Washington, DC—U.S. hospitals of any size can start combatting maternal mortality and morbidity today by taking just four actions, according to a new Perspective article published in the November edition of the New England Journal of Medicine.
“What We Can Do about Maternal Mortality — And How to Do It Quickly” is authored by several experts in maternal health, including Lisa Hollier, MD, MPH, and Haywood Brown, MD, the current president and immediate past president of the American College of Obstetricians and Gynecologists (ACOG), respectively.
The authors suggest that pregnancy-related deaths can be prevented if hospitals 1) focus on implementing protocols to address the main preventable causes of complications and death during pregnancy and childbirth, 2) implement staff meetings or huddles with all providers of the care team to assess and review each patient’s risk factors, 3) practice by simulating obstetrical emergencies in the labor and delivery unit, and 4) formalize existing relationships between lower-resource hospitals that transfer pregnant women who require higher levels of maternal care.
“We need to acknowledge that reducing maternal deaths requires a team effort,” said Hollier. “There needs to be a commitment from hospital leadership and providers across all disciplines to be ready, to recognize, to respond, and to report outcomes when obstetric emergencies arise. This is the most impactful thing we could be doing right now to reduce the rate of maternal mortality and morbidity.”
The four “R’s” — readiness, recognition, response, and report — are the tenets of the Alliance for Innovation on Maternal Health (AIM), a national, data-driven quality improvement program that endeavors to reduce preventable maternal mortality and morbidity through the implementation of maternal safety bundles, or best practices, for pregnancy-related conditions. Implementing AIM bundles is part of the first step that the authors recommend hospitals take to treat common obstetric complications such as hypertension, hemorrhage, and blood clots.
It requires hospital staff to implement something as basic as a protocol ensuring that severe-range blood pressure is treated within 60 minutes or creating an emergency lockbox containing antihypertensive medications for pregnant and postpartum patients for hospitals without 24-hour pharmacists.
Brown said establishing these types of protocols based on the AIM bundles isn’t complicated; it’s just a matter of setting a standard, enforcing implementation, and making compliance a top priority.
“These practices help ensure that the hospital is ready to respond in the event of an emergency,” said Brown. “They can easily be customized regardless of hospital size and made accessible to all clinicians.”
According to the article, approximately 50 percent of U.S. hospitals provide care for three or fewer deliveries per day. It’s especially important that hospitals be able to identify women at risk for emergencies during pregnancy and use regular briefings and simulation drills to create a “shared mental model” and train for low-probability but high-risk events.
The authors also recommend that hospitals create a “maternal health compact” that would allow for transfer of high-risk patients and/or immediate consultation in the event of an unexpected emergency that requires care that exceeds a hospital’s resources. This approach is central to ACOG’s Levels of Maternal Care program and is currently being implemented in several states.
“Many U.S. counties are experiencing a shortage of ob-gyns, which makes it difficult for pregnant women in rural areas to receive optimal care,” said Hollier. “In addition to increased collaboration among hospitals, we also need to ensure that family physicians practicing in low-resource, rural settings are trained in obstetrics.”
The authors recommend that ACOG and the American Academy of Family Physicians collaborate to ensure family physicians in rural settings are trained in obstetrics and suggest that along with training, family physicians can utilize telehealth and consultation with clinics and regional hospitals to help increase access to maternity care.
“This issue is too important; there is no reason why we can’t get 100 percent participation,” Brown said.
The American College of Obstetricians and Gynecologists (ACOG) is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. www.acog.org