How we can improve maternal healthcare -- before, during and after pregnancy

It was chaos as I got off the elevator.

I was coming back on duty
as a resident physician

to cover the labor and delivery unit,

and all I could see was a swarm
of doctors and nurses

hovering over a patient in the labor room.

They were all desperately trying
to save a woman's life.

The patient was in shock.

She had delivered a healthy baby boy
a few hours before I arrived.

Suddenly, she collapsed,
became unresponsive,

and had profuse uterine bleeding.

By the time I got to the room,

there were multiple doctors and nurses
and the patient was lifeless.

The resuscitation team
tried to bring her back to life,

but despite everyone's
best efforts, she died.

What I remember most about that day
was the father's piercing cry.

It went through my heart
and the heart of everyone on that floor.

This was supposed to be
the happiest day of his life,

but instead it turned out
to be the worst day.

I wish I could say this tragedy
was an isolated incident,

but sadly that's not the case.

Every year in the United States,
somewhere between 700 and 900 women

die from a pregnancy-related cause.

The shocking part of this story

is that our maternal mortality rate

is actually higher than all other
high-income countries,

and our rates are far worse
for women of color.

Our rate of maternal mortality
actually increased over the last decade,

while other countries reduced their rates.

And the biggest paradox of all?

We spend more on health care
than any other country in the world.

Well, around the same time in residency
that this new mother lost her life,

I became a mother myself,

and even with all of my background
and training in the field,

I was taken aback by how little attention

was paid to delivering
high-quality maternal health care,

and I thought about what that meant,
not just for myself,

but for so many other women.

Maybe it's because my dad
was a civil rights attorney

and my parents were socially conscious

and demanded that we stand up
for what we believe in,

or the fact that my parents
were born in Jamaica,

came to the United States,

and were able to realize
the American Dream.

Or maybe it was my residency training,

where I saw firsthand

how poorly so many
low-income women of color

were treated by our healthcare system.

For whatever the reason,
I felt a responsibility to stand up,

not just for myself,

but for all women,

and especially those marginalized
by our healthcare system.

And I decided to focus my career
on improving maternal health care.

So what's killing mothers?

Cardiovascular disease, hemorrhage,

high blood pressure
causing seizures and strokes,

blood clots and infection

are some of the major causes
of maternal mortality in this country,

but a maternal death
is only the tip of the iceberg.

For every death, over a hundred women
suffer a severe complication

related to pregnancy and childbirth
resulting in over 60,000 every year

having one of these events.

These complications,
called severe maternal morbidity,

are on the rise in the United States,
and they're life-altering.

It's estimated that somewhere
between 1.5 and two percent

of the four million deliveries
that occur every year in this country

are associated with one of these events.

That is five or six women every hour
having a blood clot, a seizure, a stroke,

receiving a blood transfusion,

having end organ damage
such as kidney failure,

or some other tragic event.

Now, the part of this story
that's frankly unforgivable

is the fact that 60 percent
of these deaths and severe complications

are thought to be preventable.

When I say 60 percent are preventable,

I mean there are concrete steps
and standard procedures

that we could implement

that could prevent
these bad outcomes from occurring

and save women's lives.

And it doesn't require
fancy new technology.

We just have to apply what we know

and ensure equal standards
between hospitals.

For example, if a pregnant woman
in labor has really high blood pressure

and we treat her with the right
antihypertensive medication

in a timely fashion,

we can prevent stroke.

If we accurately track
blood loss during delivery,

we can detect a hemorrhage sooner
and save a woman's life.

We could actually lower the rates
of these catastrophic events tomorrow,

but it requires that we value
the quality of care

we deliver to pregnant women

before, during, and after pregnancy.

If we raise quality of care universally
to what is supposed to be the standard,

we could bring the rates of these deaths
and severe complications way down.

Well, there is some good news.

There are some success stories.

There are some places that have
actually adopted these standards,

and it's really making a difference.

A few years ago, the American College
of Obstetricians and Gynecologists

joined forces with other
healthcare organizations,

researchers like myself,
and community organizations.

They wanted to implement
standard care practices

in hospitals and health systems
throughout the country,

and the vehicle they're using is a program

called the Alliance for Innovation
in Maternal Health, the AIM Program.

Their goal is to lower maternal mortality
and severe maternal morbidity rates

through quality and safety initiatives
across the country.

The group has developed
a number of safety bundles

that target some of the most
preventable causes of a maternal death.

The AIM Program currently
has the potential to reach

over 50 percent of the US births.

So what's in a safety bundle?

Evidence-based practices,
protocols, procedures,

medications, equipment, and other items
targeting these conditions.

Let's take the example
of a hemorrhage bundle.

For a hemorrhage, you need a cart

that has everything a doctor or nurse
might need in an emergency:

an IV line, an oxygen mask, medications,

checklists, other equipment.

Then you need something
to measure blood loss:

sponges and pads.

And instead of just eyeballing it,

the doctors and nurses
collect these sponges and pads

and either weigh them

or use newer technology to accurately
assess how much blood has been lost.