The Institute for Perinatal Quality Improvement, LLC (PQI) is proud to support the Kentucky Perinatal Quality Collaborative (KyPQC) in advancing two focused quality improvement (QI) sprints aimed at improving maternal health outcomes across the state of Kentucky: reducing severe maternal hypertension-related complications and safely lowering cesarean birth rates through evidence-based care practices.

These targeted QI sprints bring together multidisciplinary hospital teams working in the Emergency Department and Labor and Delivery, student nurses, and public health leaders to accelerate measurable improvements in maternal care. Through collaborative learning, rapid-cycle testing, data-driven strategies, and evidence-based interventions, participating teams will work to strengthen the timely recognition and treatment of obstetric hypertension during the first sprint. The second sprint will be focused on promoting safe, patient-centered approaches to reducing unnecessary cesarean births.

These sprints reflect the growing national momentum among Perinatal Quality Collaboratives (PQCs) to improve maternal and infant outcomes through structured quality improvement efforts. PQCs have demonstrated success in reducing severe pregnancy complications and supporting equitable care practices nationwide.

“PQI is honored to partner with KyPQC in supporting these important quality improvement sprints,” said Debra Bingham, DrPH, RN, FAAN, PQI's CEO. “Focused, action-oriented initiatives like these help clinical teams rapidly implement best practices that improve outcomes for birthing people and babies.”

As part of the collaboration, PQI will provide QI expertise, educational resources, coaching support, and tools designed to help participating hospitals build sustainable systems improvements. The organization’s mission is to expand the use of quality improvement science to eliminate preventable perinatal morbidity and mortality and ensure equitable outcomes for all families.

The hypertension sprint will emphasize timely identification and treatment of severe maternal hypertension, standardized response protocols, and postpartum follow-up strategies. The cesarean birth sprint will focus on evidence-based labor management practices, shared decision-making, and reducing variation in care to support safe reductions in low-risk primary cesarean births.

“These collaborative sprints represent an important opportunity for hospitals across Kentucky to learn from one another and accelerate improvements in maternal care,” said Dr. Lyndsey Neese, division director for the Kentucky Department for Public Health’s Division of Maternal and Child Health. “By working together, we can create safer birth experiences and improve outcomes for families throughout our state.”

The partnership underscores a shared commitment between PQI and KyPQC to strengthen perinatal care systems through innovation, collaboration, and continuous quality improvement.

For more information about the Institute for Perinatal Quality Improvement, visit www.perinatalqi.org.

For more information about the Kentucky Perinatal Quality Collaborative, visit KyPQC.org

Debra Bingham was invited to the MA State House to attend the ceremonial signing of the bill that she helped advocate for in her role as CEO of PQI and in her role as a a member of the MA Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN.org) Coordinating Committee. Dr. Hafsatou Fifi Diop, the inaugural Assistant Commissioner of Health Equity at the MA Department of Public Health, and Valerie Sweeney, the Legislative Coordinator for MA AWHONN also attended the landmark event.

The Institute for Perinatal Quality Improvement (PQI) is pleased to announce that Renée Byfield, MS, RN, FNP, C-EFM, has been selected to become a Fellow of the American Academy of Nursing (Academy). Renée is the Program Director and co-author of the Institute for Perinatal Quality Improvement’s SPEAK UP Against Racism Program. Induction into the Academy is a significant milestone in a nurse leader’s career in which their accomplishments are honored by their colleagues within and outside the profession. Fellows are selected based on their contributions and impact to advance the public’s health.

The Academy is a policy organization and an honorific society that recognizes nursing's most accomplished leaders in policy, research, practice, administration, and academia to advance equitable solutions to the most complex health care challenges. Academy Fellows hold a wide variety of influential roles in health care in the United States and abroad. Induction into the Fellowship represents more than recognition of one's accomplishments within the nursing profession. Fellows contribute their collective expertise to the Academy, engaging with health leaders nationally and globally to improve health and achieve health equity by impacting policy through nursing leadership, innovation, and science.

