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.

This Earth Day be a Champion for Environmental Science

Did you know that doctors are among the most trusted professionals in this country, specifically with regard to information about climate change? Environmental factors are hurting the health of millions of Americans every day and yet there is still a considerable lack of awareness about the harmful effects of things like extreme weather events, air pollution and other toxins.

As Earth Day approaches, it seems fitting that this year’s campaign is focused on environmental and climate literacy because it reminds us as ob-gyns how important it is for us to participate in the effort by leveraging the trust our patients have in us.  Our partner organization, the International Federation of Gynecology and Obstetrics, has kicked off the week by launching a social media awareness campaign around Earth Day.  You can follow them on Twitter under the handle @FIGOHQ.

Last month, I spoke at the launch of the Medical Society Consortium on Climate Change and Health that has brought together ten associations representing nearly 500,000 physicians, including ACOG, to help increase awareness among the public and policymakers about the negative health effects of climate change on Americans. During my talk, I spoke about the fact that women face some of the greatest risks from climate change over the course of their lives, and especially during pregnancy. In affected regions, climate change puts women at risk of disease, malnutrition, poor mental health, lack of reproductive control, and even death. Additionally, women’s exposure to toxic environmental agents during the preconception and prenatal stages can have a profound and lasting effect on obstetrical and later life outcomes, including increased risk of birth defects and childhood cancer.

In 2016, ACOG adopted a policy which recognizes that climate change is an urgent women’s health concern and a major public health challenge endangering fetal health. In fact, we discover new evidence every day of how it can disturb fetal development. A recent NIH study found that exposure to extreme hot and cold temperatures during pregnancy leads to increased risk of low birth weight in infants.

While the connection between climate change and women’s health may not at first seem obvious, there are a number of ways it directly impacts women’s health.  You can look at them in several categories: a healthy pregnancy starts with clean air, clean water, no toxic chemicals, and stable climate.

Air pollution poses serious risks for women’s health.  It is linked to pregnancy loss, low birth weight babies, and preterm delivery.  Fine particle air pollution affects the placenta in pregnancy, and can interfere with fetal brain development.  Ambient and household air pollution result in 7 million deaths globally per year; these effects are worse in low-resource areas.

Heavy downpours and flooding mixed with high temperatures can spread bacteria, viruses, and chemicals that lead to contaminated food and water. This results in higher levels of methylmercury in fish and shellfish, a known cause of birth defects.

Increased use of pesticides can interfere with the developmental stages of female reproductive functions, including puberty, menstruation and ovulation, menopause, fertility, and the ability to reproduce multiple offspring. These toxic exposures also affect fetal brain development, and contribute to learning, behavioral, or intellectual impairment, as well as neurodevelopmental disorders such as ADHD and autism spectrum disorder.

Extreme temperatures have fostered increases in the number and geographic range of insects. For example, Zika-carrying mosquitos have led to more than 1,500 infections in pregnant women across the United States and District of Columbia, and more than 3,200 infections in Puerto Rico and U.S. territories. Furthermore, extreme heat during pregnancy is tied to a 31 percent increase in low birthweight babies less than 5.5 pounds.

Unfortunately, in many cases, underserved and vulnerable populations are disproportionately affected by climate change. This includes individuals living in poverty, exposed to toxic materials via their occupation, who lack nutritious food, and live in low quality housing. That’s why access to health care is so critical.

We don’t all have to be experts in environmental science, but we all need to support rigorous scientific investigation into the effects of climate change and toxic environmental agents. With evidence to support us, ob-gyns must be the authoritative voice and help to ensure that the discussion on climate change includes protecting the health and safety of all women and children.

This blog post was co-authored by Nathaniel DeNicola, MD, MSHP, the ACOG liaison to the American Academy of Pediatrics Executive Council on Environmental Health, and social media director for the International Federation of Gynecology and Obstetrics Working Group on Reproductive and Developmental Environmental Health.