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Running head: MEASURES TO DECREASE MATERNAL MORTALITY AND MORBIDITY

Measures to Decrease Maternal Mortality and Morbidity

Molly M. McLemore

Auburn University at Montgomery

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MEASURES TO DECREASE MATERNAL MORTALITY AND MORBIDITY

Measures to Decrease Maternal Mortality and Morbidity

The United States has one of the highest maternal mortality rates of all developed nations

(Zelop, 2018). Falling far behind fellow wealthy nations in standards of care provided to mothers and

infants, the Center for Disease Control reported 59% of maternal deaths are preventable (Center for

Disease Control Foundation, 2017). It is imperative that hospitals approach maternal mortality and

morbidity not as un-avoidable tragedies, but as system failures. The vast majority of these mortality

rates occur from cardiovascular disease, hemorrhage, hypertensive disorders, and sepsis (Shields,

Wiesner, Klein, Pelletreau, Hedriana, 2016). Mandating effective protocols to identify early

interventions of leading causes of obstetric complications will save lives. Expanding maternal health

care initiatives, particularly employing more midwifery services, would decrease maternal and infant

morbidity rates. The American Nursing Association must advocate for risk reduction protocols and

increased access to maternal care to reduce maternal mortality and morbidity.

The California Maternal Quality Care Collaborative showed the United States loses mothers to

preventable complications at alarming rates. California is one of the few states to show a significant

decrease in maternal mortality on trend with other developed nations (California Maternal Quality

Care Collaborative,​ [n.d.]​). The CMQCC found a 55% decrease in maternal deaths between 2006 to

2013 (CMQCC​, [n.d].​). This stark decline has been attributed to California’s large scale efforts of data

collection and creation of easy to follow evidence-based protocols to prevent complications (​CMQCC,

[n.d.]​). One such effort, was proposed in a study by Shields et al. (2016). The group established a

clinical protocol, the Maternal Early Warning Trigger (MEWT) tool, adapted from a British system

(Shields et al., 2016). This assessment tool provides a map of diagnostic criteria and treatment plans

for four common maternal complications: sepsis, cardiovascular dysfunction, severe

preeclampsia-hypertension, and hemorrhage (Shields et al., 2016). The author further reported a
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MEASURES TO DECREASE MATERNAL MORTALITY AND MORBIDITY

significant reduction in morbidity and mortality rates in hospitals employing the tool (Shields et al.,

2016). This tool is an inexpensive method requiring minor staff training that could save countless lives.

Hemorrhage bundles are another cost effective tool in reducing mortality rates (​Main et al.,​ 2017).

Hemorrhage bundles include carts providing medical equipment and instructions on risk assessment

and management (Main et al., 2017). Main et al. (2017) found a 20.8% reduction in rates of postpartum

hemorrhage and severe postpartum hemorrhage in hospitals employing the bundles (Main et al., 2017).

These dramatic statistical findings should motivate facilities to incorporate hemorrhage bundles or

similar protocols onto their labor and delivery floors. Hemorrhage protocols are excellent secondary

prevention methods of maternal morbidity and mortality. However, implementation of primary

prevention methods, such as expansion of prenatal care access, can further compat maternal death tolls

(Vedam et al. 2018).

As healthcare costs continue to rise and healthcare facilities continue to decline, particularly in

rural locations, we must devise strategies to expand maternal healthcare initiatives. ​Vedam et al.

(2018) examined the availability and distribution of midwives per state then evaluated and compared

the number of spontaneous vaginal deliveries and positive health outcomes for both mother and baby.

Vetdam et al. found states with a high distribution of midwives “were associated with significantly

higher rates of spontaneous vaginal delivery, vaginal birth after cesarean” (p. 8). Expanding and

strategically distributing midwifery practices into vulnerable areas is just one affordable solution to a

growing problem (Vedam et al., 2018).

In order to decrease the United States’ maternal mortality and morbidity rates, there must be an

objective critique of our current maternal healthcare system. The American Nurses Association must

allocate its resources to petition for hospital protocols addressing maternal complications and greater

healthcare expansion.
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MEASURES TO DECREASE MATERNAL MORTALITY AND MORBIDITY

References

California Maternal Quality Care Collaborative. California pregnancy associated mortality review.

(n.d.). Retrieved from: https://www.cmqcc.org/research/ca-pamr-maternal-mortality-review

Center for Disease Control Foundation. (2017). ​Report from maternal mortality review committees: A

view into their critical role. ​Retrieved from

​https://www.cdcfoundation.org/sites/default/files/upload/pdf/MMRIAReport.pdf

Main, E., Cape, V., Abreo, A.; Vasher, J., Woods, A.; Carpenter, A., & Gould, J. (2017). Reduction of

severe maternal morbidity from hemorrhage using a state perinatal quality collaborative.

American Journal of Obstetrics & Gynecology. 216​, 298- 309.

doi.org/10.1016/j.ajog.2017.01.017

Shields, L., Wiesner, S., Klein, C., Pelletreau, B., & Hedriana, H. (2016). Use of maternal early

warning trigger tool reduces maternal morbidity. ​American Journal of Obstetrics &

Gynecology 214​ (4), 527-532. doi.org/10.1016/j.ajog.2016.01.15

Vedam, S., Stoll, K., MacDorman, M., Declercq, E., Cramer, R., Cheyney, M., et al. (2018). Mapping

integration of midwives across the United States: Impact on access, equity, and outcomes.

Public Library of Science ONE, 13(​ 2), 1-20. doi.org/10.14288/1.0363296

Zelop, C. (2018). Introducing a new series on maternal mortality. ​Contemporary OB/GYN.​ Retrieved

from:

http://www.contemporaryobgyn.net/labor-and-delivery/introducing-new-series-maternal-mortal

ity
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MEASURES TO DECREASE MATERNAL MORTALITY AND MORBIDITY