Improving maternal and infant outcomes in the United States is a top priority for the AHA and our member hospitals and health systems. While the field has worked hard to improve maternal morbidity and mortality, we must continue to work toward more equitable outcomes. Mothers can be at risk from the first days of pregnancy through the postpartum period and beyond. Hospitals, health systems, clinicians and their community partners are dedicated to improving care for mothers and infants.
OUR SHARED GOAL:
Eliminate preventable maternal mortality and reduce morbidity related to pregnancy and childbirth.
Core Principles
The AHA encourages hospitals and health systems to apply these four core principles into their maternal and infant health efforts.
1.Examine quality and outcomes data to guide strategy:
Systematically collect data, review metrics and identify inequities to drive strategies for improvement.
KEY ACTIONS
- Consistently track and review maternal morbidity and mortality data from your patient population as well as data from your community, region and state.
- Stratify data by race, ethnicity, socioeconomic status, age and other variables appropriate to your community to identify disparities in care and outcomes.
- Investigate root causes of poor pregnancy outcomes including housing security, food security, health literacy, access to prenatal care, toxic stress, systemic racism, etc.
- Deploy a systematic approach to review maternal health complications and implement strategies for improvement (e.g., maternal mortality review committee).
- Identify opportunities to improve outcomes during pregnancy, labor and delivery, and postpartum.
- Implement strategies to address medical causes of maternal morbidity and mortality across the continuum of pregnancy and postpartum including hypertension/cardiovascular disease, hemorrhage, sepsis, gestational diabetes and behavioral health.
2. Apply an equity lens
Investigate the equity implications of clinical and community-based strategies and ensure commitment toward eliminating identified disparities.
KEY ACTIONS
- Deploy care strategies to address equity gaps identified in your data.
- Investigate how your care delivery strategies enhance or detract from equitable outcomes.
- Consider how care delivery strategies could impact subsections of your population differently and tailor care to meet the needs of your community.
- Explore whose voices and perspectives are shaping your initiatives – and whose voices may be missing.
- Partner with community-based organizations and other stakeholders to improve culturally appropriate care, health literacy, address societal factors and provide wraparound services.
3. Involve patients and community in their own care
Engage patients, families and community stakeholders to design care that is responsive to their needs and preferences.
KEY ACTIONS
- Elicit diverse perspectives of pregnant people to ensure pregnancy and postpartum care and programs are culturally and socially acceptable to your communities.
- Create opportunities that empower patients and community members to share their care preferences, such as patient and family advisory councils.
- Establish forums for expecting and new moms to connect with one another and with community-based groups.
- Develop processes to screen for and address the social needs of pregnant women and new moms.
- Engage and partner with community-based groups to foster seamless care transitions between hospital and community-based providers, particularly for high-risk moms.
- Engage dads and other caregivers throughout pregnancy and postpartum care.
4. Engage and diversify workforce
Deploy interdisciplinary care teams who are trained to provide culturally appropriate care and are representative of the patient population.
KEY ACTIONS
- Customize your maternal health care teams to include nurse-midwives, doulas, community health workers, and behavioral health specialists to provide holistic care aligned with your patient population’s needs.
- Train all clinical and non-clinical staff in unconscious and implicit bias and cultural and linguistic appropriateness.
- Equip care team members with skills that foster active, empathetic interactions between patient and provider.
- Recruit providers that are reflective of the racial, ethnic and cultural makeup of your community and consider workforce development pathways.
