Mental health conditions, including substance use disorder, caused more pregnancy-related deaths in Oregon between 2018 and 2021 than any other factor.
That’s according to the state’s Maternal Mortality and Morbidity Review Committee, which assesses deaths that occur during pregnancy, childbirth and the first year postpartum. As reported in InvestigateWest, nearly all of the deaths attributed to mental health conditions were deemed potentially preventable by the committee.
InvestigateWest reporter Kaylee Tornay joins us with more details.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Mental health conditions, including substance use disorder and depression, caused more pregnancy-related deaths in Oregon between 2018 and 2021 than any other single factor. That’s according to the state’s Maternal Mortality and Morbidity Review Committee, which assesses deaths that occurred during pregnancy, childbirth, and the first year postpartum. As reported in InvestigateWest, nearly all of the deaths tied to mental health conditions were deemed potentially preventable. InvestigateWest reporter Kaylee Tornay dug into the details and joins us now. It’s good to have you back on the show.
Kaylee Tornay: Thanks. Glad to be here.
Miller: I want to start where your article started. Can you tell us about this really grim meeting that is held in Oregon every year?
Tornay: The Maternal Mortality and Morbidity Review Committee exists to examine deaths of parents within a year after a pregnancy or a birth, and they have been meeting a couple of times or a few times a year, since the legislature created the committee in 2018. It’s a Governor-appointed committee, and they found in their most recent report, released in February, that mental health conditions, including substance use disorders, were causing more deaths than any other factor, as you mentioned.
They caused 41% of maternal deaths from 2018 through 2021, and that’s quite a bit higher than even the next highest causes, which were amniotic fluid embolism or infection. To put it into perspective, those each caused about 13% of deaths, so mental health conditions are far and away causing quite a bit more.
Miller: Can you give us a sense for the kinds of cases that this legislatively-mandated committee reviews?
Tornay: They receive a lot of information about each one of these deaths, so they’ll be looking at a lot of medical records and other records related to the story of each person that they’re looking into. They work out what are the causes of the death and whether or not any sort of reasonable changes in the person’s circumstances had at least some chance of preventing the death. In about 72% of all cases, all of the pregnancy-related deaths, that was the case – that they’re potentially preventable. But that figure is quite a bit higher for mental health conditions. It’s about 93%, so a much higher likelihood of preventability, according to their data.
Miller: What kinds of racial disparities show up in the data?
Tornay: That’s an excellent question, and it’s a little bit of a nuanced answer, in that Oregon’s numbers are quite small. We do not have the highest rates in the nation so because of that, the data that the committee has presented in their report actually doesn’t shed a ton of light. They really caution people to interpret the results with some caution, because the numbers are somewhat small, but there definitely is a higher ratio of folks who are “all other non-Hispanic,” essentially people of color. We also see that reflected in national data, data that looks at broader time periods than what’s in this one report that we’ve talked about so far.
You actually had a researcher on the show a couple of years ago who co-authored a 2023 study that looked at maternal mortality over a much longer period, 1999 through 2019, and that study showed maternal mortality rates had doubled in Oregon and that, really, the greatest growths and populations that were most affected were Black and Indigenous folks.
Miller: I want to turn to a woman that you profiled named Sarah Bovee. Can you tell us first about her early years?
Tornay: Sarah experienced a lot of difficult and traumatic things growing up. She was in foster care herself because her mother struggled with substance use, and about nine years after she was removed from her custody, her mother did die of a heroin overdose. She herself had gotten involved with substances later in life. She has experienced a few pregnancies. One of them an earlier pregnancy while she was in active addiction, a couple of pregnancies when she was in recovery, and the pregnancy that we really focused on in our story was a pregnancy with her youngest son, Ryan, where she had relapsed and was in active addiction at the time of her pregnancy and at the time of the birth.
Miller: What was that birth like? What did you hear from her?
Tornay: She shared how stigmatizing and traumatic the experience was, giving birth to Ryan. As we mentioned, she was in active addiction, but she was also engaged with treatment, and she shared all of that information with her health team, but still felt really judged and dismissed throughout the time, on the questions that they asked of her.
She also raised some concerns after the birth, about feeling this pressure in her pelvic area after delivery, and she was told to go to the bathroom and then left alone there for 45 minutes. As a result of that, she ended up having a really serious prolapse that had to be surgically corrected and resulted in this infection. She had antibiotics for a few weeks, and both the psychological and physical treatment that she experienced were deeply painful for her, and it was really part of the reason why she ended up pursuing a role that she currently holds, which we also discussed in the piece.
Miller: Right. You note that she now works for something called Project Nurture. What is that?
Tornay: Project Nurture is a model of care that started at a few hospitals in Portland. It’s considered to be a really groundbreaking model that wraps in both perinatal healthcare, which is basically the kind of prenatal care that we would think of – ultrasounds, glucose checks – and wraps those together with behavioral health: substance use, treatment, medication, counseling, peer support groups.
Sarah works with Project Nurture at Legacy Emanuel Medical Center to provide peer support and also doula support to the women who are going through that program. It’s a really intentional, coordinated-care model to meet all of the clients’ health needs, and these programs have a really strong track record of keeping people and their babies healthier, and ensuring that they can keep custody and stay engaged in recovery.
Miller: What did you hear from Sarah or others about the role that stigma plays in people seeking help in the first place?
Tornay: It can really serve as a barrier to people seeking care and then staying engaged in care, and that might be any kind of care that they need, either the prenatal care or even substance use treatment. When people feel judged or they feel like there’s going to be some sort of negative consequence from being in that environment, whether that’s psychological or perhaps more punitive, that’s really not an incentive to engage with that care.
That’s basically what we heard from folks when we were asking about stigma and the role that it kind of plays, is jessentially that, even if people have access, they might not want to go because they’re afraid of what might happen when they show up in that space.
Miller: So this is what programs like Project Nurture are intending to tackle. What’s the availability of these programs like statewide?
Tornay: Excellent question. They are really well established and operating in Portland, in the greater Portland area, and then there was an expansion in 2021 of the Project Nurture model to another program called Nurture Oregon that’s funded through the Oregon Health Authority. That is focusing on more rural counties spread about the state, but it’s still only a handful. There are many rural areas, stretches of the coast and in Eastern Oregon that don’t have these sorts of programs at all, and that’s a real concern for a lot of these folks.
Miller: What might looming cuts to Medicaid mean to all the efforts you’re talking about?
Tornay: That’s a great question. The Medicaid question definitely continues to have a lot of unanswered portions, but there’s certainly a lot of concerns about people becoming unenrolled because of new requirements to do these regular enrollment checks and purges and the work requirements, and Oregon is bound to lose money.
I feel like I’m still pressing for some specific details about what that might look like for folks, but the consensus is that there’s going to be people who lose coverage, and billions of dollars are not going to be flowing to the state anymore, and programs are going to feel the impact of that because they’re not going to be able to get reimbursed for care in the same way. Then there’s also just the impact to maternity healthcare in general, where we’ve seen units closing because they are not moneymakers for hospitals and they cost a lot to operate, so I think there’s a lot of concern about continued impacts in that way as well.
Miller: Kaylee, thanks very much.
Tornay: Thank you.
Miller: Kaylee Tornay is a reporter for InvestigateWest.
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