Maternal mortality (MM) is an epidemic that is actively plaguing women on a global scale. It was recorded that 810 women died per day worldwide in 2017. The primary cause of this staggering number is pregnant women’s insufficient access to trained healthcare personnel. Those in lower-income countries are most at-risk of dying from preventable causes related to pregnancy and childbirth.
The rates for MM also remain high throughout the United States. At over three times the rate in comparison to other high-income countries, 23.8 maternal deaths for every 100,000 births were recorded by the CDC in 2020, noticeably higher than the 20.1 in 2019. With 861 women dying due to maternal related causes in 2020–a number that is only growing–it has become clear that the issue cannot be ignored. While we realize that in 2020 it’s likely COVID had an effect on this increase, the numbers are concerning nonetheless.
At Phoebe Putney Memorial Hospital, we are committed to safeguarding the health of our community. To raise awareness about this growing concern and take action in the prevention of maternal death, we worked closely with MEDITECH to develop the Obstetric Hemorrhage Management Toolkit. This solution includes screening tools that identify patients at-risk for hemorrhage–a leading and highly preventable cause of maternal mortality. These tools enable organizations to standardize care pathways that support efforts to reduce maternal death within all communities.
Recognizing risk factors
In comparison to prior generations, comorbidities and chronic diseases are impacting women at progressively younger ages. This increases the risk of maternal mortality as women more often enter pregnancy with conditions such as morbid obesity, chronic hypertension, type 2 diabetes, and even atherosclerotic CV disease.
Also severely impacting the rate of maternal deaths, particularly in lower income or rural communities in the United States, are Social Determinants of Health (SDOH), including:
- Food insecurity
- Chronic stress/anxiety
- Housing insecurity
- Health illiteracy
- Poverty
- Chronic conditions (often related to morbid obesity).
As many of these issues will take generations to rectify, it is vital to acknowledge the increase in maternal mortality immediately and begin to address the individualized needs of mothers.
Indicative of racial health disparities driving higher rates of maternal mortality, in 2020, 55.3 deaths were recorded among Black women per every 100,000 births, almost three times as much as their white counterparts. Certain conditions relating to maternal mortality occur more frequently in certain ethnic groups, but SDOH continue to be the leading force behind the increased risk of poor health outcomes in racial or ethnic minority communities.
The maternal mortality crisis clearly demands a multidisciplinary approach. Mitigation of poor outcomes due to SDOH and early risk assessment in communities of color is simply the first step to achieving health equity for mothers of all backgrounds. Correcting these factors will not only improve pregnancy outcomes, but reduce maternal mortality overall.
Physician pressure
It is estimated that 60% of maternal deaths are preventable by timely recognition and proper treatment of pregnancy complications and/or comorbidities. But a clear lack of standardized treatment protocols (or the failure to follow such recommendations) pervades American and international labor and delivery units despite evidence-based guidelines given to providers that directly outline treatments for common pregnancy related conditions.
In the U.S., the growing shortage of care providers is one cause. Physicians are left with uncompromising time constraints on their schedules, limiting room for adequate counsel which may jeopardize their patients’ health and the health of their child. This lack of support extends to communication between members of healthcare teams as well, proving to be a detrimental contributor to the rise in maternal mortality rates.
Collaboration with MEDITECH
Through our joint-effort with MEDITECH, Phoebe Putney Memorial Hospital has worked to mitigate the risks faced by expecting mothers today by helping to guide the development of the OB Hemorrhage Management Toolkit.
The goal of this toolkit is to improve management processes and standardize care pathways across the continuum of care. By incorporating patient registries, surveillance, and advanced logic, providers can promptly identify at-risk patients throughout all care stages including prenatal, intrapartum, and postpartum. To ensure that best practices are adhered to, clinical decision support is embedded throughout the care team’s workflow.
Being one of the most significant and preventable causes of maternal mortality, the risk of hemorrhage is directly addressed with the MEDITECH toolkit. For patients who are actively bleeding, the integrated Quantitative Blood Loss calculator alerts clinicians immediately when a patient meets the criteria for obstetric hemorrhage, and interventions are recommended to the provider in real-time.
We are making an effort to enhance the quality of maternity care throughout our health system by aligning our assessments with this toolkit and introducing evidence-based best practices throughout our labor and delivery settings.
Elements such as prevention of, timely recognition, and prompt management of obstetric hemorrhage, with appropriate standardized protocols and interventions, could be the difference between a normal life, a compromised life, or even the death of a mother and/or fetus. Dedication to our community demands a commitment to excelling in our initiatives to protect some of our most vulnerable patients.
MEDITECH’s EHR Excellence Toolkits recommend optimal MEDITECH EHR workflows and system setup to improve patient safety and outcomes.
