By Laura Freeman

Amid the joy of new life, one of the cruelest ironies is that giving birth still brings death to too many new mothers around the world. And it can be shocking to learn that maternal death rates in the United States are higher than in many smaller, less-developed countries. Sadly, these rates have actually been rising in recent years.

A lot of effort is going into understanding why this is true and how we can change it. One thing we do know is that maternal hemorrhage is one of the most lethal factors killing new mothers—and with a more focused effort many of those deaths don’t have to happen.

That’s why the Alabama Perinatal Quality Collaborative (ALPQC), supported by the CDC and March of Dimes, is focusing its 2024 maternal health initiative on obstetric hemorrhages.

“Our objective is to share resources and training with hospitals and health professionals across the state who might find themselves caring for a woman in labor,” Program Director Britta Cedergren, MPH, MPA said. “Lives depend on being able to recognize and assess the risk of hemorrhage early and to have preparations and resources in place ready to respond.”

Brian Brocato, DO, who is head of maternal fetal medicine at UAB, serves as Obstetrics Lead for the collaborative. “Early recognition is the key,” he said. “Pregnant women should be assessed in advance for risk factors that could increase the likelihood of a hemorrhage, and assessment should continue through labor, delivery and post partum care as conditions change. Women carrying multiple or larger than average babies, older mothers and those who have given birth multiple times, as well as women with platelet issues or other health conditions are likely to be at higher risk.

“It’s essential to measure blood loss so you have a reliable basis for knowing when it’s time to take action. It’s all too easy for blood to seep through clothing and bedding unnoticed and suddenly the situation becomes critical. You need a hemorrhage cart already prepped, a plan of action and a support team that has trained together so you can act quickly.”

The ALPQC is housed at the UAB School of Public Health, where Lora Ham, RN, MSNRN works in quality improvement and the Department of Health Policy and Organization. She has a very personal reason to champion the Obstetric Health Initiative.

“When I was born, a doctor saved my mother and me from a hemorrhage that could have killed us,” Ham said. “We want to improve the odds for a good outcome for any mother in the state who finds herself in a similar situation.”

The collaborative is putting together educational materials, training programs and resources that can be accessed online any time. They will be working with health care facilities and putting them in touch with each other to share ideas and collaborative efforts.

“One of the problems we have in Alabama is access. We’ve lost so many hospitals, and quite a few hospitals no longer deliver babies,” Cedergren said. “That doesn’t mean they won’t find a woman with a high risk pregnancy coming into the ER in an emergency. We want to make obstetric hemorrhage training and preparation available to those hospitals, too, so they’ll have what they need and know who they can call for support.”

Brocato added, “We have the MIST program here at UAB to advise rural hospitals, and our OB/GYN specialists get calls from ERs around the state. Sometimes babies just won’t wait for a hundred mile drive to get to a neonatal unit, so the nearest hospital may be where the mother has to go.”

Access to prenatal care is another challenge ALPQC is working to overcome. “Disparity is an issue,” Ham said. “Mortality rates and obstetric hemorrhages are more common in ethnic populations including black, native American and Alaska native. It’s hard to get prenatal care when you don’t have transportation or insurance and the doctor is 100 miles away. Many of these rural areas that are underserved are also the poorest. That also affects nutrition and how healthy the mothers are before they become pregnant.”

Brocato said, “When people can’t afford insurance or healthy food, or to take time off work to drive a long way to see a doctor, we start to see the effects of diabetes, hypertension and other co-morbidities that are so common in our state. When it happens to a pregnant woman who doesn’t have access to a doctor until it is time to deliver, she is at a disadvantage in overcoming complications that might arise.”

In addition to improving outcomes and reducing disparities related to obstetric hemorrhages, the ALPQC is sponsoring a second initiative in the year ahead to help newborns.

“Preventing hypothermia in newborns is the focus,” Cedergren said. “When babies leave the warm womb, they can lose so much heat very quickly. Getting chilled puts them at risk for more problems. Strategies for keeping them warm will be part of the information we’ll be sharing.”