1. Simpson, Kathleen Rice PhD, RNC, CNS-BC, FAAN

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Recent alarming data on maternal mortality in the United States indicate there is much to be done to provide safer care for childbearing women in our country (MacDorman, Declercq, Cabral, & Morton, 2016). Although other developed countries have shown improvement (World Health Organization [WHO], 2014), data from the United States indicate a continued rise in maternal deaths. Only one state, California, had maternal mortality rates that decreased over the past 14 years (MacDorman et al.). The difference between California and the rest of the United States is likely due to intensive team efforts between hospitals, healthcare systems, professional organizations, and public health agencies to address some of the major causes of maternal death, such as complications from obstetric hemorrhage and preeclampsia, via encouragement to adopt evidence-based protocols sponsored by the California Maternal Quality Care Collaborative. This work was not easy and there were many ongoing challenges, but by perseverance and working together as an interprofessional team, adoption and implementation has been successful in many participating hospitals (Lyndon & Cape, 2016).


A similar collaborative effort has been initiated by the Alliance for Innovation on Maternal Health (AIM) Program, which has partnered with most of the leading professional organizations for maternal health in the United States including the Association of Women's Health, Obstetric, and Neonatal Nurses, American College of Nurse-Midwives, American College of Obstetricians and Gynecologists (ACOG), Society for Maternal-Fetal Medicine (SMFM), and the Health Resources and Services Administration Maternal and Child Health Bureau of the United States Department of Health and Human Services. The goal is to decrease the number of severe maternal morbidity events by 100,000 and to avoid at least 1,000 maternal deaths 2018 (AIM, 2016). They have collaboratively developed various maternal safety bundles including obstetric hemorrhage, severe hypertension/preeclampsia, maternal prevention of venous thromboembolism, safe reduction of primary cesareans/support for intended vaginal birth, reduction of peripartum racial disparities, postpartum care basics for maternal safety, and patient, family, and staff support after a severe maternal event (AIM). Each bundle is formatted similarly with key aspects of readiness, recognition and prevention, response, and reporting/systems learning, and focus on giving the best care to every woman in every setting whenever an event occurs (AIM). Statewide perinatal collaboratives, healthcare systems, hospitals, and caregivers will be working to adopt the bundles over the next several years.


The usual challenges will likely impede progress including lack of resources (time, funding, personnel, etc.), and lack of will (no one is going to tell me how to practice, we've got enough to do already, the way I've been doing it is just fine and has always worked for me, bundles are cookbook medicine, etc.), but the continued increase in maternal mortality is truly a crisis and a national tragedy. Therefore, the clinical leadership and administrative teams of all hospitals and healthcare systems must all work harder to overcome these barriers to success. One approach is to thoroughly review near-miss cases by using screening criteria to identify severe maternal morbidity (ACOG & SMFM, 2016). By evaluating processes involved in near-miss cases, lessons can be learned that can potentially avoid maternal deaths. Our maternal mortality rate should be one of the lowest among developed countries in the world given our resources. We can and must do better for childbearing women in the United States.




Alliance for Innovation on Maternal Health. (2016). Maternal safety bundles. Washington, DC: Author.[Context Link]


American College of Obstetricians and Gynecologists & Society for Maternal-Fetal Medicine. (2016). Severe maternal morbidity: Screening and review (ACOG/SMFM Obstetric Care Consensus). American Journal of Obstetrics and Gynecology, 215(3), B17-B22.[Context Link]


Lyndon A., Cape V. (2016). Maternal hemorrhage quality improvement collaborative lessons. MCN. The American Journal of Maternal Child Nursing, 41(6), 363-371. doi:10.1097/NMC.0000000000000277 [Context Link]


MacDorman M. F., Declercq E., Cabral H., Morton C. (2016). Recent increases in the U.S. maternal mortality rate: Disentangling trends from measurement issues. Obstetrics and Gynecology, 128(3), 447-455. doi:10.1097/aog.0000000000001556 [Context Link]


World Health Organization. (2014). Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Geneva, Switzerland: Author. [Context Link]