1. Wisner, Kirsten PhD, RNC-OB, CNS, C-EFM

Article Content

Approximately 700 women die each year in the United States from pregnancy-related complications. American Indian/Alaska Native and Black women are disproportionately affected and are two to three times more likely to die than White women. Tragically, two-thirds of these deaths may have been prevented had the problem been detected by the patient, support person, or a clinician (Centers for Disease Control and Prevention [CDC], 2020). Several organizations have developed campaigns to raise awareness about the urgent maternal warning signs (see Box) and offer free resources that nurses can easily use to implement into perinatal teaching (Association of Women's Health, Obstetric, and Neonatal Nurses [AWHONN], 2020; CDC; Council on Patient Safety in Women's Health Care, 2020).


The CDC (2020) and Council on Patient Safety in Women's Health Care (2020) campaigns include several strategies: 1) educate patients and their support persons about warning signs and empower them to trust their instincts and speak up if something does not seem normal, 2) urge patients to pursue concerns until resolved and to be sure to inform healthcare providers about their pregnancy history, and 3) clinician education is vital so caregivers know urgent maternal warning signs and listen to and respond to patient's concerns. Both offer free patient education resources in English and Spanish. AWHONN (2020) offers a POST-BIRTH Warning Signs Online Education Course as part of their implementation toolkit covering education on maternal morbidity and mortality, communicating information to patients, and an overview of the nurse's role in preventing maternal deaths. AWHONN has free Save Your Life handouts in English, Spanish, Arabic, and Mandarin-Chinese structured on the warning signs listed in the Box using the acronym POST-BIRTH (AWHONN).


Nurses should advocate for education for all perinatal clinicians on urgent warning signs so that all caregivers who interact with patients are aware and know how to respond to them promptly. Partner with clinicians in the emergency department and outpatient offices so that all providers likely to interact with pregnant and postpartum patients are well educated about these urgent maternal warning signs. Practice and role model careful listening when interacting with patients to discern subtle cues about warning signs and contribute to a unit culture that supports patients and support persons when they speak up. Use social media resources on the CDC (2020) Web site to spread the word to your network. Explore the resources in the reference links and share them with colleagues who care for childbearing women.


Urgent Maternal Warning Signs


* Severe and persistent headache


* Dizziness or fainting


* Vision changes


* Fever of 100.4 [degrees]F or higher


* Extreme swelling in hands or face


* Thoughts of harming yourself or baby


* Difficulty breathing


* Chest pain or rapid heartbeat


* Severe nausea and vomiting


* Severe abdominal pain


* Decreased or no fetal movement


* Vaginal bleeding or leaking fluid during pregnancy


* Vaginal bleeding or discharge after pregnancy


* Severe swelling, redness, or pain in leg or arm


* Overwhelming tiredness


Sources:CDC (2020) and Council on Patient Safety in Women's Health Care (2020).




Association of Women's Health, Obstetric, and Neonatal Nurses. (2020). POST-BIRTH warning signs education program. Retrieved August 28, 2010, from[Context Link]


Centers for Disease Control and Prevention. (2020). Hear her campaign. Retrieved August 28, 2020, from[Context Link]


Council on Patient Safety in Women's Health Care. (2020). Urgent maternal warning signs. Retrieved August 30, 2020, from[Context Link]