美国国家公共电台 NPR--Maternal deaths in the U.S. are staggeringly common. Personal nurses could help

Maternal¹ deaths in the U.S. are staggeringly common. Personal nurses could help

Transcript²

In 2020, Lauren Brown of Upper Darby, Pa., had a high-risk pregnancy³. She was past 35 years old, had high blood pressure, and had a previous blood clot⁴ that could have been deadly. Plus, the COVID-19 pandemic was raging.

When it came time to give birth in December of that year, Brown, 40, needed an emergency C-section to deliver her daughter, Bella.

All of these factors contribute to a deadly trend in the U.S. The country has long stood out for its high rate of maternal mortality among wealthy countries, an issue that disproportionately affects Black Americans. The coronavirus pandemic only pushed deaths higher.

But Brown, who's Black and a first-time mom, had an experience that points to solutions.

"It was a little scary. But, being that I had the nursing group, I had my whole team at the hospital, I really felt like ... my pregnancy was very smooth," she says.

A longtime program that gets results

Brown and Bella are just one of the 56,000 families served by a national program called Nurse-Family Partnership⁵ each year.

That model, first studied in a randomized controlled trial more than 40 years ago, pairs low-income, first-time parents with a personal nurse from pregnancy through their child's second birthday.

It has an expansive goal: to help create healthier and more prosperous families. In Brown's Pennsylvania neighborhood, the program is run through a local community foundation called The Foundation for Delaware County. It is one of 774 counties across more than 40 states where the program is run.

Part of that work involves improving pregnancy outcomes for birthing parents and their babies.

Brown worked with nurse Christina Baker⁶ before, during and after her pregnancy. They could not meet up in person for more than a year due to the pandemic, but Baker kept tabs on her patient's blood pressure, stress levels and doctor's appointments remotely.

"We would have our calls, I would let her know what happened, and when my next appointment would be," says Brown, who herself went to nursing school after the birth of her daughter.

Research points to early education about pregnancy complications and multidisciplinary care for women with extra risk factors as key interventions⁷ to improve maternal health outcomes. The Nurse-Family Partnership model does both with an emphasis on empowering expecting parents to demand better care if they feel health professionals are not taking their concerns seriously.

Brown was comfortable asking questions, but many first-time parents struggle to do that, Baker says.

"One thing that I stress early on [is] that 'you need to advocate for yourself, because this is your baby, this is your pregnancy,'" she says.

This extra attention and advocacy gets results. The Nurse-Family Partnership model lowers the rates of some maternal mortality risk factors such as pregnancy-related high blood pressure, according to studies of the program's outcomes.

"I'm a fan of the Nurse-Family Partnership project because as a scientist, when I look at the data it's extremely compelling," says Joyce Edmonds, a nurse and associate professor at Boston College who's not affiliated⁸ with the program.

The causes of mortality are bigger than one program can address

Nurse-Family Partnership works to support a specific group of new parents. But it's not a fix for the larger causes driving maternal mortality in the U.S.

Experts say those go beyond the doctor's office or delivery room.

"Some of the things that I hear about being the most challenging in pregnancy are access to affordable⁹ housing and child care and mental health support," says Dr. Rose Molina, an OB-GYN and professor at Harvard Medical School who focuses on inequities in pregnancy outcomes.

A recent review of recent pregnancy-related deaths in the U.S. found that mental health conditions are a leading cause of mortality in the period up to one year after a birth, according to the Centers for Disease Control and Prevention (CDC). That same review found that 4 out of 5 of all deaths during or after a pregnancy are preventable.

Another gap is access to health care in general. In the U.S., people without health insurance qualify for Medicaid, government-subsidized health coverage¹⁰, when they become pregnant and up to 60 days after birth. More than two dozen states have joined a Biden administration program to extend that coverage up to one year postpartum. Across the country, Medicaid pays for 42% of all births.

But outside of that time period, thousands lack basic coverage. As of 2019, there were 800,000 women of childbearing age who made too much to qualify for Medicaid but not enough to afford private insurance, according to an analysis by the Center on Budget and Policy Priorities. That puts them in the "coverage gap."

Expanding Medicaid coverage, and narrowing that gap, helps reduce maternal mortalities, according to a report from Georgetown University's Health Policy Institute.

That's in part because chronic¹¹ conditions, for example cardiovascular disease, are a leading medical cause of pregnancy-related deaths. These conditions need to be treated well before conception, so that parents are "the healthiest they can be during a pregnancy," Molina says.

