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In the US, over 50 percent of maternal deaths occur in the postpartum period.
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What Clinicians Shouldn't Fear Telling Their Pregnant and Post-Partum Patients

By Nadine Gelmar | Thursday, August 1, 2019

What Clinicians Shouldn't Fear Telling Their Pregnant and Post-Partum Patients

Hours after giving birth to a healthy son, Tara Hansen began to feel like something wasn’t right. She was considered healthy and had a low-risk pregnancy, so her doctors discredited her complaints. She was soon sent home. After all, wasn’t it normal to experience pain and feel a bit unwell after having a baby? Six days after giving birth, Tara Hansen passed away as a result of complications related to childbirth.

Her story is part of a disturbing national trend. The US has the worst record of maternal deaths in the developed world. Between two and three women die of pregnancy complications each day. And the numbers are rising.

The first wave of IHI’s Better Maternal Outcomes Rapid Improvement Network launched this spring. During the opening call of the Network’s Public Webinar Series, “The First 42 Days: Best Practices for Postpartum Care,” panelists and participants shared strategies for reducing pregnancy-related morbidity and mortality in the postpartum period.

Improve Postpartum Discharge Education

In the US, 98 percent of births occur in the hospital and over 50 percent of maternal deaths occur in the postpartum period. Debra Bingham, DrPH, RN, Executive Director of the Institute for Perinatal Quality Improvement and Faculty for the Rapid Improvement Network, is working to support clinicians, including those who can reach new mothers before they go home. She was part of the development of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) POST-BIRTH warning signs program – an initiative aimed at raising awareness and educating clinicians about key postpartum complications.

When women are discharged, they routinely receive information about how to breastfeed and what to do if their newborn is sick, but not necessarily how to tell if they need medical attention themselves. “A lot of the information women are provided with is about how to take care of the baby,” Dr. Bingham noted. “Many of the materials don’t have very much info at all geared towards the mother.”

All women who give birth in a hospital should be seen by a nurse or other clinician who provides standardized postpartum discharge education. This is important to ensure that every woman leaving the hospital knows when to obtain needed care. However, many nurses are unsure how to inform women about the risk of maternal mortality and are also concerned about bringing up the topic – afraid it would only scare new mothers. AWHONN’s discharge education checklist can be used as a teaching guide for nurses to ensure that the information is presented in a consistent fashion.

Share the POST-BIRTH Warning Signs

AWOHNN’s POST-BIRTH checklist includes a list of indicators for a new mother to call her provider, symptoms that require immediate care, and suggested wording for communicating these signs quickly and clearly. For example, new mothers are encouraged to call their provider if they have a temperature at or over 100.4° Fahrenheit and to call 911 in the case of chest pain.

According to LaShea Wattie, MEd, MSN, AGCNS-BC, APRN, RNC, System Clinical Nurse Specialist at WellStar, it is important to educate everyone about these indicators. “All women who gave birth, not just those who are at high-risk, need to know the POST-BIRTH warning signs. We do not know which women will have a complication,” Wattie said.

The “Save Your Life” handout can reinforce teaching about specific warning signs and help women get care quickly. The handout includes POST-BIRTH warning signs with three key messages for all postpartum women:

  • Recognize the signs and symptoms of childbirth complications that can occur after hospital discharge
  • Respond by calling 911, going to the nearest hospital, or calling a health care provider, depending on the situation.
  • Remember to tell all health care providers (including emergency personnel) the date of childbirth, to ensure that the health care provider is aware that the symptoms could be related to postpartum complications.

Talk to Providers and Patients

Anne Santa-Donato, MSN, RNC, Director of Obstetric Programs at AWHONN, stressed the importance of including all health care providers in the education of women and their families. Reaching out to community health workers, for example, can help to ensure that mothers who have come home from the hospital are getting further support to reinforce the knowledge shared during their postpartum discharge planning.

It’s also important for clinicians to take the time to explain to their patients how much postpartum visits matter. Having that additional conversation, LaShea Wattie argued, is essential to ensure new mothers come in for their follow-up visits.

Health care providers – whether they are nurses, physicians, midwives, or community health workers – spend a lot of time with the patient and “have an opportunity to be with them at their happiest moments and at their most challenging moments.” Santa-Donato noted. “We as clinicians have an opportunity to save lives.”

Educating providers on key complications and warning signs ensures that clinicians take distressed patients like Tara Hansen seriously and save lives, and improve care.

Nadine Gelmar is IHI’s Multimedia Intern.

Wave 2 of the Better Maternal Outcomes Rapid Improvement Network will launch this fall. To learn more about this free rapid improvement network for hospital-based professionals in the United States, join an informational call on August 6th at Noon ET.

Sign up here to be added to the Better Maternal Outcomes mailing list and receive notifications about upcoming public webinars.

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