IM Response

 Respond to the following  posts in a state different than your own. Compare and contrast your findings with your classmates. Include 2 references each

Response 1 

Pregnancy-Related Mortality

             Maternal mortality is defined as the death of a women while she is pregnant or that occurs within 42 days of the termination of a pregnancy, from any cause related to or exacerbated by the pregnancy or its management (Jordan et al., 2019, p. 577). The United States is the only developed nation to have the rate of maternal mortality rise over recent years. Health disparities for infants are poorly addressed in this country and there are differences in the rates of infant mortality among the different races and ethnicities as well (Jordan et al., 2019, p. 315). This discussion will compare the rates of infant and maternal mortality in Texas to those of the rest of the nation and relate them to racial and other health disparities. The role of the advanced practice nurse (APRN) and prenatal care in adressing maternal and infant mortality will also be discussed.

            In 2017, the rate of infant mortality in the United States was 5.8 per 1,000 live births. The rate in Texas was 5.5 infant deaths per 1,000 live births (National Center for Health Statistics, 2020). This ranks Texas as having the 18th highest rate of infant mortality in the United States. The disparities in infant mortality rates (IMR) differ across racial lines as well as state lines. The highest IMR are among the non-hispanic African-American or Black population, and black infants are twice as likely as white infants to die before their first birthday (Owens-Young & Bell, 2020). The CDC found that both infant and maternal mortality rates were higher in African Americans than in Caucasians or any other races and this is most likely due to differences in socioeconomic conditions including access to health care, nutritious food, and safe housing (Jordan et al., 2019). Income inequality is also highest in the United States and it was found that this inequality was significantly related to black but not white pregnancy-related mortality (Vilda et al., 2019). As long as racial and ethnic differences cause disparities in socioeconomic status, these disparities will also exist when it comes to health outcomes.

            The role of the APRN with regard to pregnancy-related mortality should be to promote health in vulnerable populations, such as racial and ethnic minorities. This can be done by providing education about the importance of prenatal care. APRNs can also work in public health clinics that provide health care to socioeconomically disadvantaged populations in order to ensure that they have access to healthcare. Advanced practice nurses can also provide home visits to individuals that may not be able to physically commute to a standing clinic and ensure that healthcare is still being provided. By participating in some of these measures, the APRN can help to reduce the rate of pregnancy-related mortality.

            The IMR in Texas is close to the national average, but it is still higher than that of neighboring developed countries. This could be due to the higher number of minorities in the population, or the large amount of the population that is rural versus urban. Both of these factors can effect the socioeconomic status of the population and create health disparities. Differences in IMR among races may be due to cultural beliefs and the importance that is placed on prenatal care, but it has been shown that income and access to medical care are major factors creating health disparities. It is the duty of the APRN to promote health through providing proper prenatal care to disadvantaged populations and educating people on the importance of proper prenatal care. By making these changes, health disparities may be reduced, and the rate of pregnancy-related mortality may be improved.

Response 2

 According to an article by Martin and Montagne (2017), the United States has the highest maternal mortality rate than any other developed country and is the only country with a rising mortality rate. This is severely concerning. According to the Centers for Disease Control and Prevention (CDC), the rate of pregnancy related deaths increased from 7.2 deaths per 100,000 live births in 1987 to 16.9 deaths per 100,000 live births in 2016. In New Hampshire, the maternal death rate averaged to be about 22.8 deaths per 100,000 live births, while the national average was 29.6 deaths per 100,000 live births in 2019 (America’s Health Rankings, 2019). According to America’s Health Rankings (2019), the lowest maternal mortality rate in the country was 12.4 per 100,000 deaths in Alaska and the highest was Louisiana with 72 deaths per 100,000 births. New Hampshire does well with this by being below the national mean and well below the highest state. Black and American Indian/Alaska Native women have the highest morality rate, as well as women over the age of 40 and women with chronic illness.

Infant deaths in the United States range from 3.6 deaths to 8.3 deaths per 100,000 live births per state (Centers for Disease Control and Prevention, 2018). I am lucky to say that the state I live in has the lowest infant death rate, which is New Hampshire at 3.6 deaths per 100,000 live births, with a total of 43 deaths in 2018. There are not many large hospitals in New Hampshire that focus on neonatal care. I know of two, Dartmouth Hitchcock in Lebanon with the Children’s Hospital at Dartmouth Hitchcock (CHaD) and Elliot Hospital. I work at Elliot Hospital and float to the neonatal intensive care unit very often. We see many transfers to our hospital from other local hospitals because they do not have the ability to care for infants that come out very sick.

When it comes to advance practice registered nurses in the decrease of mortality rates for mothers and infants, I believe it begins with knowing one’s personal scope and the scope of the facility a person works at. When we have mothers transferred to our hospital, it is almost always because the provider knows they will be unable to adequately care for the infant once it is born. This could save an infant’s life, before he or she is even born. I believe that knowing when a patient is at risk is extremely important, so that they can be in the right place when they do deliver. For example, at our NICU, we are unable to give nitric oxide to infants after meconium aspiration. When a provider believes that an infant will benefit from this, they are sent to Boston, Massachusetts, a completely different state, to get what they need. It is the role of the provider to understand what the patient needs, and to know they are unable to provide it. If the provider does not know this, then the patient is at risk for higher mortality rates. It is also the providers role to give evidence-based care, in a timely manner. It is important to be prepared for emergencies.