The State of American Maternal Healthcare

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By Trisha L. Coady, Senior Vice President & General Manager, Workforce Development Solutions of HealthStream

A Hidden Epidemic

Women’s History Month may be over, but the time to discuss women’s equity and social progress is not. In fact, following a month in which society collectively takes a moment to appreciate the contributions of women in both the public and private spheres, is the time to continue the conversation before another year passes. 

One key element of women’s success throughout time has been trailblazing new paths in male-dominated arenas, creating frameworks for younger women to aspire to achieve their goals regardless of what cultural obstacles seem to exist. One area that highlights this disparity is in the healthcare industry in the United States (U.S.), more specifically, women’s healthcare. There is a long history in the U.S. of healthcare gaps and lack of access. However, when looking at women’s healthcare, a wide range of issues is apparent in the American system—some more visible than others. One instance that has not previously been widely discussed or identified is in maternal and infant healthcare. According to a study by the Commonwealth Fund in 2020, the U.S. shockingly has the highest maternal mortality rate of any other developed country in the world. That statistic showcases a serious gap in the healthcare system—one that highlights a very real challenge with a dire need for change and one that requires innovation like never before. 

For perspective, currently it’s safer for mothers to deliver babies in Oman, Tajikistan, Saudi Arabia and 58 other countries than it is here in the U.S. In 2020, our maternal mortality rate was 23.8 deaths per 100,000 live births, up from 20.1 deaths in 2019. These numbers match those of third world countries. Many are awestruck by that statistic. How could that be the case in the U.S., where the STEM fields are leading the rest of the world in research and development? 

How Did We Get Here?

While disturbing, the answer is simpler than you might think. One reason behind these increasingly high mortality rates is not a lack of scientific knowledge or resources to prevent these deaths. It’s a lack of formal, specialized training and education for maternal healthcare providers, creating a domino effect of damage when it comes to care. For example, nurses who would like to specialize in obstetrics (OB) are not currently required by law to have anything more than their general nursing degree to administer care to expectant or new mothers. Instead, they have no choice but to learn on the job, in real time. This creates a massive issue when it comes to on-the-job awareness as maternal and infant care can be complex as well as demand extra attention to symptoms during pregnancy, birth and even postpartum. 

In addition to this lack of institutional experience and specialized training, there are other issues not being addressed in general certifications such as racial bias with care. This results in more deaths across the board but also a disparity between races, which is not addressed in basic certifications or in nursing school. 

Unfortunately, these racial disparities that can be seen in the wider American social culture also translate to variable health outcomes. For example, the maternal death ratio for Black and Hispanic women is more than 2.5 times the ratio for white women in America. Each patient should receive the same level of care and attention no matter their race, demographic or socioeconomic status. These numbers are unacceptable, and there are several solutions to tackle these massive issues and disrupt the current system where healthcare is failing women from a systemic level.

A Case Study: Elevating OB Care 

So, what do some of those solutions look like? To start, it requires extended and ongoing training for OB providers with an omni-level approach—meaning providing online resources, in-hospital extended training, customized and affordable programs, as well as simultaneous implementation of innovative solutions that best prepare providers for any situation. It’s a matter of integrating these types of programs and products into hospitals and utilizing education as a tool to transform how we view women’s healthcare—in this instance, maternal and infant care. 

Programs that prepare nurses and OB providers with case-based training and ongoing education help blaze a new path towards a focus on improving preventable outcomes. There are companies today that are working on innovations to make an impact in this space. For example, HealthStream, a leading healthtech solutions company, partnered with a third party research group to conduct a study examining the effects of implementing a customized obstetrics program into one hospital to see if they could improve maternal/infant patient outcomes. The company is dedicated to improving the quality of care for all through advisory and development apps, software and services that enhance the qualifications of healthcare professionals, among other initiatives. Their people-first approach exemplifies how the healthcare industry could be transformed by these types of solutions when implemented across the board in a strategic way. 

The study, focused on HealthStream’s Quality OB solution, targeted two core OB competencies and four situational competencies. The results were astonishingly positive. When hospitals adopted this continuing education curriculum for their maternal healthcare providers, they achieved zero-harm: that is, 0 deaths and 0 cases of shoulder dystocia and hemorrhage (two of the top maternal healthcare complications), as well as a sixfold increase in nurses’ confidence to provide quality care. It also found that this kind of high confidence correlates with higher (better) levels of care. So, the answer is clear: the way to achieve better maternal health outcomes is to mandate and provide specialized training for these specialized providers. Additionally, this includes making resources and ongoing educational programs accessible at any level of healthcare expertise. 

