When it comes to preventing maternal childbirth-related deaths, the United States still has a "long way to go," according to Amy Compton-Phillips, EVP and chief clinical officer at Providence St. Joseph Health, who shares in STAT News five ways her health system ensures safer outcomes for maternal care.

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With maternal deaths, the US has a 'long way to go'

In 2018, about 700 women in the United States died due to pregnancy or complications during or after childbirth, Compton-Philips notes. CDC data shows that these fatal pregnancy complications impact black, American Indian, and Alaska Native women more than white women, regardless of age group, education, or other factors.

"This is inexcusable," Compton-Philips writes, "especially since the majority of maternal deaths are preventable.

In 2012, the Women and Children's Institute at Providence St. Joseph Health set out to address the issue and make childbirth safer, and the "efforts have borne fruit," Compton-Phillips writes.

Over the last three years, there has been one childbirth-related maternal death across all 51 Providence St. Joseph hospitals. "Based on the current national average, the number of deaths should have been at least 32 for an organization this size," she writes.

How Providence made childbirth safer

Compton-Phillips said there are five steps Providence St. Joseph Health followed to make childbirth safer for women.

1. Focus on the leading complications. Hospitals should prioritize addressing major delivery complications, such as hemorrhage during or after birth, cardiovascular conditions, and sepsis, Compton-Phillips writes. These conditions are "three of the leading complications that can lead to a woman's death during or after childbirth," she writes. "Providers should focus, as we did, on implementing evidence-based care for these three conditions."
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3. Focus on prevention instead of reaction. Most hospitals have emergency protocols, but "it is equally important to recognize that serious maternal issues can be avoided by identifying risk factors as early as possible," Compton-Phillips writes. Providence St. Joseph Health created an EMR Hemorrhage Risk Assessment to screen every patient for their risk of excessive bleeding during childbirth and has taken efforts to improve high blood pressure screening and treatment. "This is extremely important since hemorrhage after childbirth accounts for 11% of maternal deaths and cardiovascular conditions account for 15%," according to Compton-Phillips.
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5. Standardize protocols. Hospitals should establish consistent protocols so that every clinician has immediate access to the steps they should take in the case of a major delivery complication, Compton-Phillips writes. At Providence St. Joseph Health, Compton-Phillips' team "built the most current care pathways into the [HER] so they're readily accessible." The team "also embedded all of our postpartum hemorrhage efforts into a suite of tools that" can provide an early assessment of a pregnant woman's risk of major complications.
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7. Empower the care team. In order to address the complications, doctors, nurses, pharmacists, ward clerks, and other team members need to feel empowered to voice concerns about a potential issue, according to Compton-Phillips. "This includes specific language and tools that require everyone on a care team to stop and listen to a concern and develop an action plan for how to proceed safely," she said. "Listening to the patient is the first key to ensuring a safe delivery."
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9. Prioritize prenatal care. A lot of conditions that contribute to maternal mortality happen outside the hospital, including intimate partner violence, housing insecurity, and other health complications. As such, "It is important to champion expanding prenatal care, and ensuring appropriate rates of postpartum visits among pregnant women," Compton-Phillips writes. At Providence St. Joseph Health, a lot of the acute care hospitals provide maternal health programming, including perinatal and prenatal care and breastfeeding education, directly to the local community.

Each of the five steps "can be easily adopted by any hospital or health system" to address maternal death rates, according to Compton-Phillips. "Although it is shocking that maternal deaths are still an issue, they can—and must—be addressed. It is past time for all health systems to take action" (Compton-Phillips, STAT News, 9/13).