By Priya Agrawal, BMBCh, MA, MPH, DFSRH
Executive Director, Merck for Mothers
In 2013 alone, approximately 1200 women died from pregnancy and childbirth related complications in the United States. This number has risen sharply over the last two decades. In addition, since 1990, the rate of maternal deaths in this country has more than doubled. The question we must ask ourselves is "why?"
Why in a country that spends $111 billion on childbirth-related health care is maternal mortality on the rise?
Each maternal death is an unacceptable tragedy, and also an opportunity to learn how to prevent future deaths. Maternal mortality review boards have been used as an effective mechanism for finding out what led to maternal deaths in countries as diverse as the United Kingdom, South Africa, Malaysia and Sri Lanka.
The review board interdisciplinary group of experts conducts an evaluation to determine the root cause of the death, including reviewing case files and interviewing family members and friends of the woman who died. The benefit of reviewing cases together, rather than in isolation, is the ability to identify trends and address problems at the population level. When a review board is operating optimally, the lessons it learns can inform changes to the health care system.
It is important to emphasize that the focus of reviews is learning, which is why they are confidential and blame free – a space for providers and others to discover system problems and develop recommendations that can be used to prevent future deaths.
When we act on the lessons learned from a strong maternal mortality review process, we can save the lives of women. As an OB/GYN from the United Kingdom, I saw the direct impact of a strong maternal mortality review process firsthand. Throughout the early 2000s, the U.K. national maternal mortality review, referred to as the Confidential Enquiry into Maternal Deaths, found that there was a rise in mortality due to pulmonary embolism, a blood clot in the lung, which was not known to be a leading cause of maternal death.
Because pulmonary embolism is often preventable, the Confidential Enquiry recommended that the national health system develop guidelines for prevention, especially after caesarian delivery (e.g., placement of compression socks on the legs after surgery, use of blood thinners). After these new protocols were implemented, the number of deaths from pulmonary embolism dropped by 50 percent.
Here in the United States, we also have the opportunity to learn from maternal mortality reviews. Yet only about half of states in this country have a functioning maternal mortality review board. Our vision is that someday all 50 states will have maternal mortality review boards – and that they will examine every maternal death, with the mechanisms and resources necessary to take action so that women in the United States receive better care.
To help realize this vision, Merck, through Merck for Mothers – our 10-year global initiative to end preventable maternal deaths – provided funding for the AMCHP Every Mother Initiative. AMCHP is now working with 12 states to ensure the lessons and recommendations from robust maternal mortality reviews are carried out. For example, the Ohio maternal mortality review board recently identified a need to improve hospital team response to manage obstetric emergencies and is now exploring pilot sites for a Simulation Training Center.
As a MCH professional, you can take steps to help reverse the trend of women dying during pregnancy and childbirth. Reach out to your state maternal mortality review team to find out ways to get involved or, if your state does not have one, reach out to AMCHP, your district ACOG chapter and other organizations that care about women's health to learn how to establish one. Connect with MCH professionals in other states to exchange best practices for maternal mortality review. And finally, educate your elected officials on why every state health department should have a high functioning maternal mortality review program.
When a woman dies giving life, her family, friends and broader community suffer a terrible tragedy. Let us not add to that tragedy by failing to learn from what went wrong. Let us learn, and then do everything we can to ensure that every pregnant woman in this country gets the support and care she needs for a healthy and happy pregnancy and birth.