Hospitals can take four steps to reduce maternal mortality, according to the authors of a November 1, 2018, perspective in the New England Journal of Medicine. Women in the United States are more likely to die from childbirth- or pregnancy-related causes than women in any other high-income country, the authors said, and black women die at a rate four times higher than white women (for more information see HRC Alerts, November 2, 2016: "An International Embarrassment": Maternal Mortality Rates Rise in U.S., Even as They Decrease Elsewhere). The first step in reducing this trend is expanding the focus on preventable causes of obstetrical complications and deaths, the authors said. This can include implementing best-practice care bundles at all birthing facilities. The second step is for all hospitals to implement multidisciplinary staff meetings or huddles to assess and review each of the risk factors for each obstetrical patient. The third step is to simulate obstetrical emergencies in labor and delivery units to identify gaps in care. Step four involves using the "Maternal Health Compact," which formalizes existing relationships between lower-resource hospitals and referral hospitals that accept transfers of pregnant women who require higher levels of maternal care. The authors also recommend that the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians collaborate on an additional year of comprehensive training for family physicians interested in practicing in remote communities.

HRC Recommends: Although most mothers experience labor and delivery without significant adverse events, every pregnancy and birth carries risk of an adverse outcome for the woman. A heightened awareness of the need to improve perinatal patient safety and reduce the risk of lawsuits has resulted in successful risk management and quality strategies by health systems, hospitals, providers, and liability insurers in reducing the risk of harm to mothers and their newborns. Healthcare risk managers should consider implementing strategies such as those described above to help broaden awareness and reduce the risk of maternal mortality.