What is happening to all the pregnant women?

There has been a lot in the media and medical journals about the rising morbidity of pregnant women in the United States.  What is going on?  I have been working in maternal child nursing for my whole career of almost 40 years.   I currently work in a Level 1 obstetrical unit.  This means we should be seeing the healthiest of pregnant women delivering at our hospital and yet, as I sat down with a few colleagues on my unit this week, we were discussing the probability of needing to consider having telemetry on our unit to monitor our patient's cardiac status.  This is something we never would have thought before.

This year when we were considering the purchase of a fetal monitor attachment that would give us the capability to monitor obese patients more easily, I started to track the numbers of women who would actually need this for their labors and it was shocking.  I thought the number of women with a BMI greater than 30 would be about 30%.  However, the number turned out to be over 60%.  Obesity causes many complications we are seeing in our patient population:  gestational diabetes, hypertension in pregnancy, shoulder dystocia, obstetrical hemorrhage, cesarean sections, poor healing after birth..... and on and on...

The risks of the things we see on the OB Floors these days has necessitated that the staff become more aware of the early warning signs for many different disease processes.  We have to be aware to keep all patients safe.  This is done with drills and training with the staff,   shift huddles to discuss challenging patients, debriefing after an event occurs.  It also involves reaching out to our partners inside the hospital.  The Emergency Department is an important partner, because the pregnancy period not only includes when the mother is actually pregnant but also the time in the weeks immediately following birth.  Today our OB Educator participated in the Emergency Department skills fair to bring their team additional knowledge on obstetrical emergencies.  

It is important to work together as a team and to share information with our partners so we can best work together in emergent situations.  Obstetrics should be considered a high risk environment because we never know what is going to happen.  It isn't rocking babies and dealing with happy, healthy, easy patients any more.  We have to be ready for anything in our population especially as they present to us sicker than they ever have.  

It is also important to work on the pre-pregnancy health status of women.  We need to work together to solve the issue of obesity in women and the overall health of women prior to when they get pregnant.  Exercise, good food, and good mental status are important prior to getting pregnant.  Women should plan on seeing their OB/GYN provider prior to conception to discuss overall health.  

State Perinatal Collaboratives

In 2006 the California Maternal Quality Care Collaborative (CMQCC) was formed.  I am not sure if it was the first, but it was one of the first.  What is a state quality care collaborative?  It is when a group of people gather together to help improve the health of a population.  In the case of my specialty, that would be mothers and newborns.  

In Florida, we have our own quality collaborative, Florida Perinatal Quality Collaborative or FPQC.  The FPQC was formed in June 2010 when a meeting was held in Gainesville Florida.  The meeting included the top minds in maternal and neonatal care throughout the state of Florida and FPQC was born.   The vision of the FPQC:

All of Florida’s mothers and infants will have the best health outcomes possible through receiving high quality evidence-based perinatal care.

The mission of the FPQC is to advance perinatal health care quality and patient safety for all of Florida's mothers and infants through the collaboration of all FPQC stakeholders in the development of joint quality improvement initiatives, the advancement of data-driven best practices and the promotion of education and training.  So who are these stakeholders?  They are perinatal health-related practitioners from a  variety of professions and specialties, statewide organizations, individuals, advocates, educators, policymakers, hospitals and payers as well as involved families.  

My hospital has been involved with the FPQC from very early on in the first initiative, Eliminating Early Elective Deliveries.  It was not until I was asked to be a representative to the Hypertension in Pregnancy workgroup for the Florida AWHONN section that I got to really experience what it means to be a part of FPQC.  What was so unique about this experience is how all groups that participated in the development of the Florida Hypertension in Pregnancy tool kit worked together.  They included academic obstetricians, private practice obstetricians, ACOG District XII,  Preeclampsia Foundation, Florida Hospital Association, Healthy Start, March of Dimes, Florida Department of Health, AWHONN Florida Section, Maternal Fetal Medicine physicians, anesthesiologists, Florida Affiliate of American College of Nurse Midwives, Agency for Health Care Administration, and insurance providers.   Everyone was around the same table and worked together to make a plan that would roll out to the entire state of Florida.  We were able to use the CMQCC Hypertension in Pregnancy initiative and adapt it to make it an initiative for the State of Florida because CMQCC willingly shares.   Everyone had a voice.  The initiative has been rolled out to participating hospitals who are now working on incorporating the FPQC Hypertension in Pregnancy toolkit into their own organizations.  What is great is there is support from FPQC all along the way.  First there was a kick off in person meeting where all participating hospitals travel to learn about the initiative.  Participants were able to interact with other hospitals throughout the state.   The next support comes with monthly webinars where topics of interest are discussed and implementation problems are solved.  This is a time to ask questions and get answers from others going through the same thing in their organizations.  FPQC also offers grand rounds that can be held in your own facility.  

The thing is, this happens with ALL of the initiatives!!  The state quality collaboratives are working with the Council on Patient Safety in Women's Health Care, Alliance for Innovation on Maternal Health or AIM, on a national level.  Initiatives are shared.  No one has to work alone.  It is much better when we work together.  Through the initiatives or bundles, we are striving for Readiness on every unit, Recognition/Prevention for every patient, Response for every case, and Reporting or systems learning for every unit.

Here are the initiatives that have been worked on or are in progress by FPQC:  

• Early Elective Delivery
• Neonatal Catheter Infections
• Obstetrical Hemorrhage
• Golden Hour
• Antenatal Steroids
• Hypertension in Pregnancy
• Mother's Own Milk
• Perinatal QI Indicators

What can you do?  Join your state collaborative.  Look at the toolkits available through CMQCC, FPQC, and AIM!  Together, we can work to decrease maternal and neonatal morbidity and mortality.  We can make a change for the future!

California Maternal Quality Care Collaborative:  https://www.cmqcc.org

Florida Perinatal Quality Collaborative:  http://fpqc.org

Council on Patient Safety in Women's Health Care AIM:  http://www.safehealthcareforeverywoman.org/aim.php

World Breastfeeding Week!

Yesterday we hosted the Big Latch On at our facility.  It was our fourth year participating and our third year hosting.  We always have had the most mothers at our location out of all the locations in SW Florida.  This event is fun because we get to see the women and the babies that have been delivered at our hospital.  (and some of them are getting big!)  Looking at all those healthy babies and mothers makes me proud of getting mothers and babies off to the best possible start by all the hard work our team does to make breastfeeding successful for these families.  Food is medicine and this begins right from the start with our newborns receiving breast milk from their mothers.

But, seeing these women who have also formed bonds through our weekly breastfeeding support group was exciting too.  They have found each other and are now supporting each other through this parenting journey.  Breastfeeding is not always easy.  But it becomes easier with a community of support.  I am proud of Cape Coral for providing this support!  Normalize breastfeeding.  Give a mom a high five if you see her nursing in public!

Here is a link to a video taken from yesterday by the News Press.  It shows some of our wonderful participants!   

http://www.news-press.com/videos/news/2016/08/05/88303080/

Breastfeed with Pride Moms!

You are simply AMAZING!