Proactive Steps to Combat Rising Incidences of Maternal Injuries?
Updated: Jul 30, 2019
As maternal injury rates have been climbing in recent years, a recent analysis by the federal Centers for Disease Control and Prevention ("CDC") reproductive health division sheds insightful new detail about when women are dying during their pregnancy and postpartum periods, and reveals how their causes of death vary. With the ever-rising injury rates, undoubtedly rising numbers of malpractice claims related to maternal injury will follow. For reference, in 1990, approximately 17 maternal deaths occurred for every 100,000 pregnant women in the United States; in 2015, more than 26 deaths were recorded by 100,000 pregnant women, meaning that over a 25-year time period, American women have become 50% more likely to die in childbirth.1
The CDC Vital Signs Study
This new study by the CDC examined data for 2013-2017 from 13 state maternal mortality review committees ("MMRCs"), and found that the data reveals several areas for improving the care and treatment rendered to mothers. The findings are the result of a CDC analysis of 2011-2015 national data on pregnancy mortality and of 2013-2017 detailed data from 13 state maternal mortality review committees. CDC defines pregnancy-related death as the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication; a chain of events initiated by pregnancy; or the aggravation of an unrelated condition by the physiologic effects of pregnancy. MMRCs, which are multidisciplinary groups of experts that review maternal deaths to better understand how to prevent future deaths, linked most pregnancy-related deaths with several contributing factors, including access to appropriate and high-quality care, missed or delayed diagnoses, and lack of knowledge among patients and providers around warning signs. Notably, of the 700 pregnancy-related deaths that occur each year, the CDC found that during 2011-2015 about one-third happened during pregnancy, about one-third happened during childbirth or the week after delivery, and about one-third happened in the following year. Overall, heart disease and stroke caused 34% of pregnancy-related deaths; other leading causes included infections and severe bleeding.
Overall, the CDC's new report "underscores the need for access to quality services, risk awareness, and early diagnosis, but it also highlights opportunities for preventing future pregnancy-related deaths," said Wanda Barfield, director of the CDC's reproductive health division.
What can medical providers and health facilities do?
The CDC recommended health care providers increase their advisory role to patients in terms of helping with management of chronic health conditions and education about warning signs of dangerous complications. Specifically, providers can help patients manage chronic conditions and engage in meaningful, ongoing dialogue about the warning signs of complications. There is an opportunity for hospitals and health systems to play a role in coordinating and facilitating communication and collaboration not only among healthcare providers but also among providers and their patients. Further, providers, hospitals and health systems would be wise to adopt measures related to handling obstetric emergencies, which could include conducting simulations for emergency pregnancy-related events.
Steps to reduce potential litigation?
Although they typically make up less than one-fifth of obstetric legal claims, maternal injury accounts for almost 20% percent of all obstetric claims; the remainder were neonatal injuries. Providers, hospitals and health systems may want to consider the following in connection with risk management initiatives, and legal counsel to providers and hospitals would be shrewd to counsel their clients regarding:
Adopting and incorporating best practices from the American Congress of Obstetricians and Gynecologists (ACOG) patient safety bundles;
Institute proper triage and screening tools so early warning signs are not missed.
Creating an embedded culture of patient safety;
Practicing simulation to be ready for unexpected, rare events;
Implementing tools to facilitate dialogue among providers and their patients;
Encouraging providers to be aware of and involved in patients; management of chronic health conditions;
Consider lessons from the California Maternal Quality Care Collaborative, a program first adopted in California that was successful in reducing maternal mortality by 5% during 2006 and 2013.
CDC's Vital Signs Report: www.cdc.gov/vitalsigns/maternal-deaths
The Doctors Company Maternal Injury & Death Closed Claims Study: