “not just going to be a participation button” for working with the state to try and improve care.
Since the launch of the Perinatal Quality Collaborative, births have become safer in the state. From 2016 to late 2019, severe hemorrhaging declined by nearly 40%, and serious high blood pressure complications fell by 22%, according to data compiled by the state.
The one metric that has yet to budge is the much higher rate of complications and deaths for Black women.
“I do believe that this is going to improve outcomes, I 100% do,” she said. “I think it's going to help with improving our disparities.”
Another hospital to earn the Birth Ready Designation is Willis-Knighton South and the Center for Women's Health in Shreveport, a hospital that delivers roughly 1,200 babies every year. It’s part of the Willis Knighton Health System in northwest Louisiana, which created a maternal quality council as part of its participation in the Louisiana Perinatal Quality Collaborative.
Traci Latiolais, a coordinator of women’s and children's services and part of the maternal quality council, said the designation comes as a bright spot during the devastation wrought by the pandemic.
“In the last 18 months, with COVID, we've done a lot more with a lot less, and this one little thing, this designation means a lot,” she said. “Birth outcomes are not just for safety — it’s also equitable and dignified birth.”
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