From guest writer Dr. Rod Jenkins,

Hello, Durham County! It’s Dr. Rod Jenkins, the Director of the Durham County Department of Public Health. Earlier this week, the most recent report was released by the North Carolina Maternal Mortality Review Committee (MMRC), highlighting the work being done to reduce maternal morbidity and mortality across our state. This has been a priority focus area for Durham County in partnership with Duke University Health System and our expert community-based organizations. While there remains work to do, the findings in the report were encouraging.

The MMRC reviewed 308 pregnancy-associated deaths statewide from 2018 through 2020. The Division of Public Health’s categorizes North Carolina counties into six Perinatal Care Regions, infant health surveillance: Northeastern, and birthing people residing in the Northeastern region of the state (which includes Durham County and surrounding counties) had the lowest pregnancy-related mortality ratio (PRMR) 21.6 pregnancy-related deaths per 100,000 resident births. This compares to the state rate of 44 pregnancy-related deaths per 100,000 resident births.

From a statewide perspective, according to the report, 87% of pregnancy-related deaths occurring between 2018 and 2020 were preventable. Mental health conditions were the overall leading cause of death, accounting for 32% of all cases. More pregnancy-related deaths occurred between 43 days to 1 year after birth (48%), compared to during pregnancy (17%) or the immediate postpartum period 1 to 42 days after birth (35%). These trends highlight the importance of community support for birthing people and families, particularly related to mental health and remaining connected to care after pregnancy. Committee recommendations specific to Durham’s region included: improved coordination and follow up among health care providers, appropriate training for all health care providers, lethality assessments by law enforcement to prevent intimate partner violence, access to perinatal loss support groups, increased screening to detect risk for suicide and mental health crises, and funding for birth and postpartum doula services to reduce stressors for birthing people and families.

We are proud to report that the partnerships in Durham focused on reducing maternal morbidity and mortality are already hard at work on these recommendations that come from the 2018-2020 data. In 2018, the Born in Durham, Healthy for Life (BIDHFL) coalition began as a part of a county commissioner-led initiative to establish multiple task forces aimed at improving the school readiness of children in Durham. Over time, the focus solidified around perinatal health and the reduction of barriers contributing to health outcomes. This coalition has allowed experts from the community, the Department of Public Health, Duke University Health System, and other organizations impacting the outcomes of birthing people to sit at the table and work through system-level challenges facing families. Our valued community partners, to include Mobilizing African American Mothers through Empowerment (MAAME), Breastfeed Durham, Equity Before Birth, Helping Each Adolescent Reach Their Spark (HEARTS), and others have served an essential role of informing the public health and hospital systems about the true needs and gaps that are experienced by our families. These community organizations are also providing critical, on the ground support, through the pandemic to the present day, which speaks specifically to the recommendations of increased social support and services for mental health needs. Durham County has been proud to help fund some of the initiatives of these community-based organizations, and we know there is more work to be done.

In 2022, Durham County created a Nurse Navigator position to facilitate access to appropriate and timely care and resources with individualized follow up for patients being seen at the Department of Public Health during pregnancy. This position has developed relationships with key health system providers to implement an improved scheduling workflow to prevent delays in care. The Nurse Navigator also facilitates referrals to medical providers for follow up specialty and primary care at Duke University Health System clinics, Lincoln Community Health Center, Family Connects home visits, and Samaritan Health Center. The Navigator increased mental health screening and support for patients served by Durham County to reduce stigma and normalize discussions of perinatal mood disorders. The Navigator has fostered strong relationships with community partners to provide warm referrals to organizations offering support to families and has participated in many community-led events. 

As we look to the future, it is clear that addressing the complex factors of maternal morbidity and mortality will require a collaborative effort. Though late postpartum support and mental health needs dominate this most recent MMRC data, pregnancy-related complications can occur anywhere along the perinatal spectrum. From safe care in our hospitals to wrap around services at home and advocacy to our legislators, we will work together in Durham to continue to fight the maternal health epidemic.

Sincerely,

Dr. Rod Jenkins | Director of Durham County Department of Public Health