Ms. Byfield has educated thousands of perinatal healthcare professionals with the goal of eliminating preventable perinatal morbidity and mortality. She has experience in obstetric and neonatal care, spanning leadership roles in nursing, management, education, and curriculum development. With a career encompassing academia, hospital, and ambulatory settings, she’s made significant contributions to institutions including Drexel University as Clinical Assistant Professor for nursing baccalaureate and masters level courses; the Association of Women’s Health Obstetric and Neonatal Nurses (AWHONN) as Program Manager authoring and facilitating creation of internationally recognized perinatal, neonatal and simulation programs and was the clinical lead on the Postpartum Project Hemorrhage, a multi-state quality improvement project to improve Black maternal mortality in the US; NYP – Weill Cornell as Perinatal Safety Administrator launching team training and interdisciplinary simulation in-situ drills; and Kaiser Permanente GA as Nurse Manager for OB/GYN, Urogynecology where she launched the Percutaneous Tibial Nerve Stimulation clinic. She received AWHONN’s 2022 Diversity, Equity, and Inclusion Leadership Award in recognition of her role as a birth equity leader and innovator. As a PhD student at Emory University and a National Institutes of Health T32 Pre-Doctoral Training Scholar, her research focuses on using data science to mitigate obstetric violence.

PQI’s Founder & CEO, Debra Bingham, DrPH, RN, FAAN, said of Renée, “I’m so honored to work with Renée and have her share her expertise and brilliance as the Director and Co-Author of PQI’s SPEAK UP Program.”

The newest Fellows, selected from a competitive pool of applicants, represent 37 states, the District of Columbia, Guam, and 14 countries. Their unique expertise and expansive body of knowledge will soon bolster the collective impact of over 3,000 Academy Fellows to achieve the Academy’s vision of healthy lives for all people.

Renée and the 2024 inductees will be recognized for their substantial, sustained, and significant contributions to health and health care at the Academy’s annual Health Policy Conference, taking place on October 31 – November 2, 2024 in Washington, DC during the Induction Ceremony on the evening of November 2nd. After the ceremony, the new inductees can use their FAAN (Fellow of the American Academy of Nursing) credential, the most prestigious recognition in nursing.

Learn more about the Academy and visit the policy conference website for more details. For individuals interested in attending the Induction Ceremony, tickets can be purchased online.

About the American Academy of Nursing
The American Academy of Nursingserves the public by advancing health policy and practice through the generation, synthesis, and dissemination of nursing knowledge. Academy Fellows are inducted into the organization for their extraordinary contributions to improve health locally and globally. With more than 3,000 Fellows, the Academy represents nursing’s most accomplished leaders in policy, research, administration, practice, and academia.

From AMCHP, "The MCH Block Grant, authorized by Title V of the Social Security Act, is the only federal program of its kind devoted solely to improving the health of all women and children in the United States. It is guided by the principles of evidence, flexibility, and results. In FY19, programs funded by the MCH Block Grant served 98% of infants, 92% of pregnant women, and 60% of children nationwide. Racial and ethnic inequities persist across several indicators, with Black infant mortality rates double the rates for white infants and the maternal mortality rate for black women being three to four times higher than the rate for white women. Title V programs work to address these inequities by increasing access to quality health care services and supports for women and children and facilitating health promotion efforts across the lifespan."

Read more about the the HRSA Title V MCH Block Grant here.

Read more about AMCHP here.

The Benefits of Using Intermittent Auscultation
April 16, 2024 | 12:30 PM Eastern

Speakers: Debra Bingham, DrPH, RN, FAAN and Renee Byfield, MS, RN, FNP, C-EF

Join us for an insightful one-hour Ask the Expert webinar, “The Benefits of Using Intermittent Auscultation,” where we delve into the advantages and best practices of this essential technique in obstetric care. Led by esteemed experts in the field, this session will explore the significance of intermittent auscultation in monitoring fetal well-being during labor and delivery.

Whether you’re a seasoned obstetrician, midwife, nurse, or medical student, this webinar offers an opportunity to ask questions to gain valuable knowledge and practical insights to enhance your clinical practice and improve perinatal care outcomes. Don’t miss this opportunity to expand your expertise and contribute to safer childbirth experiences for mothers and babies alike.

