Chad Abresch testified before the Nebraska Legislature’s Health and Human Services Committee in support of LB75, introduced by State Senator Tony Vargas (District 7), which allows the state Maternal Mortality Review team to review critical incidents during labor and delivery that threaten mother’s lives in the hope they can provide recommendations for prevention.
For more than a decade, I have led CityMatCH, a national public health organization. In this role, I’ve enjoyed a firsthand look at what some states and communities around the country are doing right to improve health outcomes. Without question, there is one thing that all high-performing jurisdictions share in common: a commitment to collecting and using high-quality data.
The reason for this shared commitment should be obvious—data is a powerful tool. It can illuminate otherwise murky issues, providing clarity instead of guesswork. Data can be used to evaluate performance, improve efforts, make profits, justify hard decisions and even settle seemingly impossible disputes. In short, data can provide a factual foundation for action.
LB75 is about data
I’m here today to voice my support for LB75 because LB75 is about data. Specifically, it will provide us with clearer insights into the causes of rare, but devastating outcomes in childbirth. We have all heard that maternal mortality is a national crisis. Our nation ranks among the bottom of wealthy countries. But how are we doing, right here, in Nebraska? Well, that is somewhat difficult to say. I have included a data table, and from that data, you can see Nebraska is eleventh from the worst on the list. We have a maternal mortality rate of 28.2 deaths per 100,000 births.
However, responsible data use should point out that whenever numbers are small, our confidence in what they mean is reduced. Just imagine the Huskers winning their first game next fall. After just one win, would we assume our team is back to its winning ways? No, of course not. We would need more wins, more data, to be sure. That is why this table includes the final two columns, which show the low and high confidence intervals. Because the number of deaths in Nebraska is small for statistical considerations, to have confidence in the rate, we should acknowledge it could be as low as 17.4 or as high as 43.1.
Need additional Nebraska data
That is a large range. It could mean that we are the worst in the country. Or conversely, we could be about in the middle. If you look down just a few rows to Texas at #15, you will see they do not face this challenge. Their population is much larger, consequently their numbers for births and deaths are higher, and their confidence interval is very small. In Nebraska, we need to supplement our data to clarify the picture. LB75 will do exactly that by carefully investigating not just maternal deaths, but also severe maternal morbidities. These morbidities represent instances in which a maternal death was narrowly avoided. Maternal morbidity is about 100 times more common, which allows us to study these more plentiful events to unearth key strategies we can use to lower both severe maternal morbidity and maternal mortality. To be sure, we need this data.
Human impact isn’t small
Let me be very clear about one more point: When I say our numbers are small, I mean they are small for statistical considerations, not for human impact. Twenty-one families is far too many Nebraska families to know the unthinkable pain of losing a new mother. When my wife gave birth to our last child, she experienced a massive postpartum hemorrhage. I stood by helplessly as the room filled with nurses. A barrage of orders and a rush of activity ensued until she was whisked away for emergency surgery. I was left alone with our newborn daughter in a room that had been suddenly silenced. Praise God my wife returned. For some, the silence is enduring.
We owe it to these families to expand our data and use it to sharpen our health promotion and protection for all Nebraskans.