November 15, 2023 Breakfast Meeting Notes

November 15, 2023 Breakfast Meeting Notes


We had two guests: former member Dawn LeMieux and our speaker Dr Joseph Ebner


We opened with Tony’s famous trivia: Authors in Rotary in NH and surrounding area edition.


50/50:  Beth won and gave the money to Tom

Card game: Dawn had the chance to go for the ace but drew the 9 of diamonds. The game continues. 


Beth began with the business meeting.  We have received two thank you notes. One was from the Rotary Foundation, thanking us for our $500 donation to fight polio, and the other was  from Speare Memorial  in appreciation of our gift of $2500 towards their security upgrades in the neonatal unit.


Our next board meeting will be this Friday. We will have two grants to review at that time.


Decorating the Common for Christmas will be on November 26. Volunteers should arrive at 8:30 at Peggy’s to help bring supplies or 9 am at the Common. We will need three 16 foot ladders. Bring wire cutters if you have them; Peggy will supply wire.


Hometown Holiday celebration is Saturday December 2. We will need volunteers. Steve passed around a signup sheet; please sign up.


Alex and Steve just got back from Poland. They went further into Ukraine this time, including Kiev. Steve will have more details next week. 


Pemi Youth Center will have a Christmas party and caroling on Friday Dec 8 at 4pm. Carolers needed!


At our weekly meeting on Dec 6 we will have a presentation by the New Hampshire Electric Coop on broadband in the area. Bring family and friends who have an interest in broadband.


Dawn LeMieux, a former member of our club, spoke briefly. She is doing “work camping” in the south each winter. This year she is going to the Everglades National Park to work. She is collecting books for Little Free Libraries and has requested books that are banned in Florida. She thanked members who brought books today; if anyone else has books they would like to donate, get them to her before she leaves this Sunday. 


Tony introduced today’s speaker, Dr Joseph Ebner. Ebner is the chief medical officer at Speare Hospital and he discussed maternal mortality and what is being done to make care safer for mothers. 


Most pregnancies end in a normal delivery. But maternal deaths (defined as those that occur during the pregnancy, delivery, or within the first year after delivery) do occur. Causes of death includes those due to direct complications of pregnancy, such as high blood pressure and hemorrhage, as well as unrelated causes like auto accidents, domestic violence, or substance abuse. Many of these causes of death are preventable.


The World Health Organization, UNICEF, and other health agencies quantify maternal mortality as deaths per 100,000 births. Such deaths affect not just the woman but any surviving children and the rest of the family. In areas with a lot of poverty, maternal death will set children back for the rest of their lives. This number is a useful surrogate for the stability and effectiveness of the health delivery system in various countries. 


Maternal mortality rates worldwide vary tremendously. Norway has a rate of 2/100,000, while South Sudan has a rate of 1200/100,000. Western European countries are usually in the top 10, while southern Africa has the highest rates of mortality. In the US, our maternal mortality rate is 23rd in the world and the number has been going up, tripling in the last 30 years, so clearly wealth alone is not the only thing that determines the rate.


In NH we have a statewide maternal mortality commission to examine causes of death. Sadly, 65% of deaths occur after the baby has been delivered and of those, the great majority are due to substance abuse, with suicide being a distant second. Deaths can be due to a delay in seeking care, a delay in arriving at the hospital, or a delay in receiving adequate care if the facility is not able to handle the severity of the condition being treated or if it provides ineffective or insufficient treatment.


The Northern New England Perinatal Quality Improvement Network was started in 2002 at Dartmouth. This network includes all hospitals in northern New England. Representatives meet yearly to determine how best to take care of mothers and newborns. The process relies on checklists and bundles. The checklists allow hospital staff to go through a step-by-step process to make sure that they are doing all the required things.  Bundles are packages of tests and treatments which are commonly done, so that the doctor doesn’t have to remember to order each of the many items that might be required. 


Postpartum hemorrhage is the most severe cause of bleeding in the hospital setting; a woman can lose a liter of blood in just 2 minutes.  Most postpartum hemorrhage happens after the baby is delivered, when the delivery team is focused on the infant. The medical team tries to determine in advance if a patient is at risk and also try to quantify blood loss quickly. Caesarian sections can increase risk of hemorrhage so Speare has reduced the number of Caesarians performed.


There is a new device called JADA that is a real game-changer. This is a suction device that is inserted into the uterus after birth to shrink it down to a small size and it remains there for 24 hours, greatly reducing the risk of bleeding.


Cardiovascular disorders such as hypertension are another significant cause of maternal mortality prior to delivery as it can cause strokes and preeclampsia. Physicians are now performing a risk assessment at the first prenatal visit; people in New Hampshire that are determined to be at risk are sent to Dartmouth for high-risk prenatal care. New mothers are risk of hypertension are placed a baby aspirin once daily throughout their pregnancy to help alleviate the risk of stroke. It also helps to reduce barriers to care by providing telehealth to patients who live in remote regions. 


Infections are another potential problem. Doctors have learned to be more aggressive with surgical prophylaxis by giving intravenous antibiotics at delivery and being sure to scrub both the mother’s belly and vagina prior to delivery. Obese women get more antibiotics for a longer period as they are more prone to infection.


The hardest problems to prevent are substance abuse and suicide. All pregnant women are screened for these things and referred to counseling quickly. There are medications that can be given during pregnancy to mitigate the risk.


Many pregnant women qualify for Medicaid, including about 60% of those in our area. Historically Medicaid coverage has ended 6 weeks postpartum but as of 2023 New Hampshire has become one of 31 states that extend coverage to 1 full year postpartum. Doctors are also trying to think about seeing women more frequently postpartum and asking pediatricians to touch base with mothers during baby visits to see if they need additional help. There has also been an effort to raise awareness of these issues amongst ER doctors, to prompt them to ask their patients about substance abuse and depression.


Delay in arrival times to hospital is also a huge problem. 35% of counties in the USA have NO obstetrical provider, or no hospital at all. Each year in this country, 150,000 babies are born in these maternity care deserts. Half of hospitals in our own state have stopped providing obstetrics care in last 20 years, largely because of cost: maternity care services are very expensive to provide, and reimbursement from Medicaid is not as good as that from the private sector.


Happy dollars were shared by Tony, Ben, and Denise. 


Respectfully submitted,


Lora Miller, secretary