Transcription:

Prakash Chandran (Host):  The US has the highest maternal death rate of any developed country. What will it take to reverse the rising maternal mortality rate? This episode will explore some of the successful approaches that have worked to improve maternal mortality rates including how OB-GYN hospitalist programs can help address the issues that lead to preventable maternal deaths. Let’s talk about it today with Dr. Mark Simon, the Chief Medical Officer for OB Hospitalist Group. This is the Obstetrics podcast from OB Hospitalist Group. I’m Prakash Chandran. So, Dr. Simon, serious topic today. I think we all have an idea of what maternal mortality means but I want to start with you helping us understand what it is and how severe the problem is in our country.

Mark Simon, MD (Guest):  Sure. Happy to and happy to be with you. Maternal mortality refers to mothers who die unfortunately die either during their pregnancy or in the year following their pregnancy. And as you mentioned, the United States has one of if not the highest maternal mortality rates in the developed world. And it is actually going up and not going down as you might think it would especially when you compare us to other developed nations.

Host:  Wow. So, in your opinion, why are the maternal mortality rates so high in this country? You would think like somewhere like the US, they would be the lowest but is there any one reason or is it multifactorial?

Dr. Simon:  This is one of those situations that’s definitely multifactorial. There’s a lot of issues that lead to out maternal mortality rate. Some of them relate to the age at which our patients are delivering now. We are having an older population relatively; older population is delivering, and they are carrying with them some more chronic diseases. At the same time; you have a medical community that may have lost sight of some of the activities that they can do to prevent or mitigate against severe maternal outcomes including mortality.

Host:  I got you. So, in doing some research I see that California has been absolutely praised for its efforts in reducing maternal mortality. So, talk to us a little bit about what they did in California and why you think they were so successful.

Dr. Simon:  Yeah, I think California took this issue head on which is admirable and something that they should be praised for. What they did is they initially just looked at their maternal mortality events and investigated them and began to ass what are the causes. What are the things that are leading to these maternal deaths? Once they did that, they’ve developed some very simple toolkits for their hospitals in the state of California to use. Toolkits for things like hemorrhage and for high blood pressure during pregnancy and they rolled those out throughout their entire hospital network in that state and then the last thing that they do is they track that data. They track data how each and every one of those hospitals are doing when it comes to providing care to obstetrical patients.

So, bottom line is they put a very focused effort on addressing the issue of maternal mortality and are actively managing it.

Host:  Yeah, that makes a lot of sense. I kind of want to unpack a little bit about maybe some of the most common causes that you see for maternal mortality. You mentioned a couple things there potentially age, potentially hemorrhaging. But talk to us a little bit about what you see most commonly when there is an unfortunate death.

Dr. Simon:  Yeah, unfortunately one of the largest causes of maternal mortality is cardiovascular disease and so that’s typically patients who may have an underlying preexisting heart condition or cardiovascular condition that they bring into – bring with them into pregnancy and therefore that can be complicated during the pregnancy state and lead to a maternal mortality. Other common diagnoses or situations that you see leading to maternal death are hypertensive or high blood pressure issues during a pregnancy commonly referred to as either preeclampsia or eclampsia. Those can lead to maternal death as well as hemorrhage. So bleeding. So either bleeding during pregnancy but more commonly postpartum bleeding after the delivery.

Host:  Okay so going – coming back to what California did, I’m assuming that a lot of it has to do with a focus – based on the demographic of the person, focus on the blood pressure before the delivery, during and afterwards to really insure that some of those signs that you are seeing that cause maternal mortality are dealt with on a proactive basis. Would you say that’s correct?

Dr. Simon:  Yeah, they developed these wonderful toolkits that focus on diagnoses like high blood pressure and give hospitals and clinicians, physicians, midwives, the information they need right at their fingertips to address a high blood pressure in pregnancy in a rapid fashion. And they also gave advice to hospitals as to what medications to stock and where they should be stocked and training for the staff and drills and things of that nature so that everybody is prepared to address a high blood pressure when a patient presents with that condition.

Host:  Yeah, that’s absolutely wonderful. And I see here that Texas has also a leader in addressing this issue so what do you think that they’ve done differently that has made the difference?

Dr. Simon:  Yeah, so Texas initially had one of the higher rates if you look back at the data when it comes to maternal mortality and the leaders in Texas, both medical and political for that matter didn’t like that, right. They didn’t like being at the top – near or at the top of the list of states with high maternal mortality rates and so they too have essentially addressed the issue head on. And a couple of interesting things that they’ve done is they’ve implemented toolkits so the AIM bundles that are coming out of the CDC and other organizations actually not the CDC, sorry. So, Texas has implemented the AIM bundle which have come out of a collaborative of medical leaders in obstetrics. And so they have very similar bundles, high blood pressure, hemorrhage, things of that nature. So, they are implementing those across their hospitals.

