Maternal mortality and morbidity in the United States are as high as they have ever been. More people are dying from complications of pregnancy or childbirth than ever before. 61 percent of deaths related to childbirth occur in the postpartum period and most of those occur in the first 42 days after birth. The current estimated maternal mortality rate in the U.S. is 23.7/100,000 live births (MacDorman, Declercq, Cabral, & Morton, 2016).
There is agreement that we must improve the way we care for people in the postpartum period if we want to be able to reduce the complications and deaths that occur after giving birth. Part of this improvement lies in how warning signs information is provided to families after birth. As it is not possible to identify who will have a postbirth complication, it is imperative that everyone receive information about concerns in the postpartum period that will need to be evaluated by a health care provider. The postpartum nurse or mother-baby nurse is in a unique position to educate families on what to watch for postpartum.
Unfortunately, current research indicates that the information that postpartum nurses teach to new parents about warning signs is inconsistent and often inaccurate. There is also evidence that many postpartum nurses are not aware of the major risks that face people after they give birth that can cause death or serious complications. Families report being flooded with physical and emotional situations in the first days postpartum that make it difficult to take in important information accurately and clearly. For these reasons, the postpartum discharge education RNs provide must be clear, concise, and accurate. When appropriately informed and educated, postpartum nurses are in an ideal position to improve postbirth outcomes, if they are given adequate time to share information with the new family.
A new study, Nursesʼ Knowledge and Teaching of Possible Postpartum Complications, published in MCN: The American Journal of Maternal/Child Nursing, examines postpartum nurses’ knowledge of maternal morbidity and mortality, and information they shared with women before discharge about identifying potential warning signs of postpartum complications.
Almost half the postpartum nurses in the study were not aware that maternal mortality rates have increased. Almost all (93%) of nurses knew that hemorrhage was one of the top three causes of death, but only 68% knew that hypertension was another, and barely 39% could identify infection as the third leading cause of death.
85% of the postpartum nurses responsible for discharge education reported spending a total of 15 minutes or less going over postbirth warning signs with patients prior to discharge. The information provided to parents was inconsistent and inaccurately delivered. The more experience a nurse had, the more confident they felt in delivering appropriate information. More than 80% of nurses indicated that they stayed current on relevant information and new research through articles, books or published guide- lines, or accessed information online, but the information they shared with patients was often not accurate.
The researchers concluded from their study that nurses in the study group needed additional education to advance their knowledge about maternal mortality and potential postpartum complications women may experience after discharge. There are gaps in knowledge of nurses on maternal mortality and in the delivery of consistent education to all postpartum women about potential postpartum complications. More research is needed that focuses on best practices for providing postpartum education on postbirth warning signs and how to more effectively integrate this education into postpartum discharge teaching.
The Institute for Perinatal Quality Improvement is working to disseminate information about improving postpartum education to prevent maternal mortality and morbidity events. They recognize the importance of consistent evidence-based information and the critical role that postpartum nurses play in helping families identify problems after discharge. They have a variety of information that can help standardize and improve the quality of postpartum education delivered on their website here.
Childbirth educators can also play a key role in sharing information on potential warning signs as they cover the postpartum period in their childbirth classes. Researcher Debra Bingham, DrPH, RN, FAAN, the founder and executive director of The Institute for Perinatal Quality Improvement shared with me that "Informing new parents about the warning signs of post birth complications before discharge is an integral part of preventing maternal morbidity and mortality. Childbirth educators can share information about things to look out for during birth classes, so families are not hearing this information for the first time after birth and discharge. Working together, we can all improve outcomes."
POSTBIRTH is an extremely handy acronym that educators can use as part of their curriculum when talking about warning signs postpartum.
There is a very useful consumer page that families will find helpful when learning about it from their childbirth educator. You can direct families to this source for more information. There you can find a printable handout to purchase for you to provide to families that can hang on their refrigerator or be put in an accessible location
Spreading the word about POSTBIRTH information can play a role in reducing complications and death after birth. Getting information out about Dr. Bingham and her colleagues, Dr. Suplee and Ms. Kleppel's new study about nurses' knowledge of maternal mortality and post-birth complications and making as many people as possible aware of the POSTBIRTH acronym is an important goal. Consider joining The Institute for Perinatal Quality Improvement, The National Accreta Foundation and The Society for Maternal Fetal Medicine in a Twitter Storm #POSTBIRTH (no Q&A, just discussion) tonight, Thursday, August 17th at 8 PM EST to raise awareness about this topic.
You may also want to join a free teleconference on October 3, 2017 at 12 noon EST titled "Improving Postpartum Discharge Education About Potential Maternal Complications" to learn more about reducing postpartum deaths by sharing info on POSTBIRTH warnings. Register Here - Space is limited so register early.
Additional information is available in the form of a free slide set "Improving Postpartum Discharge Education About Potential Maternal Complications" will be released shortly. This slide deck is geared for postpartum nurses but educators may find it very useful. Sign up at the bottom of the website page to receive an electronic copy. You can also share your interest in joining a Postpartum Discharge Education Action Community by indicating your interest in the same place.
Your role as an informed childbirth educator can be key in helping families to recognize postpartum complications after discharge. Teaching about "POSTBIRTH" facts makes it easier for families to synthesize this information. There are many resources you can access including teleconferences, slide decks and websites that can provide additional information for you to review in preparing your curriculum. If everyone works together, families will benefit and lives can be saved.
MacDorman, M. F., Declercq, E., Cabral, H., & Morton, C. (2016). Recent Increases in the US Maternal Mortality Rate: Disentangling Trends From Measurement Issues. Obstetrics and gynecology, 128(3), 447-455.
Suplee, P. D., Bingham, D., & Kleppel, L. (2017). Nursesʼ Knowledge and Teaching of Possible Postpartum Complications. MCN, The American Journal of Maternal/Child Nursing, 1. doi:10.1097/nmc.0000000000000371