Ensuring that the recommendations of Maternal Mortality Review Committees (MMRCs) are translated into action at the local and state level is the return on this critical public health investment.
The implementation of solutions and interventions identified by the MMRC is the ultimate goal of the review process. Below are examples of what MMRC leaders and partners can achieve through an intentional focus on learning and collective, collaborative action.
The submitted success stories are organized by type of recommendation made by MMRCs at the following levels (aligned with the MMRIA Committee Decisions Form): Provider, Facility, System, and Community. It also includes Data and other improvements MMRCs made in their processes to identify, review, and communicate about maternal mortality.
The Kansas Maternal Mortality Review Committee (KMMRC) released an action alert in December 2019 to encourage seat belt usage of women during pregnancy and the postpartum period. The action alert encouraged providers to discuss seat belt usage to pregnant women and to educate them on the importance of seat belts. Along with the action alert, a flyer and poster were created.
Through funding from a HRSA grant Maternal Health Innovation, awarded to the Iowa Department of Public Health, Iowa is implementing statewide AWHONN’s (Association of Women’s Health Obstetric and Neonatal Nurses) POST-BIRTH Warning Signs (PBWS) Education and the POST-BIRTH Warning Signs Implementation Toolkit, a set of essential resources created by AWHONN. At least ten (10) nurses from each of Iowa’s birthing hospitals and two (2) nurses from each Title V block grant funded maternal and child health agencies are being trained via the AWHONN POST-BIRTH Warning Signs online learning portal. These PBWS resources are designed to assist nurses in educating people about the signs and symptoms of potentially life-threatening conditions that can occur after they have given birth. AWHONN’s primary aim in developing the POST-BIRTH Warning Signs resources is to help hospitals in their efforts to reduce maternal mortality rates in the United States.
Since NH’s MMRC was legislated in 2012, drug overdose has continued to be the leading cause of death for cases reviewed. In 2019, NH became a recipient of a CDC ERASE MM (Enhancing Review and Surveillance to Eliminate Maternal Mortality) grant and in 2020 officially became an AIM (Alliance for Innovation in Maternal Health) state. During that time and under the auspices of both, NH’s MMRC rolled out its objective of having every postpartum discharge with substance use disorder be equipped and educated with a naloxone kit provided by the birthing provider’s local state funded treatment center. Individual hospital level data is gathered by using an available question for situational surveillance on the birth registry.
Washington state successfully amended the state maternal mortality review law (RCW 70.54.450) requiring hospitals and birthing centers to report deaths that occur at their facility within 42 days of pregnancy to the county coroner/medical examiner offices for investigation and autopsy. Additionally, the Washington state Maternal Mortality Review Panel (MMRP) successfully rolled out recommendations and guidance for investigations and autopsies of deaths that occur within one year of pregnancy.
Links to the maternal mortality law and the autopsy guidelines can be found on the Washington state MMRP website at www.doh.wa.gov/maternalmortality.
In April 2021, Illinois became the first state in the United States to extend full Medicaid coverage to people who just gave birth from 60 days to one year postpartum. This policy implementation was based on a key recommendation made by the Illinois Maternal Mortality Review Committees in the 2018 Illinois Maternal Morbidity and Mortality Report. The report showed that one third of pregnancy-related deaths occur later than 43 days postpartum and access to care throughout one year postpartum is vital to preventing maternal deaths.
Through recommendations made by the Kansas Maternal Mortality Review Committee (KMMRC), the Kansas Perinatal Quality Collaborative (KPQC) elected to implement a maternal health quality improvement initiative beginning in 2021. The Fourth Trimester Initiative will focus on the postpartum period (through one year after delivery) of the mother to improve attendance to the postpartum visit, utilization of obstetric best practice models, appropriate screening and timely referral to services, and improved communication and collaboration among providers to improve quality of care and promote referrals/connections when indicated.
The Iowa Department of Public Health, the Iowa Maternal Mortality Review Committee (MMRC) and the Iowa Maternal Quality Care Collaborative (IMQCC), wanted to take action to reduce maternal mortality. We collaborated with key stakeholders including the Department of Transportation (DOT), Zero Fatalities, the Governor’s Traffic Safety Bureau and Safe Kids Iowa to create a statewide social media campaign to remind pregnant and postpartum women that seat belts are safe for mom and safe for baby. The campaign was from July 1- Sept. 30, 2020. The key messages are that pregnant women should wear a seatbelt as recommended: Buckling up through all stages of pregnancy is the single most effective action you can take to protect yourself and your unborn child in a crash; If you’re involved in a crash during pregnancy, even a minor impact could have major implications so contact your health care provider; NEVER drive or ride in a vehicle without buckling up first, no matter where you are seated. The Iowa MMRC developed a distribution plan of seat belt safety educational flyers, which will include healthcare providers, hospital, and community organization such as Title V agencies, WIC offices, and DOT driver’s license stations.
The New York City Department of Health and Mental Hygiene (DOHMH) has been reviewing maternal death cases since January 2018, starting with all pregnancy-associated maternal deaths of mothers who died in New York City. One of the key recommendations from the review of 2017 deaths was to identify and disseminate existing materials and resources that educate pregnant people about postpartum warning signs, with a focus on postpartum depression and hypertension. The Health Department supported the implementation of this recommendation through the dissemination of innovative, culturally relevant social media content authored by three social media influencers with mass followers who are Black and Brown women of reproductive age. These influencers shared their own birth stories on social media with messages about warning signs and symptoms of maternal mortality (MM) and severe maternal morbidity (SMM), with a focus on depression and hypertension. This effort led to the creation 23 posts, published across Instagram, Facebook, Twitter and personal blogs and were viewed by over 17,000 people online. The success of the work has buoyed other Health Department programs to explore ways of continuing to partner with these influencers.