Local Hospitals Take Action to Reduce Pregnancy-Related Deaths and Complications
Giving birth should be a joyful experience. Yet surprisingly, women in the United States die as a result of pregnancy at a rate higher than in any other developed nation. It is one of the only countries in the world where the rate is rising instead of falling. Experts cite multiple root causes, including gaps in required protocols and an increased attention on preventing infant deaths that has shifted the focus away from mothers.
Fortunately, several local hospitals have already been leading the way in implementing changes that are just being recognized as desperately needed on the national level.
Recent media attention has highlighted two of the most preventable causes of maternal death: preeclampsia (extremely high blood pressure) and hemorrhaging (excessive bleeding.) An investigation reported in USA Today calls for hospitals to monitor women’s blood pressure and blood loss during and after birth and to ensure protocols are in place for quick life-saving intervention.
“Patients in our service area will be relieved to know that we already are doing those things and more,” said Tonia Van Wieren, R.N., Director of Maternal Child Health at MidMichigan Health. “All three of our maternity centers in Alma, Alpena and Midland participate in voluntary initiatives to improve safety for moms and babies, including the Michigan Health & Hospital Association’s Keystone: Obstetrics collaborative and the Alliance for Innovation on Maternal Health (AIM.) We are actively monitoring the types of symptoms that the USA Today article warns about, and we have built that monitoring and the appropriate response into our electronic medical record system so that it is standard practice.”
Hospitals participating in the initiatives referenced by VanWieren have implemented specialized training, patient monitoring and clinical protocols that are proven to reduce infant and maternal deaths and complications.
“We also collect and report our data, which enables us to benchmark against our peers and enables all participating hospitals to learn from each other and improve,” said VanWieren.
For example, data submitted by MidMichigan Health to the AIM collaborative for the period January 2016 to December 2017 shows that 100 percent of mothers in active labor received a risk assessment for hemorrhaging upon admission to MidMichigan’s hospitals and were evaluated for high blood pressure within 15 minutes of admission. All women who had two or more abnormally high readings received blood pressure lowering medications within the recommended 60 minutes.
Keystone: Obstetrics was a collaboration among Michigan hospitals from 2008 – 2015 that impacted nearly 80 percent of all births in Michigan. The collaborative aimed at decreasing early elective births before 39 weeks of gestation and educating parents around labor management, induction, possible cesarean birth, postpartum hemorrhage and preeclampsia. From 2010 through 2014, Michigan hospitals experienced a 60 percent reduction in early elective births, positively impacting approximately 2,900 births.1
The Alliance for Innovation on Maternal Health (AIM) is a national safety and quality initiative that promotes data-driven approaches with a goal to eliminate preventable maternal deaths and severe complications across the United States. A program of the Council on Patient Safety in Women's Health Care, the alliance publishes “safety bundles” that member hospitals can adopt to improve outcomes for mothers. These recommendations cover things like training and awareness for patients and staff, new clinical protocols, checklists and other tools for monitoring and responding risk factors and data reporting mechanisms.
There currently are 11 AIM safety bundles related to obstetrics, and according to VanWieren, MidMichigan Health participates in all 11. Many of the bundles address specific conditions such as depression and anxiety, maternal venous thromboembolism (blood clots), opioid use disorder, obstetric hemorrhaging (excessive bleeding) and severe high blood pressure. Other bundles aim to improve processes and protocols, such as reducing the number of cesarean births (C-sections), reducing racial or ethnic disparities and ensuring that women have effective resources for postpartum care and ongoing preventive care after their hospital stay ends.
“We take patient safety and quality very seriously, and these are just a few of the initiatives that help us take the best possible care of our moms and babies,” VanWieren concluded.
Michigan Health & Hospital Association, Keystone Center Patient Safety and Quality Annual Report, 2015.