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

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The Joint Commission released information in August 2019 about new standards to keep mothers safe during childbirth that will be effective July 1, 2020, for their accredited hospitals. These standards are in response to alarming statistics about maternal mortality in the United States (Centers for Disease Control and Prevention [CDC], 2018; Petersen et al., 2019) and review of the literature on strategies that may be effective in minimizing risk of preventable maternal deaths. Expert panels of nurses, midwives, and physicians convened by the Joint Commission were involved in their development.


Approximately 700 women die each year in the United States from pregnancy-related complications, according to the CDC (Petersen et al., 2019). From 2011 to 2015, there were 3,410 pregnancy-related deaths in the United States; the overall pregnancy-related maternal mortality ratio was 17.2 pregnancy-related deaths per 100,000 live births. Opportunities for improvement in care of pregnant women have been identified in several large studies of severe maternal morbidity (near-miss maternal mortality) and maternal deaths (Building U.S. Capacity to Review and Prevent Maternal Deaths, 2018; Ozimek et al., 2016). Using the definition of preventable death as "if the committee determines that there was some chance of the death being averted by one or more reasonable changes to patient, community, provider, health facility, and/or system factors" (Petersen et al., p. 2), about 60% of pregnancy-related deaths evaluated by state maternal mortality review committees were identified as preventable. Leading causes of maternal deaths were cardiovascular conditions (>33%), noncardiovascular medical conditions (14.3%), infection (12.5%), and obstetric hemorrhage (11.2%).


The focus of the new standards for maternal safety is to reduce likelihood of harm related to maternal hemorrhage and severe hypertension and preeclampsia (Joint Commission, 2019). For postpartum hemorrhage, the standards involve establishing written clinical protocols, a postpartum hemorrhage supply kit, education of clinicians, hemorrhage drills, case reviews, and patient education on signs and symptoms of postpartum hemorrhage and when and how to seek care for these symptoms after hospital discharge (Joint Commission). The standards for severe hypertension and preeclampsia include accurate and timely blood pressure measurement, clinician education, case reviews, severe hypertension drills patient education on signs and symptoms of severe hypertension and preeclampsia, when and how to seek care for these symptoms after hospital discharge, and when to schedule follow-up postpartum care (Joint Commission).


Using quality improvement methods in groups of birthing hospitals, Main et al. (2017) and Shields, Wiesner, Klein, Pelletreau, and Hedriana (2017) found these types of preventative strategies for maternal morbidity and mortality from postpartum hemorrhage and hypertension to be feasible and successful. The Alliance for Innovation on Maternal Health (2016) offers detailed patient safety bundles that be helpful for birthing hospitals in promoting perinatal safety and preparing for implementing the new maternal safety standards, if they do not have these types of protocols and clinical practices in place. These new maternal safety standards will be welcomed by many clinicians as part of an overall perinatal patient safety program.




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


Building U.S. Capacity to Review and Prevent Maternal Deaths. (2018). Report from nine maternal mortality review committees. Retrieved from[Context Link]


Centers for Disease Control and Prevention. (2018). Pregnancy mortality surveillance system (Reproductive Health). Atlanta, GA: Author. Retrieved from[Context Link]


Joint Commission. (2019). Provision of care treatment, and services standards for maternal safety. R3 Report: Requirement, Rational, Reference, 24, 1-6. Retrieved from[Context Link]


Main E. K., Cape V., Abreo A., Vasher J., Woods A., Carpenter A., Gould J. B. (2017). Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative. American Journal of Obstetrics and Gynecology, 216(3), 298.e1-298.e11. doi:10.1016/j.ajog.2017.01.017 [Context Link]


Ozimek J. A., Eddins R. M., Greene N., Karagyozyan D., Pak S., Wong M., ..., Kilpatrick S. J. (2016). Opportunities for improvement in care among women with severe maternal morbidity. American Journal of Obstetrics and Gynecology, 215(4), 509.e1-509.e6. doi:10.1016/j.ajog.2016.05.022 [Context Link]


Petersen E. E., Davis N. L., Goodman D., Cox S., Mayes N., Johnston E., ..., Barfield W. (2019). Vital signs: Pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 States, 2013-2017. Morbidity and Mortality Weekly Report, 68(18), 423-429. doi:10.15585/mmwr.mm6818e1 [Context Link]


Shields L. E., Wiesner S., Klein C., Pelletreau B., Hedriana H. L. (2017). Early standardized treatment of critical blood pressure elevations is associated with a reduction in eclampsia and severe maternal morbidity. American Journal of Obstetrics and Gynecology, 216(4), 415.e1-415.e5. doi:10.1016/j.ajog.2017.01.008 [Context Link]