Across the United States, health care organizations are coordinating efforts throughout pregnancy and postpartum care to improve birth outcomes and reduce maternal morbidity and mortality. AHA’s Better Health for Mothers and Babies Initiative works with our member hospitals and health systems to help mothers and their babies thrive.
This discussion guide is designed to help teams of health care leaders identify opportunities to develop their pregnancy and postpartum strategies. The questions align with the four core principles that the AHA encourages hospitals to apply to their efforts to improve maternal health.
- Examine quality and performance data to guide strategy
- Use an equity lens
- Involve patients and the community in their own care
- Engage and diversify the workforce
How to use this discussion guide
Assemble your team. Make sure you have stakeholders present from across the continuum of your organization’s maternal health team. It is important to hear the perspectives of your physicians, quality improvement leaders, lay caregivers, patients, community stakeholders, and care administrators.
Create time and space for conversation. These discussion questions can spark deep, nuanced conversations, so we recommend convening your team in a space where everyone can devote their time and attention to maternal health.
Space your conversations. You don’t have to complete this discussion guide all at once. Consider scheduling five meetings with your team — devoting one meeting to each core principle and a final gathering to reflect on your discussions and identify programming opportunities.
You don’t have to have all the answers. This discussion guide asks a lot of questions – you may not have the answers at hand. Ask team members to review questions ahead of time so they can examine the data and follow up on outstanding questions.
Give yourself time to reflect. We ask these questions to prepare you to think critically about how your organization addresses maternal health. Some of what you find and hear can be challenging. It will be important for all team members to bring humility and an open mind to the conversation.
What happens next? Use your team discussions as a starting point. Addressing maternal health is not a one-size-fits-all solution—adapt your approach to the unique situation of your hospital and community. What themes emerged during your discussions? What new tactics can you build into your strategy? What is necessary for your organization to improve maternal and infant outcomes?
1. Examine quality and performance data to guide strategy:
Systematically collect data, review metrics and identify inequities to drive strategies for improvement.
Collect data
- How does your organization track maternal and infant morbidity and mortality data among your patients?
- Which metrics mean the most/are your KPIs?
- How do you incorporate statistics from the postpartum period?
- What sociodemographic variables (eg, race, ethnicity, language spoken) are collected and tracked?
- What social needs (eg food security, housing security, transportation needs) does your organization address during perinatal care?
- At what times during pregnancy continuity do you screen for psychological needs? What do you do with that data?
- How do you track maternal and infant outcomes in your community, region and/or state?
- How do you report collected data across the organization?
- How do you share this information with your board?
Analyze the data
- What insights do you discover in your analysis of maternal and infant health outcomes for both your patients and society at large?
- What are the most common causes of maternal morbidity and mortality?
- What are the most common health challenges for babies?
- How do your organization’s results compare to state and national benchmarks?
- In which areas are you doing well? What can you attribute it to?
- Where do you see opportunities to improve care during pregnancy, labor and delivery and after delivery?
- What do you find when you stratify your collected data by race, ethnicity, age, socioeconomic status, and/or other social domains specific to your community?
- How do you identify the root causes of contributors to these indicators?
Acts on data
- What quality and performance improvement strategies does your organization use or participate in to improve outcomes (eg, AIM Patient Safey Bundles, perinatal quality partnerships, or other toolkits)?
- What metrics do you measure to measure progress?
- What are challenges or opportunities for improvement in this space? What types of clinical guidelines would facilitate progress?
- How is your state hospital association engaging in your quality improvement initiatives? What is their role?
- What systems do you have in place to review maternal health complications?
- How does your organization respond to a poor outcome during pregnancy, childbirth and/or postpartum?
- How do you identify which outcomes were potentially avoidable?
- How do you monitor patients for complications in the postpartum period?
2. Use an equity lens
Examine equity implications of clinical and community-based strategies and ensure commitment to eliminate identified disparities.
Address societal factors that affect health
- What types of social needs are most prominent in your perinatal patients and families?
