Magazine article American Nurse Today

Early Recognition and Response: Nurses Work to Prevent Potentially Fatal Complication of Childbirth

Magazine article American Nurse Today

Early Recognition and Response: Nurses Work to Prevent Potentially Fatal Complication of Childbirth

Article excerpt

Although the United States can be credited with many scientific advances, from launching shuttles into space to helping map the human genome, it falls short in a startling way: avoiding preventable maternal deaths during childbirth. A leading cause of those deaths is postpartum hemorrhage (PPH).

Two to three women die every day in this country from pregnancy-related complications, according to the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Postpartum Hemorrhage Project (PPH Project).

"We have the highest maternal mortality rate among industrialized nations, and we're getting worse," said Emily Drake, PhD, RN, FAAN, president of AWHONN, an organizational affiliate of the American Nurses Association (ANA). "Nurses know this because we're seeing it."


The reasons behind it are multifactorial and include rising incidences of obesity and diabetes among women, the high number of cesarean sections performed in this country, a long-held practice of visually estimating blood loss, and a lack of standardized policies and procedures throughout healthcare facilities nationwide, according to Drake and other nurse experts.

Additionally, African-American women are disproportionately affected by birthing complications and are three to four times more likely to die from them than women from other racial or ethnic groups.

"We're used to thinking of the population giving birth-those 17 to 35 years old-as healthy and resilient," noted Lashea Wattie, MSN, MEd, RNC, C-EFM, an AWHONN member and PPH Project leader in Georgia. Although generally true, that belief can lead healthcare professionals to initially deny that PPH is occurring and subsequently delay needed interventions.


"Women bleeding to death in 2017 is shocking," added Robyn D'Oria, MA, RNC, APN, an AWHONN member and PPH Project leader in New Jersey. "What's even more upsetting is that experienced healthcare providers could fail to respond in a timely manner. By the time there are changes in vital signs, a woman is much more critical than they might believe."

AWHONN and its nurse members, however, are working to strengthen healthcare professionals' early response to PPH, as well as tackling other issues that place the lives of pregnant women and new mothers at risk.

Aiming to save lives

Research has shown that 54% to 93% of hemorrhage-related deaths of women who recently gave birth could have been prevented had nurses and other clinicians responded appropriately. Those alarming statistics spurred AWHONN to create the interdisciplinary PPH Project in June 2013. Its aims were to:

* promote equal access of evidence-based care practices to healthcare facilities

* support effective strategies to improve clinicians' recognition, readiness, and response to obstetric hemorrhage

* identify factors that facilitate and prevent practice improvements, as well as disseminate lessons learned.

Funded by a grant from Merck for Mothers, nearly 60 facilities in the District of Columbia, Georgia, and New Jersey participated in this quality improvement demonstration project.

"We identified leadership in each hospital within nursing, anesthesia, and medicine, among other disciplines, and held a variety of webinars and conference calls on all aspects of the initiative," D'Oria said. "We also employed a sophisticated data collection system that allowed hospitals to input and track data, including process as well as outcome measures such as the number of blood transfusions and the presence of a hemorrhage cart on the unit."

Because of this quality improvement initiative, many of the participating facilities reported practice changes that resulted in positive patient outcomes, including fewer ICU admissions after delivery.

AWHONN's Quantification of Blood Loss video, practice briefs, PPH poster, and other resources continue to be available online on the AWHONN and PPH Project websites. …

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