Dr. Carole Myers
Welcome to Health Connections. The show about people, health and policy. I'm Dr Carole Myers. Tennessee has among the highest maternal mortality rates in the United States. Today, I'm joined by nurse midwife, Jill Alliman. Welcome to Health Connections Jill.
Jill Alliman
Thank you, Carole. It's so nice to be here today.
What are the major contributors to high maternal mortality rates here in Tennessee?
In Tennessee, as you said, we are ranked last in the US in the most recent publication of data. And this is just shocking, even to me as a health care provider. But some of the major contributors to maternal mortality are mental health, as well as drug overdoses that tend to occur related to mental health in the postpartum period. And then the second leading cause is cardiovascular problems, chronic health problems that are made worse by the fact that we have so many areas that don't have adequate health care in general keep people healthy.
And then how are we specifically as it relates to maternity care?
Maternity care also is problematic. We have what's called maternity care deserts in Tennessee. So 1/3 or more of all Tennessee counties are considered maternity care deserts, which means that there is no OB care within that county. We have many rural hospitals that have closed in the last five years. We have provider shortages. So all those things are leading us to have lower rates of people having early inadequate prenatal care, which leads to higher risk for premature birth, low birth weight, and just the infant mortality rates that are growing in the US.
So, obviously we have a problem. Is there a way forward in Tennessee, a way associated with better access to maternity care and better maternal outcomes?
I always think of the fact that midwives are so under underutilized in the US and in Tennessee. It's a provider type that has been shown through studies to achieve better health for moms and babies, things like reducing the premature birth rate and increasing the health of babies when they're born, and lowering the C section rate for mothers. In other developed countries, midwives are delivering 50 to 70% of all the babies, and they have better health outcomes. In the US, we're still at about 12% of births being attended by midwives, and there's still a lack of knowledge about the benefits of midwife care that we need to overcome.
Do you have a Tennessee specific number for the number of births attended by nurse midwives?
We are at about 13% of all of our births being attended by midwives, which is about what the national rate is. So we're not way under it, but we have lots of room to grow, especially with all the counties that don't have any OB care.
So, let's segue to talking about that. What policy interventions are needed to increase the number of midwives providing care in Tennessee?
We could have a lot more care provided if midwives could practice to the full scope of their education and training. There was a study that was done recently that showed that when states allow full practice authority, the outcomes are better.