- What programs does your organization have in place to address social needs?
- How could they be specifically targeted/designed for pregnant and postpartum women?
- What programs or resources do you have for pregnant patients with substance use disorders?
- What community-based organizations do you partner with to support pregnant and postpartum women?
- How do you identify and address implicit bias in pregnancy and postpartum care?
- What programs or strategies have you specifically designed to address the medical, social, and cultural needs of segments of society that experience health disparities (eg, Black, Indigenous, immigrant)?
- What programs do you have in place to address upstream factors affecting maternal health?
- How do you assess the impact of your processes and programs? What feedback do you collect from patients, community members, and providers?
Improve your strategy for mother equality
- How is improving maternal health addressed in your organization’s strategic plan? Who is responsible?
- Who are the Maternal Health Equity Champions in your organization? How can you work with them to improve care?
- What would it take to make improving maternal and infant outcomes an organizational priority?
- Describe challenges that prevent your organization from eliminating inequities in maternal health. What support or resources are needed to make progress?
- What can your organization do to raise awareness of maternal health inequalities?
3. Involve patients and society in their own care
Engage patients, families and community stakeholders to design care that is responsive to their needs and preferences.
Engage pregnant women and families
- What processes does your organization use to identify patient needs and preferences for maternity care and birth experiences?
- How do you elicit patient feedback about their birth experiences? Surveys? Interviews?
- Are the respondents representative of your community? Whose voices and perspectives might you miss?
- Does your organization have a patient family advisory board? If so, how do you engage the PFAC or other patient advisory groups?
- How can maternity care needs be reflected in your community health needs assessment process?
- Do you host conversations with community stakeholders to better understand the various issues people face during pregnancy and postpartum?
- What aspects of maternity care do your patients value highly? What are the areas for improvement?
- How can you empower patients to advocate for themselves and engage them in their own care?
- What types of strategies have worked to build a trusting relationship between provider and patient?
- How does your organization engage fathers and other family members during pregnancy and postnatal care?
Cooperation with community stakeholders
- What community-based organizations do you partner with to address maternal health needs?
- Do you have an inventory of existing resources to support mothers and families?
- Are there opportunities to build on or expand your partnerships? Consider health centers, churches/religious organizations, schools, health centers, and mental health providers.
- How do you measure the impact of your partnerships?
Supporting perinatal mental health
- What programs and resources do you offer pregnant patients with mental health needs (eg, existing mental health diagnoses, perinatal depression/anxiety, substance abuse)?
- How are doctors trained to address maternal mental health?
- How can these resources be tailored to meet the social and cultural needs of your community?
- What strategies are in place if there is a shortage of mental health professionals?
- What support do you offer to families experiencing birth complications (eg baby in the NICU or infant loss)?
4. Engage and diversify the workforce
Deploy multidisciplinary care teams that are trained to provide culturally appropriate care and are representative of the patient population.
Deployment of multidisciplinary care teams
- What types of doctors and lay people are involved in maternal care throughout pregnancy in your health care organization?
- Obstetrician? Nurse midwives? Nurses? Doulas? Health care workers in the community? Psychiatrists/psychologists? Breastfeeding specialists? Social worker? Other?
- What types of professionals may be missing from the care team?
- What would it look like to build a culture of team-based maternity care?
- What can your organization do to more effectively coordinate care during pregnancy and after delivery?
Train your care teams
- What type of continuing education/training does your organization offer your maternity staff on implicit bias, cultural appropriateness, health equity and active listening?
- Is the training compulsory or voluntary?
- Who receives the training? Are there any occupations that should be trained that currently are not?
- How does your organization intersect with birth and emergency health care professionals to help increase access and accessibility to obstetric care?
To diversify the workforce
- To what extent does your maternity care workforce reflect the community you serve?
- What types of partnerships or efforts does your organization use to increase workforce diversity?
- What limitations and challenges does your organization face when it comes to hiring diverse healthcare professionals?
