In affluent countries, maternal death rates are usually on the decline. However, the opposite is true in the United States. Every year, more than 700 women die of pregnancy-related causes, while 65,000 women face life-threatening complications, according to the US Centres for Disease Control and Prevention (CDC). Despite medical advancements, this number continues to rise over the last 25 years.

In seeking the reason for the rise, a study (published in MCN: The American Journal of Maternal/Child Nursing) was done and its findings revealed that the answer lies in nurses who give postpartum care to mothers.

Not educating because it is happy times

The study surveyed 372 postpartum nurses across the country and discovered that they were not well-equipped with the knowledge of postpartum health risks that mothers could face. Terribly lacking in this area, the nurses are then not able to educate mothers about symptoms like painful swelling, headaches, heavy bleeding and breathing problems – all of which could be indicators of life-threatening complications.

Roughly half of the nurses surveyed were not aware that the US maternal mortality rate had gone up. On the other hand, 19% of them thought the number had gone down. Only a small 12% knew about the upward trend of the maternal mortality rates.

“If nurses aren't aware that there's been a rise in maternal mortality, it makes it less urgent to explain to women what the warning signs are,” emphasised Debra Bingham, head of the Institute of Perinatal Quality Improvement and the study’s co-author.

The majority of pregnancy-related deaths are due to heart condition. Nonetheless, women also die from infections, bleeding, blood clots, and high blood pressure, known as pre-eclampsia. The death rates are three times higher in black mothers and mothers from rural areas.

Cardiovascular complications account for more than a quarter of the maternal deaths in the country. Unfortunately, this is the subject that nurses feel least comfortable educating mothers. Nurses also spend very little time—10 minutes of less—in pointing out warning signs of potential complications. Bingham highlighted, this is because the talk about life-threatening conditions after giving birth makes them uncomfortable, as it was supposed to be a happy time for the mothers.

Standardised tools to overcome death rates

The solution, then, is in the postpartum education given by nurses to mothers before they leave the hospital. Typically, the mother doesn’t return to the hospital until six weeks later for follow-ups. However, there are instances, whereby due to complications like transportation, finances and just general lack of concern or overwhelmed with caring for an infant—up to 40% of mothers do not even return.

The first few days after giving birth are also deemed unsuitable for educating, as hormones are high and energy is drained. An older study from 2014 in New Jersey and Georgia – where maternal mortality rates are especially high – revealed that postpartum nurses spend most of the time educating about the baby’s care, rather than the mother’s wellbeing. If at all the education on mothers were present, they were inconsistent and sometimes ill-informed.

Fortunately, insights were gathered from focus groups and it gave rise to standardised tools that nurses could roll out on postpartum mothers. Short and targeted information concisely filled a checklist, a script that nurses could follow and a one-page referral about postpartum warning signs, complete with instructions on when to see a doctor or call for help. Upon testing them in 2015, women were quick to return to the hospital with delivery-related symptoms.

Through this study and its publication, it is hoped that these tools would have wider use – thus, bringing down maternal mortality rates. “Something as simple as creating educational and training programs for nurses… can have a real impact,” expressed funder of the study from Merck for Mothers, Mary-Ann Etiebet. MIMS

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