In addition, Texas has set up maternal levels of care. So they are designating their hospitals so lower level up to higher level kind of hospitals to care for obstetrical patients and what they are doing is they are trying to ensure that patients with higher risk conditions are cared for at the higher level locations. And again, the goal there is to try to get patients where they need to be for their treatment so that hopefully the care that they receive will prevent maternal mortality or morbidity.

Host:  Yeah, it really does seem like they are much more intentional and proactive around addressing the issues of maternal mortality. I see here that your company OB Hospitalist Group has OB-GYN physicians in hospitals really across the country. So, I’m curious as to what your clinicians are doing to address maternal mortality and morbidity and are you able to use the scale of your network to leverage those efforts?

Dr. Simon:  Absolutely. So, our clinicians, we encourage them, and we are working with them to help our hospital partners implement toolkits like the ones that come out of California or the AIM bundles, things like that to make sure that those types of processes, protocols, policies are in place at their institutions so that the patients can receive the appropriate care. And as OB hospitalists, we are physically present 24/7 and so we’re deeply engrained and interacting with hospital leadership and nursing leadership to implement toolkits like these.

In addition, we put a concerted effort in making sure that an obstetrician is involved in the care of a patient who presents postpartum so after delivery with high blood pressure because one of the interesting facts if you want to call it that, that comes out from the maternal mortality data is that a significant number of women actually die after delivery in the weeks and after delivery. And so, it’s really important that we have clinicians, obstetricians who are there to help see those patients especially those that come with high blood pressure after delivery and ensure that they receive the right care for that condition.

Host:  Yeah, you’ve talked about a number of things here especially around to toolkits and the processes that these hospitals should adopt. But I’m curious to unpack that a little bit. So, in your opinion, what are some of the most important steps that hospitals should take to reduce maternal mortality?

Dr. Simon:  So, there’s a couple. One, I think they should be aware of it, right. So I think people need to at least acknowledge and be aware that this is a problem in the country and that we need to address it. Second thing is, there are very straightforward toolkits that we’ve mentioned many times already that can be implemented and so you have to have the cultural will to implement those at your hospital because sometimes it creates a change in culture or how practice has been done at that institution. So, you need nursing champions and you need physician champions as well and that’s as I was talking about earlier, that’s where OB hospitalists can certainly play a role is being that physician champion to help move the needle and ensure that these toolkits are implemented.

Because it’s one thing to have a toolkit that tells you how you should approach a certain condition. The next step or probably the most important step is you have to implement that toolkit. And you have to have the buy-in at the hospital level for the entire department and the entire unit to follow the guidelines that are in those toolkits.

Host:  It really is a cultural shift around first and foremost acknowledging the problem and secondly, putting processes in place to actually do something about it. And that’s really what an OB hospitalist program does, doesn’t it. It ensures that these processes are actually being followed. So, in wrapping up here, I’m curious to hear your thoughts on just the rise of this maternal mortality rate in the US and what do you think it’s going to take to reverse things? We’ve talked a lot here today about this awareness and acknowledgment and then obviously implementing these processes to make sure that proactive measures are taken so this doesn’t happen but is there anything else that you feel can be done to help reverse the rising maternal mortality rate?

Dr. Simon:  Yeah, I think it’s going to take the effort of a lot of different stakeholders. That includes hospitals, clinicians, and the patients and their families themselves. So raising awareness is more than just raising awareness for the institution or the clinicians. It’s also raising awareness for the general population. And it also is going to take the general population, the families, the patients themselves to advocate on their own behalf. If something is not right in a pregnancy, during the pregnancy, or in the postpartum period; that they need to raise that issue and make sure that they’ve been heard. Now it’s not all on the patients obviously.

As clinicians, we have to listen, right and I acknowledge that, however, it’s also very important for any of us as patients to be our own advocates for any condition and that it’s imperative in the obstetrical situation where if you feel like you are not being heard by the healthcare system; keep stating it. Shout until someone hears you. Because you know best and you know what’s wrong with you with your condition and so advocate on your behalf and so I think putting that all together and this raised awareness. I have faith that the United States healthcare system can turn this around and we can make a huge impact on these lives of these women and their families.

Host:  All right Dr. Simon, really appreciate your insight here today. That’s Dr. Mark Simon, the Chief Medical Officer of OB Hospitalist Group. Thanks for checking out this episode of the Obstetrics Podcast. If you’d like to learn more about how OB hospitalists programs are addressing maternal mortality, please visit www.onhg.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.