Combating the Rising Maternal Mortality Rate

If asked how Afghanistan, Sudan, South Africa, Venezuela, and the United States are

alike most people would be hard-pressed to find similarities. The answer may surprise you.

These are all countries in which the maternal mortality rate on the rise. Maternal mortality rates (MMR) is significantly higher in the United States than in any other developed country and has continued to increase over the last two decades despite our increasing awareness of issue. Current statistics suggest that greater than 50% of sentinel events in maternal health are preventable (Zuckerwise & Lipkind, 2017).

At the turn of the nineteenth century maternal mortality was commonplace accounting for

as many as 7 deaths per 100 births in the United States. Most deliveries were done at home by midwives without aseptic techniques leading to infection which accounted for 40% of all

maternal deaths at that time. Maternal mortality rates steadily improved and plateaued in the

early twentieth century to 6-9 deaths per 1000 births. During the 1930’s maternal mortality

gained the spotlight which lead to the establishment of the first review committees for the issue.

In the years that followed, maternal health would see many advancements in care including

antibiotics, the development synthetic oxytocin, increased understanding of hypertensive conditions in pregnancy, improved blood transfusion procedures, and more rigorous clinician qualifications leading to a steep decline of 71% in mortality and morbidity. Along with these advancements, delivery was moved to and favored in the hospital setting as opposed to home deliveries (Ozimek & Kilpatrick, 2018). Cerebrovascular and cardiovascular accidents, maternal sepsis, and post-partum hemorrhage accounted for the overwhelming majority of sentinel events contributing to MMR. These are some seriously sad statistics for America mothers.

So, you might ask, what can be done to fix this problem? Many have looked to technology for an answer. Wouldn’t it be great for us to be proactive in the prevention of maternal mortality rather than reactive? Enter maternal early warning systems (MEWS). MEWS are a set of criteria that have been established based up serial vital signs in the postpartum period. This criteria can track vital sign trends and alert the nurse of possible obstetric decline. Carroll (2018) has issued a call to action on this front from nursing informaticists to explore these systems as a proactive management strategy to combat increasing maternal mortality.

What does this mean for my practice? Firstly, there is some data to suggest that these systems could be applied to telehealth in rural area mothers. Women are at risk of infection, hemorrhage, and thrombosis for months after leaving the hospital. Some are even exploring its use for the prenatal period. As a nurse practitioner in a rural area, these systems could be valuable tools when working with perinatal and post-partum women. Secondly, this would mean that practitioners would be alerted sooner to maternal status deterioration.

There is of course the proverbial ‘but’ in this scenario. How effective these technologies are in predicting maternal decline is still unclear although preliminary studies have indicated promise. More datasets are needed to make these answers clear (Carroll, 2017). Most MEWS are incorporated in charting systems making them intuitive and easy to use as they work in the background.

One thing is certain. More needs to be done in research and developing systems that will combat the rising maternal mortality rate in America. Technology may be a solid place to start.

Carroll, W. M. (2018). Predicting severe maternal morbidity and mortality - An informatics

opportunity. Online Journal of Nursing Informatics, 22(3), 8. Retrieved from http://search.ebscohost.com.libpublic3.library.isu.edu/login.aspx?direct=true&db=ccm&AN=136493760&site=eds-live

Ozimek, J. A., & Kilpatrick, S. J. (2018). Maternal mortality in the twenty-first

century. Obstetrics and Gynecology Clinics of North America, 45(2), 175–186. https://doi-org.libpublic3.library.isu.edu/10.1016/j.ogc.2018.01.004

Zuckerwise, L. C., & Lipkind, H. S. (2017). Maternal early warning systems—Towards reducing preventable maternal mortality and severe maternal morbidity through improved clinical surveillance and responsiveness. Seminars in Perinatology, 41(3), 161–165. https://doi-org.libpublic3.library.isu.edu/10.1053/j.semperi.2017.03.005