Improving the Maternity Care Safety Net: Establishing Maternal Mortality Surveillance for Non-Obstetric Providers and Institutions

Joan L. Combellick (), Bridget Basile Ibrahim, Aryan Esmaeili, Ciaran S. Phibbs, Amanda M. Johnson, Elizabeth Winston Patton, Laura Manzo and Sally G. Haskell
Additional contact information
Joan L. Combellick: Department of Veterans Affairs, Veterans Health Administration, Office of Women’s Health, 810 Vermont Ave NW, Washington, DC 20420, USA
Bridget Basile Ibrahim: School of Nursing, Yale University, 400 West Campus Drive, Orange, CT 06477, USA
Aryan Esmaeili: Health Economics Resource Center (HERC), Palo Alto VA Medical Center, Menlo Park 795 Willow Road, Palo Alto, CA 94025, USA
Ciaran S. Phibbs: Health Economics Resource Center (HERC), Palo Alto VA Medical Center, Menlo Park 795 Willow Road, Palo Alto, CA 94025, USA
Amanda M. Johnson: Department of Veterans Affairs, Veterans Health Administration, Office of Women’s Health, 810 Vermont Ave NW, Washington, DC 20420, USA
Elizabeth Winston Patton: Department of Veterans Affairs, Veterans Health Administration, Office of Women’s Health, 810 Vermont Ave NW, Washington, DC 20420, USA
Laura Manzo: School of Nursing, Yale University, 400 West Campus Drive, Orange, CT 06477, USA
Sally G. Haskell: Department of Veterans Affairs, Veterans Health Administration, Office of Women’s Health, 810 Vermont Ave NW, Washington, DC 20420, USA

IJERPH, 2023, vol. 21, issue 1, 1-11

Abstract: The siloed nature of maternity care has been noted as a system-level factor negatively impacting maternal outcomes. Veterans Health Administration (VA) provides multi-specialty healthcare before, during, and after pregnancy but purchases obstetric care from community providers. VA providers may be unaware of perinatal complications, while community-based maternity care providers may be unaware of upstream factors affecting the pregnancy. To optimize maternal outcomes, the VA has initiated a system-level surveillance and review process designed to improve non-obstetric care for veterans experiencing a pregnancy. This quality improvement project aimed to describe the VA-based maternal mortality review process and to report maternal mortality (pregnancy-related death up to 42 days postpartum) and pregnancy-associated mortality (death from any cause up to 1 year postpartum) among veterans who use VA maternity care benefits. Pregnancies and pregnancy-associated deaths between fiscal year (FY) 2011–2020 were identified from national VA databases. All deaths underwent individual chart review and abstraction that focused on multi-specialty care received at the VA in the year prior to pregnancy until the time of death. Thirty-two pregnancy-associated deaths were confirmed among 39,720 pregnancies (PAMR = 80.6 per 100,000 live births). Fifty percent of deaths occurred among individuals who had experienced adverse social determinants of health. Mental health conditions affected 81%. Half (n = 16, 50%) of all deaths occurred in the late postpartum period (43–365 days postpartum) after maternity care had ended. More than half of these late postpartum deaths (n = 9, 56.2%) were related to suicide, homicide, or overdose. Integration of care delivered during the perinatal period (pregnancy through postpartum) from primary, mental health, emergency, and specialty care providers may be enhanced through a system-based approach to pregnancy-associated death surveillance and review. This quality improvement project has implications for all healthcare settings where coordination between obstetric and non-obstetric providers is needed.

Keywords: maternal mortality; pregnancy-associated mortality; maternal outcomes; veterans; pregnancy outcomes; pregnancy; high risk; epidemiologic surveillance (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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