Saving moms in Montana: A maternal mortality review initiative
William J. Peters, MD, past District VIII chair and past Montana Section chair
Currently, there is a state legislative initiative to re-establish a formal Montana maternal mortality review. The initiative is an effort to improve maternal safety and quality of care by clinically correlating rising maternal death rates in Montana and the nation.
The average maternal mortality ratio for 2000–09 in Montana was 13.7 deaths per 100,000 live births. This ratio was consistent with rates across the US. Increases in this ratio prompted the Centers for Disease Control and Prevention to set a nationwide goal to reduce it to 11.4 deaths per 100,000 live births by 2020.
One issue with this goal is that Montana and 15 other states do not have a formal process for maternal mortality review. Thirty-four states do have a formal process. We have maternal mortality statistics from the Montana Department of Public Health and Human Services; however, no clinical correlation review process currently exists.
Prior to 1985, the Montana Medical Association (MMA) had a Maternal Welfare Committee. The Montana Department of Public Health and Human Services provided the MMA with maternal death records. The MMA Maternal Welfare Committee then requested the Montana Section review the maternal deaths. The review process was disbanded in 1985 due to questions of its lack of non-disclosure and the medical liability crisis that year.
The Montana Section would like to re-establish a maternal mortality review by legislatively amending the existing Fetal, Infant, and Child Mortality Review (FICMR) Prevention Act (established in 1997). Adding “M” (for “maternal”) to FICMR would provide a budget-neutral infrastructure, which has non-disclosure and confidentiality agreements in place. It would take advantage of an established process by using the 28 local FICMR teams across Montana and avoid establishing a new duplicative, separate process with added costs and no infrastructure.
This amendment to FICMR requires legislation. The MMA Legislative Committee assisted the Montana Section with this legislative effort. An important legislative step and successful turning point happened on August 20, with the unanimous acceptance of the FICMR Amendment Bill by the Legislature’s Montana Children, Families, and Health and Human Services Interim Committee. It was the only unanimous legislative decision made that day by the bipartisan committee.
The FICMR Amendment Bill now has appropriate sponsorship by State Rep. Liz Bangerter (R-Helena) and State Sen. Jason Priest (R-Red Lodge). The bill will be introduced to the Montana Legislature before the December 15 deadline. The FICMR Amendment Bill, having had unanimous, bipartisan acceptance and support from the Montana Children, Families, and Health and Human Services Interim Committee, is favored to be passed by the Legislature.