Guest Blog: We Took AIM at Maternal Mortality and Made a Difference

No woman should die on what ought to be the happiest day of her life. Yet that is exactly what’s happening in the United States at a rate unmatched in the developed world. ProPublica-NPR recently highlighted the realities of maternal mortality in an article about a 36-year-old African-American mother—an epidemiologist at the Centers for Disease Control and Prevention—who died after giving birth from complications of high blood pressure.

The rates of maternal mortality in our home state of Michigan are stunning. There are 10.6 pregnancy-related deaths per 100,000 women, and African-American women die at a rate that is 4.9 times higher than white women. There are many causes of maternal death. The leading causes include heart attack or heart failure, stroke from high blood pressure, severe bleeding, serious infection, and blood clots. And, as more pregnant women have chronic health conditions such as obesity and heart disease, they become more likely to die during or after pregnancy. Even more startling is that, for every woman who dies, there are 100 more who suffer severe maternal morbidity—life-threatening injuries, infection, or disease due to chronic or acute conditions

Last month, the Alliance for Innovation for Maternal Health (AIM), a national initiative championed by 19 women’s health care organizations including ACOG, has already shown early steps toward reducing severe maternal morbidity. The goal of AIM is to reduce preventable maternal mortality and morbidity through hospital implementation of proactive patient safety bundles and resources for common pregnancy-related complications, such as preeclampsia and hemorrhage.

In 2015, Michigan became one of the first eight states to join AIM. ACOG’s Michigan Section teamed up with the Michigan Health & Hospital Association and the Michigan Department of Health & Human Services, along with the American College of Nurse Midwives and the Association of Women’s Health, Obstetrical and Neonatal Nurses to align resources and work cohesively as a single initiative for all birthing hospitals in the state. The initiative is called MIAM.

Roughly 80 hospitals in Michigan have committed to implementing the AIM safety bundles. They have also committed to collecting and reporting data on maternal outcomes to drive quality improvement. This reporting allows hospitals of similar size and capacity to assess and compare their performance and progress.

While this type of work requires a culture shift that will take time to fully adopt, we are already seeing dramatic improvements in maternal health. In Michigan alone, there has been a

  • 10.5 percent decrease in severe maternal morbidity since 2016
  • 17.9 percent decrease for other complications during labor and delivery among women who experience hemorrhage
  • Five percent decrease among women who experience hypertension

Recent data from four of the original eight AIM states, which collectively represent 266,717 births, also shows a marked difference in maternal outcomes. There has been a 20 percent decrease in the severe maternal morbidity rate.

Mother’s Day is a good reminder that we as health care providers must resolve to remain diligent in our efforts to reduce maternal mortality and morbidity. We commend each of our AIM hospitals and urge hospital administrators to stay focused on the task at hand: to provide the necessary support to make the AIM initiative a priority so we can succeed at keeping mothers safe.

For a long time, Michigan hasn’t been the safest place for moms—especially African-American moms—to give birth. The good news is that, over the past few years, the numbers have been finally going in the right direction. We are poised to continue making improvements and ensuring that every mom can safely give birth in Michigan, and every state in the country.

Written by ACOG Members Jody Jones, MD, and Matt Allswede, MD

We MUST Do Better on Maternal Health

The first time I saw a new mother die, I was early in my career. A healthy, young woman had a complication during labor and needed a C-section. While the care team delivered a healthy baby, the mother never regained consciousness and eventually passed away. I remember seeing her husband late that night in the hospital, holding his new baby. It was supposed to be the happiest moment of his life, but instead he looked completely lost.

That moment had a profound effect on me and is one of the reasons I’ve committed my career—and now my ACOG presidency—to reducing preventable maternal mortality. As I said last week at the 2018 ACOG Annual Meeting in Austin, Texas, where I was sworn in as the 69th president of ACOG, “To achieve our full potential not just as women, but as a country, and as a global community, the health of women MUST be a priority.”

As ob-gyns, we dedicate our lives to advancing women’s health, and there is no contradiction more stunning than the rise of maternal mortality and morbidity in the United States. While other countries have been able to reduce maternal deaths over the last 20 years, the U.S. continues to see rates grow. Worse yet, African American women are two to four times as likely to die from pregnancies than Caucasian women.

