INSIGHT: Improving Maternal Patient Outcomes

Maternal Mortality – Where Do We Go from Here?

Strengthening healthcare systems across the world presents the possibility to save the lives of almost 300,000 mothers that are dying from preventable causes each year.

To help raise awareness and encourage discussion around the global problem of unacceptably high rates of maternal mortality, we launched an INSIGHT series back in February. Every other month, we have been highlighting issues surrounding maternal mortality and what we as nurses and midwives can do to help improve patient outcomes. As we recap and conclude the series with this final post, it is important to explore where do we go from here.

A Review of the Top Causes
The World Health Organization (WHO) cites five major complications that account for nearly 75% of all maternal deaths.

  1. Severe bleeding (mostly bleeding after childbirth)
  2. Infections (usually after childbirth)
  3. High blood pressure during pregnancy (pre-eclampsia and eclampsia)
  4. Complications from delivery
  5. Unsafe abortion

The remainder of deaths are caused by or associated with infections such as malaria or related to chronic conditions like cardiac diseases or diabetes.

Four Best Practices

At the HRSA’s (Health Resources and Service Administration) Maternal Mortality Summit last year, international subject matter experts from the United States, Brazil, Canada, Finland, India, Rwanda, the United Kingdom, and the WHO came together. They discussed evidence-based approaches and innovative solutions for decreasing maternal mortality rates across the globe. Practices for lowering maternal mortality were identified, including:

  1. All births should be attended by skilled health professionals, as timely management and treatment can make the difference between life and death for the mother as well as for the baby.
  2. Addressing inequities in access to and quality of maternal health care. Ensure that women receive risk-appropriate maternal care.
  3. Ensuring accountability to improve quality of care through quality data collection. You can’t fight what you can’t see. Healthcare providers need access to comprehensive clinical data on maternal patient outcomes. Creating maternal mortality review boards would allow providers to collect data on known causes for maternal death.
  4. Improving the quality of maternity services through the utilization of a standardized approach to managing known obstetric complications and emergencies related to pregnancy and childbirth in all birthing facilities.

What is Next?
Nearly five years into the United Nations’ Sustainable Development Goal (SDG) era, maternal mortality rates worldwide are still unacceptably high. The (SDG) calls for reducing the global maternal mortality ratio to fewer than 70 per 100,000 live births by 2030. The global maternity mortality rate was 211 deaths per 100,000 live births in 2017.

Many countries have made great strides in making interventions available to address the immediate causes of maternal death, such as routine care services, skilled attendants at birth and life-saving maternal health medicines.

We should be optimistic about the possibility of improving maternal mortality. In some ways, it’s a matter of focus and prioritization of our collective efforts. With global attention focused on maternal mortality, there are tremendous opportunities to work together and learn from each other. The dramatic progress occurring in some countries should be closely examined to learn how these successes could be replicated.

For example, Kenya. The First Lady of Makueni county, Nazi Kivutha, has partnered with the County Department of Health to advance the national Beyond Zero Campaign at a local level. Through her advocacy, a 120-bed capacity hospital was opened in Makueni County in December of last year, allowing more women access to a skilled facility delivery. The hospital had only seven maternal deaths in 2018 compared to 14 in Makueni County. The facility’s reduction in maternal mortalities can be attributed to:

  • A dedicated 24-hour theater for maternity cases.
  • Staff training on Basic Emergency Obstetric and Newborn Care.
  • A nurse mentorship program that ensures continuous mentoring of staff and students on labor monitoring and obstetric emergency management.
  • An active Maternal and Perinatal Deaths Surveillance and Response (MPDSR) system that tracks all maternal and perinatal deaths and institutes corrective measures to prevent future deaths.

According to First Lady Kivutha, family planning has proven to be an additional cost-effective practice in preventing maternal deaths in Makueni County. She noted it has also contributed to economic growth, reduced child mortality and reduction of unplanned pregnancies and unsafe abortions.

As we conclude our INSIGHT series on maternal mortality, we recognize significant progress has been made. But there is still more to be done. One of the most effective methods of bringing about healthcare changes is to prioritize them. To impact the global rate of maternal mortality and save the lives of mothers around the world, we need to keep learning from each other and sharing best practices.

Do you have follow-up questions, suggestions, nursing news or issues you would like to share? Email us at [email protected]. or text us via WhatsApp at +1 832 589 0097. We welcome your feedback and thoughts on this series.

Yours in Nursing,


Lisa D. Cole, MA, RN
Director
MBF Center for Global Nursing Development