Tom Corwin is the Health Reporter for The Post and Courier. He is a graduate of the University of Missouri and has covered science, medicine, politics and state legislatures for newspapers in Missouri, Tennessee, Georgia, and South Carolina.
The high rates of infant deaths and mothers who die soon after birth has long been a concern in South Carolina. Now, the state's Medicaid program is getting a $17 million grant from the federal government to improve care.
South Carolina is among 15 states getting grants to implement the Transforming Maternal Health model. A key piece of that is offering those mothers more choices and a more personalized birth plan. That includes not only education for physicians and caregivers, but better ways to communicate with mothers before and after birth.
The Medical University of South Carolina has created a model that helps mothers communicate their needs and get the help they need. Medicaid needs to "meet them where they are" to improve maternal health and the health of their infants, said officials with the S.C. Department of Health and Human Services.
The Palmetto State is 38th in infant mortality rates, according to the Centers for Disease Control and Prevention, and has the eighth-worst rate for infant mortality.
The state's Medicaid program was studying the results of its Birth Outcomes Initiative and focusing on how its patients fared compared to the state as a whole. While the overall infant mortality rate is lower for Medicaid than the state itself, officials noticed key differences in some preventable causes, such as accidental suffocation, were higher for Medicaid members, said Jordan Desai, chief of quality for Medicaid.
"So for us, that was an immediate call to action" to work with providers on safety workshops to help prevent that, she said. The federal grant will enable the state do that kind of prevention in a much larger and broader way. And because Medicaid covers roughly 60 percent of the births in South Carolina, it could have a wide-ranging impact.
"It's such a huge win for our state," said Dr. Constance Guille, professor of psychiatry and obstetrics/gynecology at MUSC, who is leading initiatives to help get pregnant women and new mothers much-needed care.
It is especially important for Black mothers in South Carolina, and the death of Shaquilla June of Sumter, who died in May 2021 three days after giving birth and hours after being discharged, is an example of that.
Black women in South Carolina are 4.2 times more likely to die giving birth or soon after compared to White women, according to data from the state's Maternal Morbidity and Mortality Review Committee.
The new federal program aims to help states take a "whole person" approach to supporting pregnant women and new mothers by increasing access to services and providing more support. For instance, the model aims to make it easier for women to access additional support from caregivers such as doulas and midwives, which could be important for states like South Carolina that lack obstetricians. Nearly a third -- 14 out of 46 -- of counties do not have an obstetrician.
It is also recognizing that some women may traditionally have accessed birth care in other ways and finding what makes sense for that particular mother, Desai said.
"How do we make sure that individuals have access to the type of care they want," she said. It also means building a "best-in-class service array" that mothers have access to that ensures better and safer outcomes, Desai said.
A big piece will be overcoming those "really significant racial disparities" in birth outcomes for some women, Guille said. And that involves both a health system change and a community-level change, she said. That could mean having health systems work with people in the community, the doulas and the Community Health Workers that are already trusted, "helping women to feel empowered to reach out for appropriate help and get appropriate help if needed," Guille said.
MUSC may already have a model for that outreach. Called Listening to Women and Pregnant and Postpartum People, the approach used phone and text messages to help screen women for mental health, substance use issues, instances of domestic violence or other social impacts on health. By using the phone, which most people always have with them, as opposed to relying on office visits, not only were more women referred to services, but they were also five times more likely to actually get those services, Guille said. And Black and White women had equal rates of treatment, overcoming otherwise enormous racial barriers, "which was really exciting," she said.
That MUSC program is one the state is eyeing in terms of outreach and is trying to determine if it is "scalable" to cover the entire state, Desai said. The Medicaid program foresees having a number of different initiatives "to braid all of those pieces together," she said. The state had surveyed the innovative programs already happening and sees the new model as a way to leverage those with the new funding without duplicating them, Desai said.
Those collaborations, physician education, and support for them and other providers, should impact not only those covered by Medicaid, but all future mothers in South Carolina as the program rolls out in the next few years, she said. And a mother who is in better health, particularly better mental health, "is ultimately going to help the baby do well," Guille said.