Health officials outline efforts to reduce maternal deaths in Iowa

DES MOINES — Iowa’s top health official says new programs and efforts to reduce preventable maternal deaths and severe and potentially life-threatening complications during pregnancy and delivery are showing promising signs.

Kelly Garcia, director of Iowa’s Department of Health and Human Services, addressed lawmakers Thursday about maternal programs as national metrics show maternal health outcomes have worsened in the state in recent years.

Iowa's maternal death rate and infant mortality rate have climbed as birthing units have closed in recent years. Expectant mothers in those areas are less likely to access prenatal care, according to a study by the University of Iowa published in the Journal of Rural Health that examines prenatal care at seven counties where labor and delivery units were shut down at their hospitals.

A 2023 report from the March of Dimes found a third of Iowa's counties are "maternity care deserts" — that they have no hospital birthing centers or OB-GYN providers.

Lawmakers passed measures last year funding family medicine obstetrics fellowships in rural areas and "Centers of Excellence" to encourage collaboration between health systems, with a focus on creating access to specialty care in rural areas.

Lawmakers allocated $560,000 for the current fiscal year to reimburse teaching hospitals to train up four fellows. To qualify, physicians need to complete a medical residency, complete a one-year obstetrics fellowship and engage in full-time family practice for five years in rural or underserved areas of Iowa

Dr. Robert Kruse, state medical director, who briefed lawmakers with Garcia, said the department anticipates issuing a request for teaching hospitals to apply this spring.

Iowa physicians and abortion rights advocates have argued recently passed laws restricting abortion are hindering efforts to recruit and retain OB-GYN specialists.

Sue Huppert, chief external and government affairs officer at Des Moines University, earlier this month told officials with the Iowa Board of Medicine she worries proposed rules related to the state’s law banning abortions early in pregnancy — which in on hold while in court — would prevent the full scope of training necessary to practice in Iowa.

The University of Iowa houses the only obstetrics and gynecology residency program in the state. However, Huppert said, there has been interest from other health care organizations to create another residency program in Iowa. She urged the board to consider national accreditation requirements that are needed for the programs.

Iowa has among the fewest OB-GYN specialists per capita of any state in the country, according to data from the American College of Obstetrics and Gynecology.

Kruse pointed to regional efforts by health systems in central, Western and southwest Iowa to improve rural health outcomes for moms and babies. Of the five “Centers for Excellence” established in rural communities, three are focused on maternal health:

“There’s a lot of good things happening out there,” Kruse said.

Garcia said the department is looking to “break new ground” in Iowa’s maternal health system, and has provided patient safety “bundles” to Iowa’s 56 hospitals with open labor and deliver units to support best practices that make birth safer.

The bundles provide a collection of evidence-informed best practices and actionable steps developed by experts, which address specific conditions in pregnant and postpartum individuals.

She said the department also has provided “safety bundles” to hospitals focused on reducing primary caesarean birth, obstetric hemorrhages and sever high blood pressure.

Garcia presented department data that showed the program reduced low-risk caesarean birthrates and reduced disparities from 2020 to 2022. However, rates rose in 2023 above a national benchmark to improve health and well-being over the next decade, according to provisional data.

Incidents of severe, potentially life-threatening health problems due to hemorrhaging during birth declined sharply from the later half of 2022 to the first half of 2023, falling from 47 cases per 10,000 births in the summer of 2022 to 19.5 cases per 10,000 births in spring 2023, according to the department’s data.

Garcia said the department is looking at requiring facilities that receive reimbursement through Iowa Medicaid to participate in the patient safety bundle program. She said state officials are also contemplating “an infusion of dollars” through the state’s hospital-directed payment program tied to outcomes metrics as a way to incentivize health systems to address the leading known causes of preventable severe maternal morbidity and mortality in Iowa.

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