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To protect women and babies we need a new approach to labor and delivery

To protect women and babies we need a new approach to labor and delivery
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The U.S. has the worst rate of maternal deaths in the developed world – and it continues to increase.

There are many factors behind this tragedy, but two are high on the list: too little emphasis on maternal/fetal safety, and an obstetric model in which delays in care are inevitable.

The combination can be deadly.

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Last month, the Texas Task Force on Maternal Mortality wrapped up its investigation into the state’s high rate of maternal mortality. In its report, the task force identified common factors related to maternal deaths, including delays and poorly coordinated response to diagnosis and treatment in the pregnancy, delivery, and the postpartum period; lack of leadership and communication; and delayed or no response to warning signs.  

If the U.S. wants to lower our dismal maternal mortality rate, we cannot continue a model in which the status quo is acceptable. The traditional model of labor and delivery (and postpartum care) can — and must — be improved upon by policymakers and hospitals.

First, U.S. health policymakers should follow Texas’ lead in promoting implementation of safety protocols developed through the Alliance for Innovation on Maternal Health (AIM), a national data-driven maternal safety and quality improvement initiative.

The AIM program features patient safety bundles and tools proven to save lives and reduce maternal morbidity by ensuring that the hospital and clinical team are prepared to act quickly and effectively when an emergency happens. Outcomes data suggest significant improvements in maternal morbidity rates including those related to hemorrhage, a main cause of mortality highlighted in the Texas Task Force report.

Almost 20 state and nearly 1000 hospitals nationwide already participate in AIM. State leaders and health departments, providers and others should coordinate to quickly expand implementation.

Second, hospitals should embrace new models, such as OB hospitalist programs.

Laboring women are intrinsically linked to the schedules of their obstetricians, who must not only run a community practice, but be on call at all times, day or night. They can be summoned any day of the week, including weekends, and must rush to the hospital to deliver a baby and provide care for the mother.

Imagine an airline pilot or a nuclear plant technician in similar circumstances. A text alert arrives and they scramble from dinner or straight out of bed. They arrive unnerved and exhausted to take the control of a 747 aircraft or manage nuclear equipment. Does this sound reasonable? Of course not.

But it is under this same premise that labor and delivery units have traditionally functioned.

OB hospitalist programs overcome these delays by providing coverage and support to community OBs until they can arrive at the hospital or when the woman has no obstetrician, staffing hospitals on a 24/7 basis, including nights and weekends.

With a clinician onsite at all times, urgent health concerns and emergencies are quickly addressed by an OB/GYN with specialized training in those situations. In fact, an analysis by the nation’s largest non-profit health system identified a 31 percent reduction in serious harm incidents before and after implementation of OB hospitalist programs.

Equally important, OB hospitalists maintain close contact with ED physicians — who are likely the first responder to postpartum patients with medical complications. With data showing that nearly 35 percent of pregnancy-related deaths occur after delivery, OB hospitalists are pivotal in supporting emergency physicians in the diagnosis of postpartum preeclampsia and other conditions.

There are other important changes that must be made to improve health outcomes for women and babies, such as addressing the racial inequities that lead to higher mortality rates among women of color, and investing in better community-based social services and prenatal care. But improving upon the traditional labor and delivery and postpartum model must be at the top of the list.

Policymakers and hospital administrators can do their part by prioritizing AIM safety protocols and adopting new care models that protect precious lives.

Dr. Mark Simon is chief medical officer of Ob Hospitalist Group (OBHG). Dr. Rakhi Dimino, a practicing OBGYN in Houston and a regional medical director for OBHG, serves on the Texas Medical Association's Council on Science and Public Health.