Editor’s note: This story is part of an ongoing series by The Frontier to examine and investigate maternal health in Oklahoma.
Seven of eight maternal deaths in Oklahoma could potentially have been prevented with proper and timelier medical intervention, a review by a state committee found.
The state Maternal Mortality Review Committee presented the findings in a draft of its first-ever report during a meeting last month, which was obtained by The Frontier through an open records request. The committee is expected to release more details on the causes and circumstances surrounding maternal deaths in a final report later this year.
Jill Nobles-Botkin, an advanced practice registered nurse, oversees the Oklahoma State Department of Health’s Maternal Mortality Review Committee. The team started tracking whether maternal deaths were preventable only about a year ago, she said.
“There’s a lot of different things that possibly could contribute to preventing maternal death,” Nobles-Botkin said. “So if there’s any way that we feel, the team that’s reviewing that case, feels that something could have been done differently that could have prevented the death, they classify it as potentially a preventable death.”
On average, one woman dies each month in Oklahoma from complications related to pregnancy or childbirth. Black women were more than two and a half times more likely to die than white women, the draft shows.
The committee has reviewed more than 110 maternal deaths since 2009.
The 26-member committee, which includes medical doctors, advocates and public health employees, has reviewed maternal deaths quarterly since 2009, but it has never released its findings. It’s expected to release its first report in October, which will include recommendations on preventing future deaths and summaries of maternal mortality in the state.
The board has been working on the report for about two years, Nobles-Botkin said. Members identify maternal deaths — those that occurred while a woman was pregnant or within 42 days from the end of a pregnancy —and comb through medical records and other documents to determine whether it was pregnancy-related. They then examine the causes and circumstances surrounding those cases.
The committee also identifies pregnancy-associated fatalities, which are defined as deaths during or within one year of pregnancy related to health problems from pregnancy.
Investigations have been paused because of the coronavirus, which has put the team’s meetings on hold over the past six months, Nobles-Botkin said.
Across the U.S., two-thirds of maternal deaths during or within a year of pregnancy were preventable, according to a study from the Centers for Disease Control and Prevention.
On average, one woman dies about every 12 hours in the U.S., but the cause isn’t a “one-size-fits-all,” said Dr. Rahul Gupta, chief medical and health officer and senior vice president at the March of Dimes.
The national organization advocates for the health of moms and babies, with programs that focus on preventing maternal risks and deaths.
It’s critical to understand what is happening at a state level through maternal mortality review committees, Gupta said. That allows decision makers to address problems at a local level, such as health care provider shortages or disparities in certain populations, he said.
“It becomes very important at the state level that we understand better the data in order to then develop plans to be able to address that data,” Gupta said.
The CDC came out with guidelines earlier this year for states in an effort to standardize data collection on maternal deaths and create a reliable way to compare what was happening across states.
In Oklahoma, the number of mothers dying during pregnancy or the 42 days after pregnancy is on the rise. The most recent measurement taken from 2016 to 2018 shows 24.9 maternal deaths out of every 100,000 live births, according to the draft. From 2011 to 2014 the rate was at 15.1.
The national rate was 17.4 maternal deaths per 100,000 live births in 2017, compared to 12.7 in 2007 — when the CDC last updated the rate.
Experts and researchers agree: There is no single cause for the rising number of mothers dying.
For every woman who dies, about 70 experience potentially fatal complications, accounting for nearly 2 percent of all births in the state in 2017, data obtained from the Oklahoma State Department of Health shows. The complications included severe bleeding, infections and heart failure.
Oklahoma hospitals reported 830 women had life-threatening complications in 2017, according to the data. Hospitals recorded 800 cases in 2016.
Women should immediately notify their health care providers if they’re having complications, said Nobles-Botkin, who also is a certified nurse-midwife.
“A lot of women I think are waiting too long or if they call once and they’re told it’s OK, but they feel like it’s getting worse,” she said.
“Because I can tell you as a labor and delivery nurse, also that we’d much rather see you and tell you that everything is OK then for you to wait, you know, for women to wait to come in until it’s too late.”