Ensuring that the recommendations of Maternal Mortality Review Committees (MMRCs) are translated into action at the local and state level is the return on this critical public health investment.
The implementation of solutions and interventions identified by the MMRC is the ultimate goal of the review process. Below are examples of what MMRC leaders and partners can achieve through an intentional focus on learning and collective, collaborative action.
The submitted success stories are organized by type of recommendation made by MMRCs at the following levels (aligned with the MMRIA Committee Decisions Form): Provider, Facility, System, and Community. It also includes Data and other improvements MMRCs made in their processes to identify, review, and communicate about maternal mortality.
From 2014-2017, the Ohio PAMR program presented three types of training. On the Road, Train the Trainer, and Advanced Train the Trainer courses served 298 obstetric professionals representing 69 hospitals in Ohio. These were both direct clinical trainings and opportunities for obstetric nurse educators to learn the use of simulation to train staff. Six-month follow up revealed retention of both knowledge and skill sets with an overall increase in simulation trainings held by participating institutions.
This successful program was adapted for use with emergency medicine professionals beginning in Fall 2020. Given the COVID-19 pandemic, all trainings have been virtual.
Through funding from a HRSA grant Maternal Health Innovation, awarded to the Iowa Department of Public Health, Iowa is implementing statewide AWHONN’s (Association of Women’s Health Obstetric and Neonatal Nurses) POST-BIRTH Warning Signs (PBWS) Education and the POST-BIRTH Warning Signs Implementation Toolkit, a set of essential resources created by AWHONN. At least ten (10) nurses from each of Iowa’s birthing hospitals and two (2) nurses from each Title V block grant funded maternal and child health agencies are being trained via the AWHONN POST-BIRTH Warning Signs online learning portal. These PBWS resources are designed to assist nurses in educating people about the signs and symptoms of potentially life-threatening conditions that can occur after they have given birth. AWHONN’s primary aim in developing the POST-BIRTH Warning Signs resources is to help hospitals in their efforts to reduce maternal mortality rates in the United States.
Since NH’s MMRC was legislated in 2012, drug overdose has continued to be the leading cause of death for cases reviewed. In 2019, NH became a recipient of a CDC ERASE MM (Enhancing Review and Surveillance to Eliminate Maternal Mortality) grant and in 2020 officially became an AIM (Alliance for Innovation in Maternal Health) state. During that time and under the auspices of both, NH’s MMRC rolled out its objective of having every postpartum discharge with substance use disorder be equipped and educated with a naloxone kit provided by the birthing provider’s local state funded treatment center. Individual hospital level data is gathered by using an available question for situational surveillance on the birth registry.
Washington state successfully amended the state maternal mortality review law (RCW 70.54.450) requiring hospitals and birthing centers to report deaths that occur at their facility within 42 days of pregnancy to the county coroner/medical examiner offices for investigation and autopsy. Additionally, the Washington state Maternal Mortality Review Panel (MMRP) successfully rolled out recommendations and guidance for investigations and autopsies of deaths that occur within one year of pregnancy.
Links to the maternal mortality law and the autopsy guidelines can be found on the Washington state MMRP website at www.doh.wa.gov/maternalmortality.
Two initiatives were implemented to address preventable mortality related to postpartum hemorrhage. Between 2010 and 2019, the pregnancy-related mortality ratio due to hemorrhage declined from a rolling three-year average of 3.4 hemorrhage deaths per 100,000 live births in 2010-2012 to 2.1 deaths in 2017-2019.
Connecticut passed the extension of coverage to Medicaid eligible pregnant and postpartum women to one-year postpartum.
The New York City Department of Health and Mental Hygiene (DOHMH) has been reviewing maternal death cases since January 2018, starting with all pregnancy-associated maternal deaths of mothers who died in New York City. One of the key recommendations from the review of 2017 deaths was to identify and disseminate existing materials and resources that educate pregnant people about postpartum warning signs, with a focus on postpartum depression and hypertension. The Health Department supported the implementation of this recommendation through the dissemination of innovative, culturally relevant social media content authored by three social media influencers with mass followers who are Black and Brown women of reproductive age. These influencers shared their own birth stories on social media with messages about warning signs and symptoms of maternal mortality (MM) and severe maternal morbidity (SMM), with a focus on depression and hypertension. This effort led to the creation 23 posts, published across Instagram, Facebook, Twitter and personal blogs and were viewed by over 17,000 people online. The success of the work has buoyed other Health Department programs to explore ways of continuing to partner with these influencers.
In partnership with Wisconsin Department of Health Services (DHS) leadership, the Wisconsin Maternal Mortality Review (MMR) program helped to write and release a Health Alert through the DHS Health Alert Network (HAN) to encourage urgent efforts to intensify COVID-19 vaccine education and to accelerate primary vaccination and booster doses of COVID-19 vaccines for people who are pregnant, recently pregnant (including those who are lactating), who are trying to get pregnant now, or who might become pregnant in the future.