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24-WD-SPEC-419-09.24.24 Promoted Webinar-No Mother Left Behind-Email Hero Image-FINAL-CN (1)

No Mother Left Behind: Effective Solutions for Obstetric Care and Support

November 1st, 2024
November 1st, 2024

Maternal mortality rates in the United States are the worst among developed countries and reports show that the rates have been rising over the past several years and continue to climb.

HealthStream recently conducted a webinar titled, “No Mother Left Behind: Effective Solutions for Obstetric Care and Support,” to discuss strategies that could improve maternal outcomes and reduce the risk of death or complications. The webinar was led by HealthStream’s Tanesha Riley, MS, RNC-OB, Solution Executive, Child and Maternal Health, and featured:

  • Henry M. Lerner, MD, Founder, Newton-Wellesly OB-GYN
  • John Yosaitis, MD, Clinical Director, MedStar Simulation Training and Education Lab (SiTEL)

Maternal Health in the U.S.

A report from the Centers for Disease Control and Prevention (CDC) said 1,205 U.S. women died of maternal causes in 2021 as compared with 861 in 2020 and 754 in 2019. Perhaps more disappointing is the fact that the Maternal Mortality Review Committees from 36 states reported that 84% of the reported deaths between 2017 and 2019 were preventable. Dr. Lerner noted that there are many reasons why a mother could die giving birth. Factors such as older women giving birth, women presenting with more medical issues, and the rise in obesity have all contributed to the problem.

Dr. Yosaitis discussed how there are millions of women who have limited or no access to prenatal care and that results in more patients who present at the end of their pregnancies without ever receiving care.

However, Dr. Lerner believes the mortality rate can improve. “These numbers can be reduced if clinicians caring for patients are aware of why the situations that cause maternal mortality and morbidity arise and seek to prevent them by being prepared educationally and functionally,” he said. “By practicing these emergency situations that give rise to these statistics, we can improve outcomes and save lives.”

What Happens When There is Limited Access to Obstetrical Care?

Dr. Yosaitis discussed some of the risks associated with limited or no access to prenatal care. For example, he shared that patients who need to travel further for care may present at higher risk because they have not received proper prenatal care. Dr. Lerner further explained that patients who have an emergency are more at risk if they must travel far because it delays care. The closure of rural hospitals has also impacted the increased risk of maternal risk and mortality.

“Having care at a facility that may be hours from your home depersonalizes the labor and delivery experience,” Dr. Lerner said.

Financial losses, staffing issues, and a reduction in birth numbers have created an untenable situation for women in rural areas in the US. More than half of all rural hospitals are without labor and delivery services. In addition to the fact that millions of American women have limited or no access to maternal healthcare, maternal mortality has recently hit an all-time high and has doubled over the last two decades, with Black mothers experiencing the highest mortality rates.

Managing High-Risk, Low-Incidence Scenarios

High-risk, low-incidence maternal conditions occur when the pregnancy is high-risk but it does not happen often so a provider may lack the skills needed to care for the patient. The webinar speakers discussed how widespread obstetrical unit closures combined with high-risk, low-incidence maternal conditions create a challenge for healthcare educators who want to prevent bad outcomes.

How do you prepare providers, including those who may not be in obstetrics, to manage these emergencies? Dr. Lerner, who has 40 years of obstetrical experience, said having rules for practice, checklists, and templates can help providers avoid mistakes.

“Historically, training has been too long, repetitive, and lacking sufficient emphasis on the clinical aspects of care, communication and teamwork,” he said.

Education is needed to help providers mitigate the risks associated with inadequate assessments of expectant mothers. HealthStream’s Quality OB solution provides concise, effective learning modules that address clinical assessment and reasoning with virtual simulations. Provider retention is also optimized because the educational material is presented in more concise segments.

  • Integrating simulation exercises into educational modules can improve the retention of knowledge about emergency situations. The Institute of Medicine published a report, “To Err is Human: Building a Safer Health System,” recommending the combination of simulations and teamwork education as a best practice.
  • Riley described HealthStream’s OB Safety Sims Toolkit as a simulation toolkit that providers can use for the following OB emergencies:
  • Breech vaginal delivery
  • Hypertension emergencies
  • Maternal collapse
  • Postpartum hemorrhage
  • Shoulder dystocia
  • Umbilical cord prolapse

Dr. Yosaitis also emphasized the importance of simulation. “The didactic portion is important, but to truly put that information into practice, providers need the simulation,” he said. “In order to know the necessary steps, and to master teamwork and communication, you have to practice.”

The simulation drills are quick, and easy to do right in the unit, Riley noted. There are also checklists to help ensure that important steps are not overlooked. Templates are available to ensure that medical notes accurately reflect the quality of care provided to the patient.

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