During my year as president, ACOG will continue its good work surrounding the issue of maternal mortality through three initiatives:

  1. Advocacy on the state and federal level to establish maternal mortality reviews. These state-based reviews offer a valuable opportunity to understand maternal death through a detailed review of medical records and autopsy reports. By finding causes of and contributing factors to maternal death, we can identify opportunities to prevent them.
  2.  A stronger culture of patient safety in hospitals. ACOG helped found the Alliance on Innovation on Maternal Health (AIM), a national maternal safety and quality improvement initiative to reduce maternal mortality and severe morbidity. Together with 19 partner women’s health care organizations, ACOG has worked with hospitals and health systems to implement patient safety bundles across the country. Today, 23 states are part of AIM, and it’s our goal to sign on all 50 states.
  3. A taskforce devoted to heart disease in pregnancy. Cardiovascular disease is the number one cause of death in women in the U.S. (400,000 deaths annually), and cardiovascular events and cardiomyopathy are the leading causes of maternal mortality, accounting for nearly 25 percent of deaths. This multidisciplinary taskforce will concentrate on creating evidence-based, best practice guidelines addressing screening for, diagnosis, and management of cardiovascular disease in women, before, during and after pregnancy. It will also address the pregnancy-related contributions to lifelong cardiovascular risk by evaluating the evidence, making recommendations, and prioritizing research that will drive better care.

While I’m excited to have this opportunity to focus on safe motherhood, one of the most enjoyable aspects of this position is to meet you, my fellow members. I look forward to working with you, and our new class of Fellows who took the oath last week, to provide the best clinical care to women of this country. Please connect with me on Twitter @TXmommydoc, and follow @acognews to keep up with the latest news in our profession.

Advancing Women’s Health Care at Home and Abroad

Every year on March 8 we mark the occasion of International Women’s Day. For women’s health care providers, it creates an opportunity to reflect upon the patient population we serve, at home and the world. This year, to commemorate International Women’s Day, I’d like to celebrate ACOG’s recent successes in women’s health, while they are proud achievements to be sure, there is still significant work to be done to gain sustainable improvements around the globe.

ACOG is committed to leveraging the expertise and commitment of our Fellows to support women’s health programs around the world through the Office of Global Women’s Health (OGWH). Our mission is to increase women’s access to quality health care:

  • by building provider skills,
  • supporting implementation of high impact interventions,
  • and scaling proven solutions to decrease maternal mortality and morbidity.

OGWH has a portfolio of programs in 11 countries, including Malawi, Uganda, Rwanda, Ethiopia, the Dominican Republic, El Salvador, Guatemala, Honduras, and more. While our work in each country is unique, it’s guided by a shared set of goals.

It would take a great many pages to provide a detailed overview of all OGWH’s efforts, but I’ll share two success stories from different parts of the globe.

In Malawi, ACOG implemented a demonstration project based on the Alliance for Innovation on Maternal Health. Together with the Malawi Ministry of Health and Baylor College of Medicine, ACOG tailored post-partum hemorrhage (PPH) bundles to improve recognition and management of obstetric complications. Hundreds of local hospital staff were trained in team communication and PPH management, and prepared for implementation of the bundles. The program reduced incidences of maternal hemorrhage and increased lifesaving interventions from 3.7 percent to 34.4 percent for patients who had uterine atony after delivery.

In Central America, ACOG works to enhance professional education and training standards through the Central American Residency Program. Our efforts support development of residency accreditation and administration of in-service exams, establishment of minimal educational standards, quality assurance processes and mentorship of hospital leaders. Over time, we’ve built very strong relationships and now engage with 75 percent of all ob-gyn residency programs in Central America.

These are just two snapshots of OGWH’s work to advance women’s health across the globe, but they help to illustrate the breadth of opportunity – from preventing maternal deaths to raising the standard of medical practice. As women’s health care providers, we must continue to work together with our colleagues near and far to build a health care system that serves every woman’s needs. In addition to the programs outlined above, ACOG annually hosts a meeting of academic ob-gyn from across the globe to ensure a continuous exchange of knowledge and experience sharing.

ACOG has a unique platform to share knowledge and resources to improve the delivery of care globally. If you’re interested in learning more about how to become involved with these opportunities, visit www.acog.org/ogwh.