Innovation fuel needed to ensure Arkansas moms survive and thrive

Although I haven’t birthed a baby, I am a dad who has been at my wife’s side during two very emotional and tense deliveries for the births of my sons. My oldest arrived via emergency cesarean section (C-section) after routine labor hit a snag when the umbilical cord got wrapped around his neck, and nurses could not detect his pulse. Perhaps stricken with a fear of missing out, my youngest arrived via C-section a month before he was expected to arrive.

My dad was right when he urged us to show resilience when best-laid plans go awry. I just never expected that advice to extend to birth plans. Everything turned out fine for our family despite some harrowing moments, but I still think about how quickly everything went from normal to chaotic, despite reports of healthy and usual progress during all the pre-natal visits.

We were fortunate to be surrounded by capable, compassionate healthcare providers and to have robust guidance and support both before and after our boys arrived. In addition, my wife was in good health as we planned our family and throughout pregnancy. Unfortunately, for many families in Arkansas, that’s not the case.

According to data from the Centers for Disease Control and Prevention (CDC) visualized in the Arkansas Center for Health Improvement’s (ACHI) 100 Arkansas Moms series, for every 100 new Arkansas moms in 2021:

• 14 had no insurance coverage one month prior to pregnancy (compared with only three out of 100 moms in the best-performing state).
• Only 54 had an intended pregnancy (compared with 72 in the best-performing state).
• 10 smoked cigarettes during the last three months of pregnancy (compared with two in the best-performing state).
• 25 reported experiencing depression during pregnancy (compared with eight in the best-performing state).

An ACHI analysis of birth records showed wide variation in the likelihood of having a C-section depending on the residence of the mother. Among first-birth moms with low-risk deliveries — i.e., full-term pregnancies of singletons (not twins or multiples) in a head-down position — the likelihood of having a C-section was 28% statewide but ranged from 15% in Woodruff County to 45% in Desha County. ACHI is still working to understand the extent to which variations in health status among mothers and differing practices among healthcare providers are contributing to the variation in C-section rates.

Healthy People 2030, a federal initiative that identifies public health priorities, has set a national target of reducing the national C-section rate among first-birth mothers to about 24%. Of course, C-sections can be necessary in certain circumstances, as was the case for my wife. However, for most pregnancies — especially among women giving birth for the first time — a vaginal delivery is safer for both moms and babies, with a lower risk of complications such as infection, blood loss, blood clots, and injury to organs for moms and fewer respiratory problems for babies.

These and other risks along the birthing journey have led to focused attention on maternal health in Arkansas and new efforts to make the state a healthier place to have a baby. In late 2022, the University of Arkansas for Medical Sciences was awarded CDC funding to establish a perinatal quality collaborative to improve the quality of care for moms and babies statewide. Just last month, Gov. Sarah Sanders issued an executive order creating a committee to develop a statewide maternal health plan. This follows actions by the Arkansas General Assembly in 2023 to require insurers to cover and healthcare providers to offer depression screening for new mothers and to require Arkansas Medicaid, which covers nearly 60% of all births in Arkansas, to separately reimburse for providing long-acting reversible contraception to new mothers.

Positive steps are being taken to change course on maternal health in Arkansas, where the risk for death or severe complications during or shortly after birth are a real threat and substantial racial disparities in outcomes and experiences persist. Interrelated, ongoing efforts include streamlining insurance coverage transitions for new moms, a goal mentioned in the governor’s order; training and deploying doulas, who provide non-clinical, community-based support to moms throughout the birthing journey; and using “patient safety bundles,” or maternal healthcare plans that draw on evidence-based standards of medical care.

However, considerable investments in interventions all along the birthing journey are needed to ensure that Arkansas moms survive and thrive. A new federal opportunity — the Transforming Maternal Health Model — will soon be available to support states in addressing the physical, mental and social needs experienced during pregnancy, at birth and in the postpartum period. Should Arkansas elect to pursue it, the opportunity could offer both a rallying space for ongoing initiatives and innovation fuel to achieve the end goal of making Arkansas the healthiest place for the birthing journey.

Editor’s note: Craig Wilson, J.D., M.P.A., is the director of health policy for the Arkansas Center for Health Improvement, an independent, nonpartisan health policy center in Little Rock. The opinions expressed are those of the author.