Elizabeth Howell: How we can improve maternal healthcare -- before, during and after pregnancy
Elizabeth Howell is working to address maternal mortality in the United States. Full bio
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as a resident physician
of doctors and nurses
to save a woman's life.
a few hours before I arrived.
and the patient was lifeless.
tried to bring her back to life,
was the father's piercing cry.
and the heart of everyone on that floor.
the happiest day of his life,
to be the worst day.
was an isolated incident,
is actually higher
for women of color.
actually increased over the last decade,
than any other country in the world.
that this new mother lost her life,
and training in the field,
by how little attention was paid
maternal health care.
not just for myself
was a civil rights attorney
for what we believe in.
were born in Jamaica,
the American Dream.
women of color were treated
I felt a responsibility to stand up,
by our healthcare system.
on improving maternal health care.
causing seizures and strokes,
of maternal mortality in this country.
is only the tip of the iceberg.
suffer a severe complication
having one of these events.
called severe maternal morbidity,
and they're life-altering.
between 1.5 and two percent
that occur every year in this country
having a blood clot, a seizure, a stroke,
such as kidney failure,
that's frankly unforgivable
of these deaths and severe complications
and standard procedures
these bad outcomes from occurring
fancy new technology.
in labor has really high blood pressure
blood loss during delivery,
and save a woman's life.
of these catastrophic events tomorrow,
the quality of care
to what is supposed to be the standard,
and severe complications way down.
actually adopted these standards,
of Obstetricians and Gynecologists
and community organizations.
standard care practices
throughout the country.
is a program called
in Maternal Health, the AIM program.
and severe maternal morbidity rates
across the country.
a number of safety bundles
preventable causes of a maternal death.
has the potential to reach
of a hemorrhage bundle.
might need in an emergency:
to measure blood loss:
collect these sponges and pads
assess how much blood has been lost.
crises protocols for massive transfusions
in the use of these types of bundles,
saw a 21 percent reduction
this bundle in the first year.
across the country is spotty or missing.
of evidence-based practices
for women of color in the United States.
to suffer a pregnancy-related death
who deliver in this country,
in the United States
drive these disparities,
as compared to a white woman
to suffer a severe pregnancy complication
that education was our salvation,
perinatal health measures,
are even more pronounced
more likely to die
than is a white woman.
are probably familiar with
of Dr. Shalon Irving,
who died following childbirth.
in ProPublica and NPR
of hearing her mother speak.
racial and ethnic disparities in health.
this was her first baby,
a complicated pregnancy,
and was discharged from the hospital.
from complications of high blood pressure.
by healthcare professionals
was not recognized.
is just one of many stories
in health and health care
that the social determinants of health,
an additional underlying cause:
by clinicians in those three weeks,
in the setting of childbirth
of racial and ethnic disparities
and severe maternal morbidity
for a variety of reasons,
in a specific set of hospitals,
outcomes for both black and white women,
of all black women
deliver in those same hospitals.
of having a life-threatening complication
in one hospital than another.
are more likely to deliver
of the black-white disparity.
social determinants of health
equitable health care in this country,
and they will take some time to resolve.
we can tackle quality of care.
across the care continuum
and reliable contraception
providing preconception care,
and optimize health.
high-quality prenatal and delivery care
postpartum and inter-pregnancy care
to have a healthy next baby
between life and death,
after having an elevated blood pressure
was her second pregnancy.
that had happened two years earlier,
in the last few weeks of her pregnancy,
elevated blood pressures,
don't worry, you'll be fine.
You're a little nervous."
for Maria last time.
the signs and symptoms of preeclampsia
if she was not feeling well,
sent her to the hospital.
ordered urgent lab tests.
to multiple different monitors
to her blood pressure,
to prevent a seizure.
so high it put her at risk for a stroke,
blood pressure in 15 minutes
according to the latest correct protocol.
as a coordinated team
lowered her blood pressure.
a tragedy became a success story.
from the hospital,
the signs and symptoms of preeclampsia,
her blood pressure checked,
postpartum health and what to expect.
with her pediatrician
her blood pressure,
as a new mother.
across the care continuum looks like,
standard care practices,
maternal morbidity rates would plummet.
would no longer be an embarrassment.
of unacceptably high rates
complications during delivery
for moms, babies and families,
our poor performance on maternal mortality
is within reach.
pregnant women from every community?
to ensure that when we do,
ABOUT THE SPEAKERElizabeth Howell - Maternal health reformer
Elizabeth Howell is working to address maternal mortality in the United States.
Why you should listen
Elizabeth Howell is a physician, researcher and advocate committed to improving the health and well-being of women. She is an expert in quality-of-care and racial and ethnic disparities in maternal and child health. Her research focuses on the intersection between quality-of-care and disparities in maternal and infant mortality and morbidity, as well as postpartum depression and its impact on underserved communities.
A graduate of both Harvard Medical School and the Harvard Kennedy School, Howell is a pioneer in research in health equity. She has conducted extensive research on maternal morbidity and mortality in New York City and the significant racial and ethnic disparities that exist. She is a professor in the Departments of Obstetrics, Gynecology, and Reproductive Sciences and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai. In addition, as the founding Director of the Blavatnik Family Women's Health Research Institute at Mount Sinai, Howell is building a competitive research program that advances the science of women's health across the life span. She has served on several expert committees for organizations including the National Academy of Medicine, National Institutes of Health, the Joint Commission and the American Congress of Obstetricians and Gynecologists.
Elizabeth Howell | Speaker | TED.com