OB/GYNs: Call to Action

I hope this graph alarms you as much as it does me. As an OB/GYN, I’m embarrassed to see that the United States is the only developed country in the world with an increasing mortality rate for mothers. This has not gone unnoticed by the media and there has been a lot of attention over the last year, including a very damning article in USA Today about a year ago that called out specific hospitals and some very bad outcomes.

The two leading causes of preventable death for pregnant moms in the United States are excessive bleeding and complications from high blood pressure. Retrospective analyses have indicated as many as 93% of deaths from hemorrhage and more than half of deaths from hypertension could have been prevented. There are varying opinions about why mortality is increasing but I am sure no one will disagree that it should not be happening. And we all know that it is not for a lack of resources or money being spent on healthcare. Many providers point to the patients – more chronic diseases, older patients, more obesity, lack of prenatal care – and while these are definitely cofactors, they do not explain away the problem, and blaming the patient certainly does nothing to create a solution for improvement.

The California Maternal Quality Care Collaborative (CMQCC) has been working on improving the safety for mothers in California for more than a decade. Through their efforts, the maternal mortality rate in California was reduced by 55% between 2006 and 2013. Implementing the practices they have developed into toolkits is a proven way to effect change for the rest of the country and yet most other states have not followed their lead.

The Joint Commission recommendations from 2010 were to have an early warning system hospital-wide. Although most organizations have implemented such a system, many have excluded pregnant patients from surveillance because of the normal changes in vital signs for a pregnant woman that would over-alert providers. However, this has left our patients out of this safety net. The American College of Obstetricians and Gynecologists has been recommending early warning systems specific to pregnancy for years. Using such a system has been proven to improve the mortality rate by helping to recognize morbidities early enough to intervene. Has your organization implemented such a system?

Before implementing any solution, it is important to know the starting point for your own patient cohort. The CDC has identified a list of severe morbidities that, when recognized and treated, will reduce the maternal mortality rate. I urge you to use that list to identify your own and your organization’s severe maternal morbidity rate as a starting point for improvement. Regardless of the actual rate you determine, I am pleading with all of us in this profession to search for ways we can improve as a whole for our patients.

We, as a profession, need to take on this challenge ourselves and not wait for the inevitable regulatory requirements to change the way we practice. Let’s start the conversation among ourselves. What other suggestions do you have or have you implemented within your organizations to improve the safety of your obstetrical patients?