Maternal mortality is not a subject that is easy to discuss, but it is something that is critically important to get a handle on. Maternal mortality is defined as any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.
According to the American Journal of Managed Care (AJMC), among 11 developed countries, the United States has the highest maternal mortality rate and maternal deaths have been increasing in the United States since 2000 and according to a new report from the Centers for Disease Control and Prevention, maternal mortality in the U.S. increased by more than 15% in 2019. The surge occurred as the country was on the brink of the COVID-19 pandemic and its disruption of traditional medical care. The report also confirmed that Black women still suffered from the highest rate of maternal mortality when compared with white and Hispanic women.
Although 700 pregnancy-related deaths occur each year, two-thirds of these deaths are considered to be preventable. The most common causes of pregnancy-related deaths are heart disease, high blood pressure, diabetes and other chronic conditions and is seen predominantly in African American and Hispanic women. Although women are dying each day of these conditions, these deaths are largely preventable with two basic services: access to health coverage and prenatal care.
These statistics are heartbreaking which is why physicians from around the country are coming together to turn these numbers around. Our team of experts at The Children’s Hospital of San Antonio have been leaders in Texas in ensuring a safe delivery for both mom and baby. Below are just a few examples of programs this team has introduced to curb these numbers.
- Practicing For Patients: This is a national program whose development was led by Dr. Shad Deering and the American College of Obstetrics and Gynecology (ACOG) Simulation Working Group in collaboration with the Patient Safety Council for Women’s Health Care. It was created to allow every size hospital the ability to conduct simulation drills on their labor and delivery unit in order to better care for women who experience a postpartum hemorrhage. Dr. Deering, Dr. Brook Thomson, Dr. Carey Eppes and the TexasAIM team worked together to provide instructor courses to over 120 hospitals across Texas in 2020. As the pandemic accelerated, a virtual instructor course was created and additional hospitals were trained in Louisiana and Maryland to provide these life-saving tools.
- 2. The Children’s Hospital’s Department of Obstetrics and Gynecology received a five-year, $2 million dollar grant from the Agency for Healthcare Research and Quality (AHRQ) to develop a national program to train doctors, nurses and paramedics on how to save pregnant moms who experience cardiac arrest. This program is desperately needed as current training programs have little to no information regarding this vulnerable population.
Obstetric Life Support (OBLS) is a simulation-based curriculum designed to promote the key components and unique approaches necessary to treat maternal cardiac arrest effectively. In addition to creating content for both first responders/paramedics and physicians and nurses working at the hospital, the team has worked with Laerdal to create a new simulator designed specifically to represent a pregnant patient that requires resuscitation. These tools will enhance the care of pregnant patients who experience cardiac arrest and overcome some of the current barriers to quality CPR such as not knowing where to place hands for compressions or AED pads because of a woman’s breasts, or how to perform left uterine displacement to improve blood flow to the fetus. After OBLS, providers are prepared to immediately start CPR without fear of harming the patient or fetus with the goal of improving survival rates for women experiencing cardiac arrest.
- 3. In addition to the course being developed, a recent virtual meeting was held with an OBLS (Obstetric Life Support) Core Team that included attendees from across North America and Norway. This group was formed to develop a curriculum to resuscitate pregnant women experiencing maternal cardiac arrest. Participants evaluated in-hospital and out of hospital simulation scenarios, megacode checklists, and pilot testing data summaries. Using a standard-setting methodology called Angoff, they established the minimum passing scores for participants taking the course. Participants also discussed manual edits and how to best engage our learners. Future meetings are planned to continue the discussions.
To commemorate this important work, the Office of Governor Abbott issued an official proclamation to make January 23, 2021 the inaugural Texas Maternal Health Awareness Day to bring increased awareness to the importance of maternal health. A committee was also put together at the state level to continue to watch and provide research in this important area. The committee published a biennial report in September 2020.
There is so much more work to be done to combat the staggering maternal mortality statistics. The physicians at The Children’s Hospital of San Antonio are committed to putting programs in place to educate the community as well as to work closely with physicians from around the country to create collaborative training programs. Together, we will make an impact and stop these deaths that are highly preventable among the women we care for.