ST. LOUIS — Seventy women die every year in Missouri of pregnancy and birth complications.
In December of 2023, Missouri Gov. Mike Parson announced a plan to improve maternal health.
5 On Your Side wanted to find out what’s been done on the state level since the announcement.
We reached out to the governor’s office. We also talked with Dr. Karyn Fowler, Medical Director for Women’s and Neonatal Clinical Programs at SSM Health; Okunsola Amadou, founder and CEO of Jamaa Birth Village; Eboni Hooper-Boateng, owner of Birthing You Doula Services, and Jasmine Williams, who is a wife, a mother of five, and a doula.
In her work and through her own experience, Williams has a unique insight into how such a joyful time can sometimes fall apart for Black, indigenous and other women of color (BIPOC).
"As you know, the mortality rate for pregnant women, Black women, is at its highest right now,” said Williams, who is mom to Journey, 13; DeAndre, 9; Jade, 6; Jezreel, 5; and DeAmir, 2.
She struggled with mental health issues during the last three of her pregnancies.
"I don't know what it is,” Williams said. “I think after birth, everything just goes out of whack."
Why mothers die
Poor health and death in the first year after giving birth can be caused by a number of health problems, everything from cardiac issues to hypertension.
But mental health accounts for 50% of why moms in Missouri die.
Nationally, Missouri ranks among the worst states for maternal mortality.
Maternal mortality prevention plan
In December, Parson announced a maternal mortality prevention plan was funded with $4.3 million and includes five domains of action, ranging from changes in hospital protocol to improved obstetric and postpartum training and toolkits for providers.
I reached out to the governor’s office to find out how the money had been spent.
In an email, the communications director for the Missouri Department of Health and Senior Services, Lisa Cox, outlined the specifics. They are summarized here, and include:
- Standardized training for maternal care providers
- Development of new maternal quality care plans for hospitals
- The Maternal Health Access Project, a resource for doctors and providers to connect new moms with mental health resources. DHSS contracted with the University of Missouri to establish this collaborative hub-and-spoke model which launched in April 2024
- Convened the Optimizing Postpartum Care Task Force to develop recommendations for extended postpartum care pathways in Missouri. Under this part of the plan, health experts would meet monthly to develop a postpartum plan-of-care template and recommendations for implementation, with a special focus on reducing racial disparities.
- Development of a Maternal and Child Health (MCH) Dashboard, along with a new MCH Data Sources webpage, both published in June 2024.
As for the allocation of the $4.3 million in funding: as of June 2024, $2.8 million had been spent.
Here is a list of organizations receiving the funding:
- $1,455,000 was contractually allocated to the University of Missouri.
- $2,425,000 was contractually allocated to the Missouri Hospital Association.
- $339,500 was allocated within DHSS for the creation of the MCH Dashboard.
- The remaining $130,500 of the $4.3 million was held for the Governor’s reserve.
Impact for patients
I asked Dr. Karyn Fowler, medical director for Women’s and Neonatal Clinical Programs at SSM Health, if the funding was adequate.
“It's a good start,” said Fowler. “It's a good start.”
Fowler said one of the most useful new domains is the Maternal Health Access Project. It’s a new network of resources doctors and health care providers can use to link patients with mental health care.
"If we have a patient who has screened positive for depression or anxiety, has clear needs for mental health support, we can access this network 24 hours a day,” Fowler said.
But patients have to visit a health care provider to get connected to that help.
"We've got a lot of work to do,” Fowler said.
She also said healthier outcomes need to start before pregnancy, with access to quality healthcare and a healthy lifestyle.
“Even before you get pregnant, being less susceptible to diabetes, being physically active and fit, managing obesity, or becoming a healthy weight, all of those things that we have access to,” Fowler said. “And it can start as simple as access to healthy food. Access to that kind of support for healthy families makes a huge difference in the outcomes.”
She also said Missouri needs to copy the programs of states that are getting it right.
"It's awareness, collaboration,” Fowler said. “And even more importantly, it’s coordination with the state. And the people who pay for these things in healthcare."
Finding help
Jasmine said a doctor prescribed medication for her after the birth of her third baby.
“I felt like a zombie,” she recalled. “I didn't feel like a mom."
She stopped taking it and got online.
"Facebook, and of course, TikTok everything,” said Jasmine. “And so finally, I got a friend that told me you need mental health help."
It was talk therapy that helped Jasmine feel better. Now, with her personal experience and her training as a doula, she's working to help other moms have an easier time getting the help they need.
“I didn't feel like I was being heard,” Jasmine said. “They just brushed it off and said, ‘Oh, that's because you had a baby.’ But I did find someone you know, that looked like me, who helped me through that postpartum period ... That helped.”
Community-based trailblazers
I also talked with local Black maternal health leaders and doulas.
Okunsola Amadou is the founder and CEO of Jamaa Birth Village. She believes hospitals are just now becoming interested in reaching BIPOC moms. She said what’s missing are midwives and doulas who have models of care that are proven to work and prevent maternal mortality.
Yet, Amadou said, “most of the funding goes to the hospitals.”
I also talked with Eboni Hooper-Boateng, owner of Birthing You Doula Services. She said she’d like to see inclusive decision-making and an effort to engage doulas and midwives at the grassroots patient care level.
“It feels like there's a disconnect in terms of accessing resources,” said Hooper-Boateng.
She would also like to see the state of Missouri pay for doula services for patients.