EVANSVILLE — Indiana and Kentucky are among the worst states in the nation when it comes to people dying while pregnant or giving birth.
The reason for that, according to state records and experts, is multi-faceted and complicated. But most of the deaths are preventable, and many of them can be traced to drugs.
By the Centers for Disease Control and Prevention's classification, pregnancy-related deaths can happen while the victim is pregnant, giving birth, or a year postpartum. According to the CDC, almost 700 women die every year in the U.S. due to pregnancy or delivery complications.
But the numbers aren't perfectly accurate.
Dr. Nicole Plenty, a maternal fetal medicine physician with Ascension St. Vincent in Evansville, said when she served on the state's Maternal Mortality Review Committee, a volunteer group that consists of doctors and nurses that was established in 2018 and reviews all deaths reported within one year of pregnancy, she and others weren't able to look at every case.
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"It takes a lot of time to review each one of those cases," Plenty said. "The data is skewed just because we don't have all the data reviewed."
In Indiana and Kentucky, substance use disorder is the most common factor in deaths, with 33% of Indiana's fatalities contributed to overdoses. The Indiana Maternal Mortality Review Committee cited in their report that 80% of deaths in 2019 could have been prevented. And Kentucky's Maternal Mortality Review Committee found 52% of deaths were linked to substance use disorder, and 91% of the deaths were preventable.
The numbers have only reason in subsequent years. In 2021, Vanderburgh County alone saw 106 overdoses, 81 of which were fatal.
Scarcity of care is also a problem. There are 34 out of 92 counties in Indiana that do not have a obstetric center, meaning women have to travel elsewhere to deliver. Two of those counties, Posey and Gibson, are in the Tri-State. Women there often have to go to Vanderburgh County for care.
"When you have a city that doesn't have any obstetrical care doesn't mean there's not an OB-GYN in the city. It just means there's not an OB-GYN that delivers there in the city," Plenty said. "There are some OB that just are doing prenatal care and there are some family medicine doctors that doing prenatal care."
Indiana and Kentucky are among the few states with a maternal mortality review committees. Indiana's committee has done two reports so far, and members hope to continue reviewing the data and offer recommendations, Plenty said.
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Post-Roe World
Any strides, though, could slow after the overturning of Roe v. Wade.
After the U.S. Supreme Court nixed the constitutional right to abortion access in June, the Indiana General Assembly responded by passing a bill that bans abortion except in cases of rape or incest, fatal abnormalities or where the life of the person giving birth is at stake.
The bill criminalizes medical professionals who perform an abortion that does not meet these exceptions. It is a level 5 felony and violators could potentially serve up to six years in prison and pay a fine up to $10,000.
Gov. Eric Holcomb signed the bill on Aug. 5 and it is set to go into effect Sept. 15.
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IU Health has said in a news release that its priority is to make sure patients understand their options clearly when making a decision about their pregnancy.
"The bill's restrictions on a physician's ability to do what is medically proven and appropriate for the health and life of a pregnant patient, plus the threat of criminalization, impact our ability to provide safe and effective patient care and could deter physicians seeking to live and practice healthcare in Indiana," the release stated.
In Kentucky, the restrictions are even stricter. When Roe was overturned, a trigger law went into effect that banned all abortions, with no exceptions, past 6 weeks of pregnancy: long before most people know they're pregnant.
Postpartum
Indiana's Maternal Mortality Review Committee reported 85% of maternal deaths happened postpartum. That can be due to a variety of things such as hemorrhaging, not going to the first-week check up, and postpartum depression.
"When we look at reducing the risk, or the rate of mortality, that postpartum period is something we really need to hone in on," Plenty said. "There are a lot of patients that decide not to come back for those visits because they have a child now and they're busy or they're exhausted. And they already have to take their child to their one week postpartum."
Plenty said one of more common postpartum issues women deal with is pre-eclampsia, or high blood pressure. They may not even be aware of it. They also might not realize it could be fatal.
"Pregnancy can be a very uneventful process, right? It's the happiest time of women's lives and most patients are low risk. But you don't know that you're high risk until you're high risk sometimes," Plenty said. "I would encourage patients to seek care and immediately if they don't feel well."