Maternal health
Maternal health is the health of women during pregnancy, childbirth, and the postpartum period. In most cases, maternal health encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to ensure a positive and fulfilling experience. In other cases, maternal health can reduce maternal morbidity and mortality. Maternal health revolves around the health and wellness of pregnant individuals, particularly when they are pregnant, at the time they give birth, and during child-raising. WHO has indicated that even though motherhood has been considered as a fulfilling natural experience that is emotional to the mother, a high percentage of women develop health problems, sometimes resulting in death. Because of this, there is a need to invest in the health of women. The investment can be achieved in different ways, among the main ones being subsidizing the healthcare cost, education on maternal health, encouraging effective family planning, and checking up on the health of individuals who have given birth. Maternal morbidity and mortality particularly affects women of color and women living in low and lower-middle income countries.
Maternal morbidity and mortality
WHO estimates that about 295,000 maternal deaths occurred in 2017. The causes of these maternal deaths range from severe bleeding to obstructed labour, all of which have highly effective interventions. Further, indirect causes of maternal mortality include anemia and malaria. As women have gained access to family planning and skilled birth attendance with backup emergency obstetric care, the global maternal mortality has fallen by about 44 percent, which represented a decline of about 2.3 percent annually over the period from 1990 to 2015. While there has been a decline in worldwide mortality rates after much effort, high rates still exist, particularly in low and middle income countries. Sub-saharan Africa accounts for approximately two thirds of these deaths and South Asia accounts for about one-fifth of them. One third of the maternal deaths occur in India and Nigeria. The mother's death results in vulnerable families, and their infants, if they survive childbirth, are more likely to die before reaching their second birthday.Both maternal mortality and severe maternal morbidity are "associated with a high rate of preventability."
In 2010, the U.S. Joint Commission on Accreditation of Healthcare Organizations described maternal mortality as a "sentinel event", and uses it to assess the quality of a health care system.
Subsidizing the cost of healthcare helps to improve the health status of women. In countries such as the U.S, U.K, and others, government and non-governmental bodies work to reduce and even eliminate fees for pregnant women or women who have health issues related to pregnancy. When women deliver their babies in certified healthcare facilities without paying or paying a very small amount, they can use their money on the diet of the baby, clothing, and other needs. Also, when women attend clinics without charge and are issued free supplements, their health is maintained, and this reduces the monetary resources that the government invests in healthcare. In turn, the maternal morbidity rate, together with mortality rates, is lowered.
Education on issues related to maternal health is essential to control and improve the healthcare of women. Women who have resources have a low chance of their health status deteriorating, due to their knowledge. These women are informed to make decisions regarding family planning, the best time to give birth as far as their financial capabilities are concerned, and their nutrition, before, during, and after giving birth. Additionally, many approaches involve women, families, and local communities as active stakeholders in interventions and strategies to improve maternal health. Gannon reports that the maternal rate of mortality dropped by 70% between 1946 and 1953, when women began receiving maternal education. The study recommended that the focus should be on communities that are marginalized and girls who are under the age of 18. When the government manages to reduce unwanted and unplanned pregnancies among these two groups of people, it becomes easier to reduce maternal health problems and the cost associated with them.
Factors influencing maternal health
Poverty and access to healthcare
According to a UNFPA report, social and economic status, culture norms and values, and geographic remoteness all increase maternal mortality, and the risk for maternal death in sub-Saharan Africa is 175 times higher than in developed countries, and risk for pregnancy-related illnesses and negative consequences after birth is even higher. Poverty, maternal health, and outcomes for the child are all interconnected.Women living in poverty-stricken areas are more likely to be obese and engage in unhealthy behaviors such as cigarette smoking and substance use, are less likely to engage in or even have access to legitimate prenatal care, and are at a significantly higher risk for adverse outcomes for both the mother and child. A study conducted in Kenya observed that common maternal health problems in poverty-stricken areas include hemorrhaging, anemia, hypertension, malaria, placenta retention, premature labor, prolonged/complicated labor, and pre-eclampsia.
Prenatal care
Generally, adequate prenatal care encompasses medical care and educational, social, and nutritional services during pregnancy. For example, prenatal care could include serum integrated screening tests for potential chromosomal abnormalities as well as blood pressure measurements, or uterus measurements to assess fetal growth. Although there are a variety of reasons women choose not to engage in proper prenatal care, 71% of low-income women in a US national study had difficulties getting access to prenatal care when they sought it out. Additionally, immigrants and Hispanic women are at higher risk than white or black women for receiving little to no prenatal care, where level of education is also an indicator. Adolescents are least likely to receive any prenatal care at all. Throughout several studies, women and adolescents ranked inadequate finances and lack of transportation as the most common barriers to receiving proper prenatal care.Income is strongly correlated with quality of prenatal care. Sometimes, proximity to healthcare facilities and access to transportation have significant effects on whether or not women have access to prenatal care. An analysis conducted on maternal healthcare services in Mali found that women who lived in rural areas, far away from healthcare facilities were less likely to receive prenatal care than those who lived in urban areas. Furthermore, researchers found an even stronger relationship between lack of transportation and prenatal and delivery care. In addition to proximity being a predictor of prenatal care access, Materia and colleagues found similar results for proximity and antenatal care in rural Ethiopia. Also, inadequate and poor quality services contributes in increasing maternal morbidity and mortality.
