Expert Opinion
National Partnership for Maternal Safety: Consensus Bundle on Support After a Severe Maternal Event

https://doi.org/10.1016/j.jogn.2020.09.160Get rights and content

Abstract

Supporting women, families, and clinicians with information, emotional support, and health care resources should be part of an institutional response after a severe maternal event. A multidisciplinary approach is needed for an effective response during and after the event. As a member of the maternity care team, the nurse’s role includes coordination, documentation, and ensuring patient safety in emergency situations. The National Partnership for Maternal Safety, under the guidance of the Council on Patient Safety in Women’s Health Care, has developed interprofessional work groups to develop safety bundles on diverse topics. This article provides the rationale and supporting evidence for the support after a severe maternal event bundle, which includes structure- and evidence-based resources for women, families, and maternity care providers. The bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning, and it may be adapted by nurses and multidisciplinary leaders in birthing facilities for implementation as a standardized approach to providing support for everyone involved in a severe maternal event.

Section snippets

Readiness: Every Unit

The Readiness domain includes four components that refer to policies and protocols at the facility level and the availability of required resources and services to care for women at risk of severe maternal events. The first three components of Readiness are discussed in the following sections as they relate to women, families, and clinicians:

  • 1.

    Develop a Unit-Based Protocol

  • 2.

    Establish a Response Team

  • 3.

    Provide Unit Education on Protocols, Including Drills and Debriefs

Recognition: Every Woman, Family, and Maternity Clinician

The Recognition domain includes two components that relate to clinician capacity and assessment to identify acute stress disorder among those involved in a severe maternal event. These components are discussed in the following sections as they relate to women, families, and clinicians.

  • 5.

    Perform Timely Assessment of Emotional and Mental Health Status of Women, Families, and Maternity Clinicians

  • 6.

    Build Capacity Among Maternity Clinicians to Recognize Signs of Acute Stress Disorder

Response

The Response domain consists of three components that refer to timely, supportive communication with women and families and offering support and resources. The three components of Response are discussed in the following sections as they relate to women, families, and clinicians.

  • 7.

    Provide Timely Interventions

  • 8.

    Communicate With Women and Families

  • 9.

    Offer Support and Resources

Reporting and Systems Learning

The Reporting and Systems Learning domain includes incorporation of the needs and perspectives of women, family members, and clinicians when addressing system-level improvements. Applying the principles of continuous quality improvement at the birth facility level is vital to the process of systems learning and improving maternal safety and quality of life. National maternal safety and quality improvement initiatives, such as the American College of Obstetricians and Gynecologists AIM Program (

Conclusion

Supporting women, families, and maternity care clinicians with informational, emotional, and health resources is a newly recognized priority when severe maternal events occur. Women and their family members who experience severe maternal events are at increased risk of mental health concerns, and there may be serious emotional effects on the clinicians involved. When a maternal death occurs, the devastation is even more profound and requires an even more concerted institutional support of the

Acknowledgment

The authors acknowledge Elliott Main and members of the Patient, Family, and Staff Support Work Group: Ilene Corina, Ryan Hansen, Susan Kendig, Donna Montalto, Catherine Ruhl, Laney Poye, and Eleni Tsigas.

Christine H. Morton, PhD, is a research sociologist, California Maternal Quality Care Collaborative, Stanford University, Palo Alto, CA.

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    Christine H. Morton, PhD, is a research sociologist, California Maternal Quality Care Collaborative, Stanford University, Palo Alto, CA.

    Michelle Flaum Hall, EdD, LPCC-S, is an associate professor in the Department of Counseling at Xavier University, Cincinnati, OH.

    Sarah J. M. Shaefer, RN, PhD, is a retired nurse and former director of the National Fetal and Infant Mortality Review Program, American College of Obstetricians and Gynecologists.

    Deborah Karsnitz, DNP, CNM, FACNM, is a professor at Frontier Nursing University, Versailles, KY.

    Stephen D. Pratt, MD, is an anesthesiologist at Beth Israel Deaconess Medical Center, Boston, MA.

    Miranda Klassen, BS, is a maternal health advocate and the Executive Director, Amniotic Fluid Embolism Foundation, Carlsbad, CA.

    Kisha Semenuk, MSN, RN, CPHQ, is a perinatal and maternal child health quality nurse, Maternal Safety Foundation, San Diego, CA.

    Cynthia Chazotte, MD, is a maternal–fetal medicine specialist, professor emerita of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY.

    The authors report no conflicts of interest or relevant financial relationships.

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    © 2020 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.