Legislative Landscape

Another aspect of tackling this issue within maternal healthcare is the historical lack of attention to this increasingly urgent crisis, which was recently elevated to the federal level. Policies requiring additional standards and training have become essential. It is clear that these initiatives are necessary in order not only to raise the standard of maternal healthcare, but also to bring equality in the treatment received from patient to patient. One goal here is to ensure that DE&I initiatives are high priority to reduce the occurrences of racial bias affecting quality of care.  

In 2020, The Joint Commission, the oldest and largest standards-setting and accrediting body in American healthcare, started collecting and publicly reporting hospital performance on two perinatal care measures for Cesarean birth rates and unexpected complications. They began reporting on this data as the maternal and infant mortality rates were reaching an all-time high and demanded the attention of the legislature. In light of this analysis and abhorrent results, they officially recognized the importance of improving training and continuing education options with the implementation of 13 new initiatives, escalating the need to a policy level.

As of March 2022, both chambers of the 117th United States Congress have validated this policy need with the introduction of a host of bills that support research, training and education initiatives aiming to improve the state of American maternal healthcare. For example, the Tech to Save Moms Act supports the use of technology to improve and address disparities in maternal health outcomes. It builds on a pair of identical bills designed to address the paucity of maternal healthcare training initiatives through the issuance of “guidance to […] educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models, and for other purposes,” as noted in the bill. If passed, these bills will fund essential research and solutions development that could help the industry work towards being up to par with our international peers. 

Potential Solutions & Looking Ahead

One of the biggest training challenges facing OB nurses is the lack of accessibility. To solve problems like this, it’s a matter of dispersing knowledge that already exists in a way that is digestible and adaptable to the unpredictable schedules of nurses everywhere. In addition to dispersing knowledge that already exists, there is a significant need to innovate new ways of training through creative avenues that address each hospital, each patient, and each provider’s medical situation. There must be customizable solutions with overarching frameworks that can be tailored to fit a variety of needs, from implementing the latest technology in the healthcare industry in hospitals across the U.S. to ensuring nurses who are working 12-hour shifts, some back-to-back, with families and personal lives, are able to participate and access this specialized training.

The answer is to meet them where they are while providing the most accessible options for any environment. The program must combine theoretical understanding with practical experience that communicates the complexity and context of common maternal healthcare crises. The first time an OB nurse encounters a case of shoulder dystocia should not be in real time with a real patient—it should be in a learning setting or simulation, where mistakes don’t lead to poor outcomes but a deeper understanding of how to address the situation when it matters most. To this end, case-based training is arguably the most valuable form of training that can be provided and used to create a model that can encompass varying needs as complex as medical complications in the surgery room. And because science and best practices in medicine are constantly evolving, this training is equally valuable to nurses fresh out of school and to those with many years of experience. 

When we implement case-based, practical and hands-on training for our maternal healthcare providers, we know that we can improve the quality of care new and expectant mothers can rely on. We can no longer allow a slow rollout of band-aid “quick fixes” in a broken system, but rather we need to dive into the innovations currently showcasing strong results and saving more lives. Just as a doctor would look for the root cause of an ailment rather than only treat symptoms, we must look at the root of these systemic issues in maternal/women’s healthcare to make a change. Only when we embrace advanced training programs for these healthcare providers will we be on par with our peers in the maternal healthcare arena.

It’s important to recognize where we started and how far we have yet to come in women’s healthcare. Armed with new innovations alongside legislative awareness, the industry has the potential to be transformed.

About HealthStream

HealthStream (HSTM) is dedicated to improving patient outcomes through the development of healthcare organizations’ greatest asset: their people. Our unified suite of solutions is contracted by healthcare organizations across the U.S. for workforce development, training & learning management, nurse & staff scheduling, clinical education, credentialing, privileging, provider enrollment, performance assessment, and managing simulation-based education programs. HealthStream’s corporate office is in Nashville, Tennessee. For more information, visit http://www.healthstream.com or call 800-521-0574.

About Trisha L. Coady

Coady joined HealthStream in 2013 and is currently serving as Senior Vice President & General Manager, Workforce Development Solutions. She is responsible for the company’s full suite of workforce development solutions, which includes clinical, resuscitation, compliance, and revenue cycle solutions—as well as those for the continuum of care. As a nurse, healthcare entrepreneur and nationally recognized thought leader on professional development for clinicians and other healthcare professionals, her expertise helps guide HealthStream’s strategy for the full range of its workforce solutions. Prior to coming to HealthStream, Coady was the healthcare Practice Manager at Bluedrop Performance Learning; founder and President of Medsenses and the Nurses Network; and a registered nurse at several healthcare organizations. She holds a Bachelor of Science in Nursing from the University of Moncton.