In December 2014, the Council on Patient Safety in Women’s Health Care announced funding for a program called the “Alliance for Innovation on Maternal Health (AIM).” Three and a half years later, there are 22 states currently participating, and on May 31, Texas announced enrollment of 166 hospitals in Texas AIM, including many in North Texas that are part of the region’s largest health systems.
AIM is a public, private, and professional collaboration focused on reducing obstetric hemorrhage, severe hypertension, venous thromboembolism, primary cesarean births, and the racial disparities present in statistics surrounding maternal morbidity and mortality.
The organization’s goal to “eliminate preventable maternal mortality and severe morbidity in every US birth center” is broad but attainable—if Texas hospitals adhere to strategies espoused by AIM. Following the national framework of best practices, Texas has chosen to take on hemorrhage, hypertension, and opioid abuse.
There is little debate that maternal mortality in Texas and the U.S. is unacceptably high (despite the report in April revising the maternal mortality rate in Texas from 36 deaths to 14.6 deaths per 100,000 births). For Texas and the U.S. to make long-term inroads in curbing maternal mortality, I believe the healthcare community must aggressively address conditions identified in mothers prior to delivery that impact the survivability of newborns and themselves.
To start, I believe obstetricians and other participating care givers can do three things:
First, prepare hospitals to adopt safety bundles and to follow AIM’s four “R’s”, which are:
- Readiness: Staff to anticipate, develop awareness, and understand the disease process.
- Recognition/prevention: Identify and address the problem, preventing an adverse outcome, and recognize how age or race might influence responses to medications or therapy.
- Respond: Act on a patient’s condition without delay, move quickly treating hypertensive crisis or OB hemorrhage, and address opioid abuse.
- Repeating and system learning: Collaborate with AIM and other hospital entities, sharing patient data within the limits of the law.
Second, continue to make every attempt to reduce the primary C-section rate without compromising care of mom or baby. The rate of C-sections in the U.S. has increased precipitously. Roughly one out of every three babies born in this country is by C-section. Each repeat C-section puts the patient at higher risk for uterine rupture, fetal compromise, and placental implantation disorders; those can lead to hemorrhage, hysterectomy, and/or lower extremity blood clots. The AIM initiative’s best-practice to reduce hemorrhage is to scrutinize moms with previous C-sections during subsequent pregnancies.
Third, track and address racial disparities in maternal mortality. According to a recent report from the Maternal Health Task Force, the underlying complications resulting in death for non-Hispanic black women are preeclampsia, eclampsia, and embolism. Women who have access to regular, comprehensive prenatal visits are more likely to have blood tests and evaluations of the organ systems affected by these diseases, which puts populations that have higher rates of being uninsured or underinsured at higher risk. Additionally, consideration of physician and institutional bias should be taken into consideration. Creating a comprehensive and inclusive approach to care is a solid step toward resolving racial disparities in maternal mortality.
Thankfully, evidence-supported protocols can guide decisions regarding diagnosis, management, and treatment for underlying conditions that might otherwise result in a fatality. Looking ahead, I believe, Texas AIM-initiated programs can address maternal mortality close to home and on a national level. Our great state can make a difference because we do care, and we need to do all we can.
Dr. Marc Zepeda is an obstetrician for Ob Hospitalist Group and Baylor Scott & White Medical Center – McKinney.