New program hopes to improve Missouri’s high maternal mortality rate

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COLUMBIA, Mo. – The state is making a historic investment into a maternal mortality prevention plan after Missouri has one of the highest rates of pregnancy-related deaths in the country. 

In a new report from the state, an average of 70 Missouri women died while pregnant or within one year after giving birth between 2018 and 2020. The most sobering piece of the report is that nearly 85% of those deaths were preventable. 

It’s being called the “Missouri Perinatal Psychiatric Access Project,” known as MO-PPAP. Those behind the effort at the University of Missouri believe it will be helpful to providers like OBGYNs and midwives to give the best mental health resources to their patients. 

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“Addressing mental health and substance use disorders, we’re going to have healthier kids and families,” program coordinator for MO-PPAP Wendy Ell said. “At the federal level, Missouri has been on heat maps for years of a strong need for perinatal psychiatry access program.”

Missouri is looking at new ways to help save moms and their families. According to a recent report from the state’s Pregnancy-Associated Mortality Review (PAMR) Board, the number one cause of pregnancy-related deaths was mental health conditions, including substance use disorders. 

“When you look across the country, Missouri does rank one of the worst when it comes to perinatal health and mortality,” chair of Mizzou’s Department of Psychiatry Laine Young-Waler said. “The stress that the mom feels, the increase in stress hormones that the mom experiences, are things that the child is also exposed to.”

The second leading cause is cardiovascular disease, like high blood pressure, followed by homicides. The number of suicide deaths doubled when compared to 2017-2019 with 2018-2020. 

The PAMR Board found that the pregnancy-related mortality ratio was 32 deaths per 100,000 live births, which is up from 25.2 deaths in the 2017-2019 time frame. The report found the highest number of pregnancy-related deaths happened in 2020, at 85 deaths. 

“Not only knowing that Missouri’s maternal mortality is one of the worst in the nation, but that most of these patients that have these mental health and substance use disorders go untreated,” Ell said. “Only about 15% receive the care that they need. We’re really hoping with this program, we get more moms, more women into care that need it and lack that currently.”

With money from the Department of Health and Senior Services (DHSS) and the federal government, the University of Missouri is creating a new tool to help providers. MO-PPAP offers providers a consultation over the phone with a perinatal psychiatrist who will then provide a treatment place within 30 minutes. 

“Until now, there has been some fear in some providers, ‘Well, they are bipolar,’ but we can’t give these medicines because of the baby. But there are experts that show what medication are less risky,” Young-Walker said. 

This program is similar to the “Missouri Child Psychiatry Access Project, known as MO-CPAP, aimed at helping pediatricians give the best mental health resources to their parents. Since the program started in 2018, MO-CPAP has delivered more than 2,000 child psychiatry consultations to providers across the state. 

“The same program is hopefully going to have that same impact but with a different audience,” Ell said. “MO-CPAP has exceeded our expectations. We have providers call it their lifeline. Without that program, they wouldn’t be able to quickly identify, diagnosis and treat children with mental health conditions.”

Earlier this year, the governor called the state’s maternal mortality rate, “embarrassing.” Lawmakers approved legislation extending Medicaid coverage for new moms from 60 days after giving birth for up to one year. By extending the coverage for up to one year after giving birth, the legislation is estimated to help more than 4,200 new moms a year.

With a large shortage of mental health care professionals in Missouri, and $5 million being spent on this new project is expected to bridge the gap. 

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“You don’t have to refer a patient,” Ell said. “That could maybe take months to get into services. With our service those professionals practicing in those medically underserved areas have the expertise at their fingertips.”

The report also found that women living in metropolitan counties were almost twice as likely to die of a pregnancy-related death than women in rural counties. 

Click here to see the full 2018-2020 PAMR Board report. 

The program is still in the development stages, but the goal is to open enrollment, which is free for providers after the first of the year. The 1-800 number will be available Monday through Friday. 


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