Pre-existing conditions
Pregestational diabetes
Pre-existing maternal Type 1 or Type 2 diabetes is a known factor that increases the risk of adverse outcomes, including pre-term birth, preeclampsia, and congenital birth defects. Studies from the United States and Australia indicate that the prevalence of pregestational diabetes is around 1% of pregnancies. Even healthy pregnancy causes a state of hyperglycemia. As a result, mothers with pregestational diabetes are at an increased risk for hyperglycemia.HIV/AIDS
Maternal HIV rates vary around the world, ranging from 1% to 40%, with African and Asian countries having the highest rates. Whilst maternal HIV infection largely has health implications for the child, especially in countries where poverty is high and education levels are low, having HIV/AIDS while pregnant can also cause heightened health risks for the mother. A large concern for HIV-positive pregnant women is the risk of contracting tuberculosis and/or malaria, in developing countries. 28% of maternal deaths are from obstructed labour and indirect causes, meaning diseases that complicate pregnancy or that are complicated by pregnancy.Maternal weight
During pregnancy, women of an average pre-pregnancy weight should expect to gain between over the course of the pregnancy. Increased rates of hypertension, diabetes, respiratory complications, and infections are prevalent in cases of maternal obesity and can have detrimental effects on pregnancy outcomes. Obesity is an extremely strong risk factor for gestational diabetes. Research has found that obese mothers who lose weight between pregnancies reduce the risk of gestational diabetes during their next pregnancy, whereas mothers who gain weight actually increase their risk. Women who are pregnant should aim to exercise for at least 150 minutes per week, including muscle strengthening exercises. However, it is recommended that pregnant women discuss what exercise they can do safely with their OB/GYN in the early prenatal period.Vigorous Exercise
The current guidelines for moderate intensity activity during pregnancy have been outlined by organizations such as the WHO and ACOG to be the same 150 minutes per week as regular physical activity guidelines. Certain modifications such as avoiding supine position after 20 weeks are also recommended. Vigorous activity guidelines during pregnancy have not been outlined as clearly or studied as much, so consulting a healthcare professional to get a safe, tailored, fitness plan is recommended. Current research supports that vigorous activity for most non-complicated singleton pregnancies is beneficial and has little negative impact on fetal wellbeing. It has also been shown to have similar benefits to those who perform the same level of activity outside of pregnancy. The concerns related to high intensity exercise during pregnancy are usually around fetal wellbeing measures such as heart rate and blood flow. No abnormal measures of fetal distress, such as heart rate or maternal/fetal blood flowwere found during high intensity/vigorous exercise, if the mother stayed under 90% of her heart rate maximum. Risks of exceeding this heart rate included decreased uterine artery blood flow and fetal bradycardia. If using vigorous exercise as a means of lowering maternal weight gain during pregnancy, it's important to note there is little evidence to suggest that higher intensity has more of an effect than moderate intensity activity on normal pregnancies; It was shown in one study that the obese/overweight population during pregnancy had improved maternal weight gain with more vigorous exercise compared to moderate although more studies are needed. When related to birth outcome measures such as mode of delivery, pain control, and duration all were unaffected when compared to moderate intensity.High intensity exercises such as stationary biking, uphill running, cross country skiing, and resistance circuit training, all showed similar benefits.
It is important to further study the effects and limitations of vigorous exercise during pregnancy as it becomes more prevalent for female athletes, and in the average population. Overall if one is already performing vigorous activity before pregnancy, no negative effects were found with the continuation of similar activity levels during pregnancy, if staying under 90% of the mothers heart rate maximum. Always consult a physician to ensure any physical activity performed is safe during pregnancy, as the recommended amount of physical activity can depend on other factors during pregnancy as well.
During and after pregnancy, mothers should receive continuous care from a physician, in-person or via telehealth depending on the need, to monitor the growth and status of the fetus. Maternal health organizations suggest that at a minimum pregnant women should receive one ultrasound at week 24 to help predict any possible growth anomalies and prevent future gestational concerns. It is also stated that pregnant women should also fulfill any missing vaccinations as soon as possible including the tetanus vaccine and influenza vaccine. For pregnant women who are at an increased risk for Pre-eclampsia, one could take a dietary supplement of low dose aspirin as prophylaxis before 20 weeks gestation. Pregnant women should also monitor their blood sugars as they are able to monitor the potential development of gestational diabetes. Other prenatal screening tests include serum integrated protein tests, cell free DNA blood tests to check for chromosomal abnormalities, and nuchal translucency ultrasounds. If their medical system is able to provide them, mothers can also undergo more invasive diagnostic tests such as an amniocentesis, or chorionic villous sampling to detect abnormalities with greater accuracy.