Expanding access to Medicaid would also increase the reach of Nurse-Family Partnership programs, according to that organization, because Medicaid dollars can be used to help fund them.

Trusted professionals are key

The cornerstone of the Nurse-Family Partnership model is building a trusting relationship.

Trusted supporters, whether nurses, doulas or midwives, can help lower the rate of birth complications and address the racial differences in birthing care, studies show.

Ja'Mil'Lion DeLorenzo, a 19-year-old mom who goes by Jayy, had reasons to distrust medical professionals in the past. When she was younger, DeLorenzo saw a rotating cast of social workers and therapists when in treatment for depression.

"So now, I have to sit here, tell my whole life story again, get comfortable with them, do stuff with them, and then they leave again," she says of that experience.

But since March, DeLorenzo has been participating in the Nurse-Family Partnership, working with nurse Carole Kriessman. DeLorenzo's son, Haiyden, was born in May.

Kriessman and DeLorenzo share Instagram reels with parenting tips in them, and Kriessman reminds DeLorenzo to take time for herself. DeLorenzo says she likes that Kriessman has stuck around.

During a recent visit, Haiyden is all gummy smiles in his red onesie. Kriessman and DeLorenzo gush¹² about his latest developmental milestone¹³: sitting up all on his own.

"You're so cute sitting up!" Kriessman says as she weighs him.

She'll be around for his next milestone, too.

1 maternal   

adj.母亲的，母亲般的，母系的，母方的

参考例句：

• He is my maternal uncle.他是我舅舅。
• The sight of the hopeless little boy aroused her maternal instincts.那个绝望的小男孩的模样唤起了她的母性。

2 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

3 pregnancy   

n.怀孕，怀孕期

参考例句：

• Early pregnancy is often accompanied by nausea.怀孕早期常有恶心的现象。
• Smoking during pregnancy increases the risk of miscarriage.怀孕期吸烟会增加流产的危险。

4 clot   

n.凝块；v.使凝成块

参考例句：

• Platelets are one of the components required to make blood clot.血小板是血液凝固的必须成分之一。
• The patient's blood refused to clot.病人的血液无法凝结。

5 partnership   

n.合作关系，伙伴关系

参考例句：

• The company has gone into partnership with Swiss Bank Corporation.这家公司已经和瑞士银行公司建立合作关系。
• Martin has taken him into general partnership in his company.马丁已让他成为公司的普通合伙人。

6 baker   

n.面包师

参考例句：

• The baker bakes his bread in the bakery.面包师在面包房内烤面包。
• The baker frosted the cake with a mixture of sugar and whites of eggs.面包师在蛋糕上撒了一层白糖和蛋清的混合料。

7 interventions   

n.介入，干涉，干预( intervention的名词复数 )

参考例句：

• Economic analysis of government interventions deserves detailed discussion. 政府对经济的干预应该给予充分的论述。 来自辞典例句
• The judge's frequent interventions made a mockery of justice. 法官的屡屡干预是对正义的践踏。 来自互联网

8 affiliated   

adj. 附属的, 有关连的

参考例句：

• The hospital is affiliated with the local university. 这家医院附属于当地大学。
• All affiliated members can vote. 所有隶属成员都有投票权。

9 affordable   

adj.支付得起的，不太昂贵的

参考例句：

• The rent for the four-roomed house is affordable.四居室房屋的房租付得起。
• There are few affordable apartments in big cities.在大城市中没有几所公寓是便宜的。

10 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

11 chronic   

adj.(疾病)长期未愈的，慢性的；极坏的

参考例句：

• Famine differs from chronic malnutrition.饥荒不同于慢性营养不良。
• Chronic poisoning may lead to death from inanition.慢性中毒也可能由虚弱导致死亡。

12 gush   

v.喷，涌；滔滔不绝(说话)；n.喷，涌流；迸发

参考例句：

• There was a gush of blood from the wound.血从伤口流出。
• There was a gush of blood as the arrow was pulled out from the arm.当从手臂上拔出箭来时，一股鲜血涌了出来。

13 milestone   

n.里程碑；划时代的事件

参考例句：

• The film proved to be a milestone in the history of cinema.事实证明这部影片是电影史上的一个里程碑。
• I think this is a very important milestone in the relations between our two countries.我认为这是我们两国关系中一个十分重要的里程碑。