The United States is in the middle of a maternal health crisis and is the only developing nation with worsening birth outcomes for moms and babies, according to Charleston maternal health care professionals.
South Carolina is no exception.
The 2022 March of Dimes Report Card gave South Carolina an F grade based on indicators such as preterm birth, infant mortality, low-risk cesarean births and inadequate prenatal care, which refers to births before 37 weeks of gestation. A normal pregnancy is 37 to 42 weeks.
“We have to look at caring for moms first,” said Simone Lee, a certified lactation counselor, Lamaze childbirth educator and doula. “Education begins prenatally, and if our moms and our babies aren’t getting the best care and the best outcomes in that perinatal state, then that leads to a domino effect of poor outcomes for children later on.”
Lee is co-founder and director of maternal and fetal outcomes of the Beloved Early Education and Care (BEE) Collective in downtown Charleston. It is a multifaceted nonprofit organization that focuses on maternal health resources, advocacy and education services. It seeks to enact changes to reduce the maternal health crisis, Lee said.
Preterm birth rates on the rise, data show
The March of Dimes report from its Perinatal Data Center indicates South Carolina has a higher infant mortality rate than the U.S. standard, Lee said, and there has been no improvement in the state’s percentage of babies born preterm.
Charleston County has a 11.6% preterm birth rate, which indicates about one in nine babies born in 2021 were preterm, according to the March of Dimes report. The preterm birth rate in South Carolina has steadily climbed since 2014, increasing from 10.8% to 12.1% statewide in 2021. The nationwide preterm birth rate for 2021 is 10.5%.
The report also found the rate of preterm birth in Charleston County is highest for Black infants at 18.3%, which is nearly double the percentage of White infants at 9.3%. South Carolina has a rate of 6.5 infant deaths per 1,000 live births, which is also above the national average of 5.4 infant deaths per 1,000 live births.
South Carolina also has a higher percentage of low-risk cesarean births than the national average, Lee said, with 27% of births designated low-risk cesareans. The majority of low-risk cesareans are often medically unnecessary, she said, and can lead to medical complications.
One of the main issues the BEE Collective confronts is maternal mortality (death) and morbidity (illness/disease), she said.
“We want to be able to make sure that everyone has good outcomes regardless of their background, income and circumstances — that they have the support and are able to understand what leads to good outcomes in pregnancy, labor and delivery,” Lee said.
“We also understand that Black and brown moms are three to four times more likely to die than their White counterparts. And this isn’t just nationwide, this is something that we see here in this area as well.”
Inadequate maternal
health care
The BEE Collective has encountered worsening outcomes for moms and babies since the Covid-19 pandemic, Lee said.
“One of the things that I would attribute to it is there were a lot of times when moms had to go into hospitals and doctor appointments by themselves,” she said. “So when we restrict individuals from having labor support people or their husbands or partners with them, we have worsening outcomes.”
Lee said the U.S. public health system doesn’t necessarily highlight the importance of how hormones affect labor and delivery. If a woman is not feeling safe in her delivery location, then her stressed body produces increased adrenaline, which is the fight-or-flight hormone. That can cause stress, which can lead to early labor, among other negative outcomes.
“There are a lot of areas where people don’t get the access to maternal care they actually need,” Lee said, “so we have these deserts where people just don’t have [access to] providers [of] quality care.”
Another factor measured in the March of Dimes report is the percentage of inadequate prenatal care. According to the March of Dimes report, 18% of pregnant South Carolina women in 2021 did not receive adequate prenatal care, which is defined by the percentage of women who receive less than 50% the appropriate number of visits for the infant’s gestational age or who did not receive care until the fifth month of pregnancy or later.
“We have so many families who aren’t getting adequate prenatal care,” Lee said.
Expanding Medicaid to cover doula and midwifery services could be a key factor in lowering that percentage. Doulas are trained to support the physical and emotional needs of pregnant people before, during and after birth. Doula care reduces chances of infection, low preterm birth rates and postpartum depression, and increases breastfeeding health, newborn health and overall satisfaction with delivery.
“We have to look at ways to make doulas a staple not only nationwide, but specifically here in the Lowcountry region.”
Molina Healthcare of South Carolina and Charleston Community Impact will host a community baby shower for local new or expectant mothers with complimentary diapers, food and wipes from 2 to 3:30 p.m. on May 20 at The Gathering Center, 1520 Remount Road, North Charleston.
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