Reversing the Rise in Maternal Death Rates: Implications for Nursing Awareness and Advocacy

While maternal outcomes have improved over the years, a considerable number of women in the United States die from or continue to experience a number of pregnancy-related complications. According to the National Center for Chronic Disease Prevention and Health Promotion [NCCDPHP], each year approximately 700 women die of pregnancy related causes while 50,000 women experience severe pregnancy complications. Women living with chronic conditions such as hypertension, diabetes, heart disease, and obesity are at a higher risk for complications during pregnancy, childbirth, and the postpartum period. In particular, African American women are more likely to die from pregnancy-related complications when compared to their white counterparts. Notably, maternal mortality is higher in the United States than in any other developed nation.

Severe maternal mortality is due to severe pregnancy complications. According to the NCCDPHP, these rates have doubled from 2000–2010 and have affected more than 50,000 women in the United States. Some contributing factors include: maternal age, persisting chronic conditions, complications during delivery, and pre-pregnancy obesity. Researchers note that approximately half of pregnancy-related deaths are preventable and point to implications for reducing maternal mortality.

Efforts to reverse these disturbing statistics will require a multifaceted and comprehensive approach. Interventions must include a focus on better data collection, quality improvement measures, provider and patient education, earlier identification and intervention targeting high-risk women, proactive preconception health approaches, and improved obstetrical and maternal care services. Many hospitals and health systems across the country are addressing the mortality death rates and have designed programs, which include some of the aforementioned strategies.

The rise in maternal morbidity and mortality has stimulated discussion and action among nongovernmental and governmental agencies, advocacy, and professional groups and the United States Congress. Groups such as the American College of Obstetricians and Gynecologists, Black Women’s Health Imperative, and the Alliance for Innovation on Maternal Health (AIM), to name a few, are speaking out for legislative action. The table below provides a brief snapshot of legislative proposals introduced at the federal level during 2018, the second half of the 115th Congressional Session. These and other initiatives are a critical first step to reversing the poor maternal health outcomes for women.

Nurses are encouraged to stay abreast of this issue by identifying the state of maternal health in their respective communities. Nurses wishing to improve maternal outcomes can do so by helping to identify high-risk populations and working with their respective institutions to develop educational programs, outreach initiatives, and quality standards for maternal care. As health care providers, nurses are well-suited to work with multidisciplinary teams to disseminate best practices as well as advocate for sound public policies focused on alleviating poor maternal outcomes.

Additionally, nurses can look to professional/specialty organizations to identify what organizations are doing to address maternal mortality. For example, the Association of Women’s Health, Obstetric and Neonatal Nurses, one of nursing’s leading organizations devoted to women’s health and newborns, has a number of resources on this issue and advocates for work that expands the work of state-based Maternal Mortality Review Committees. Maternal Mortality Review Committees are critical to collecting, reviewing, and monitoring data on pregnancy-related deaths.

RESOURCES

American Colleges of Obstetricians and Gynecologists
www.acog.org/Advocacy/ACOG-Legislative-Priorities

Association of Women’s Health, Obstetric and Neonatal Nurses
www.awhonn.org

Maternal Health Task Force
www.mhtf.org/topics/maternal-health-in-the-united-states

Severe Maternal Morbidity in the United States
www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html

• H.R. 5761 Ending Maternal Mortality Act of 2018 Rep. Raja Krishnamoorth (D-IL) Amends the Public Health Service Act to require Department of Health and Human Services to publish every two years a national plan to reduce maternal deaths occurring during or within 12 months of pregnancy Introduced 5/10/18
• H.R. 5457 / S. 2637 Quality Care for Moms and Babies Act Rep. Eliot Engel (R-NY) / Sen. Debbie Stabenow (D-MI) Amends Title XI of the Social Security Act to improve the quality, health outcomes, and value of maternity care by developing maternity care quality measures and supporting maternity care quality collaboratives Introduced 4/16/18
• H. Resolution. 818 / S. Resolution. 459 Black Maternal Health Week Rep. Alma Adams (D-NC) / Sen. Kamala Harris Creates awareness about the maternal health care crisis in the black community and the urgency to reduce maternal and morbidity among black women Introduced 4/11/18