Pricing: Free

Register Here

PQI recently joined 63 other organizations in signing a letter in support of Healthy Start funding. In the finalization of FY24 funding levels, Congress proposed cuts to maternal child health (MCH) and public health programs, including zeroing out Healthy Start.

The Association of Maternal & Child Health Programs (AMCHP) drafted a letter to "House and Senate leadership to fund Healthy Start at its current allocation of $145 million. Further, since the House committee report implies that Healthy Start is duplicative of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, we clarify this misconception and delineate key differences in this letter."

Visit here to review the letter and its signers.

Visit here to learn more about AMCHP's efforts.

PQI's cohort 1 SPEAK UP Faculty members are Andrea Cross, MSHA-RN, Audra Meadows, MD, MPH, Connie Clauson, RN, BSN, CCRN, MEd, and Lauren Nunally, MPH, RM, BSN, RNC-OB, C-ONQS. 

Click here to learn how you can become eligible to apply to become SPEAK UP Faculty. The next faculty course will be held in 2024. Applications are accepted at anytime. 

Andrea Cross, MSHA-RN is a native of Illinois, born and raised on the south side of Chicago; a divorced mother of four and grandmother of eleven. She is committed to demonstrating love, fairness, equality, compassion and fairness to others. Prior to her career in healthcare, she was employed with the federal government, Internal Revenue Service. Currently she has been a professional registered nurse for forty years. All
of her nursing career has been dedicated to maternal child services, the development of her clinical staff and services to the community. Andrea's clinical expertise includes labor and delivery, newborn, intermediate & special care. Advancing to nursing administration, executive liaison for inpatient obstetrics outpatient ambulatory clinic, currently she is the Perinatal Network Administrator for the John H. Stroger, Jr. Hospital Health & Hospital System. Providing oversight and implementation of the Illinois Department of Public Health Maternal-Child Healthcare Code.

Audra Robertson Meadows, MD, MPH is a Professor and Vice Chair for Culture and Justice in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Diego School of Medicine. Dr. Meadows is a board-certified Obstetrician/Gynecologist and birth optimizer - providing care, championing health equity, and improving health systems for nearly 20 years. Dr. Meadows is nationally recognized for her expertise leading perinatal quality collaborative teams, innovating prenatal care, and developing tools to improve obstetric equity. She is a founding director of the Massachusetts perinatal quality improvement collaborative, PNQIN MA, where she currently leads implementation of the PNQIN Maternal Equity Bundle across hospitals and leads an NIH-funded hybrid effectiveness-implementation study of safety bundles to improve maternal morbidity and inequity. At UCSD, Dr. Meadows is active in clinical practice and research, directs the Equity in Systems Science course for undergraduate medical students, and leads equity and justice initiatives for her department. She enjoys inspiring students and trainees to innovate and optimize health systems having mentored undergraduate and graduate students in public health as well as medical trainees (medical students, residents, fellow) in maternal health equity. Dr. Meadows completed training in OB/GYN at The Brigham & Women’s Hospital and Massachusetts General Hospital at Harvard Medical School. After residency, she was awarded the Commonwealth Fund Fellowship in Health Equity Leadership and received a Master of Public Health degree from Harvard’s TH Chan School of Public Health. Recently, she was a 2021 Health Systems Science Scholar of the American Medical Association. Dr. Meadows is funded by the National Institutes of Health (NIH), Centers for Disease Control (CDC), and Robert Wood Johnson Foundation (RWJF) to investigate strategies to address maternal quality and birth experiences. Dr. Meadows serves on national boards and professional committees to address maternal health equity and has received national honors and awards for her career accomplishments and community service.

Connie Clauson, RN, BSN, CCRN, MEd is a neonatal nurse and educator with decades of experience teaching both adults and children. After graduating from a small nursing program in the Midwest, Connie worked as a travel nurse for many years. The opportunity to live in various parts of the US allowed her to gain perspective on the differences in healthcare cultures, structures, and accessibility across regions. After settling in the Boston area, Connie completed the Boston Teacher Residency; a teacher prep program designed to transition midcareer professionals to public school teachers while providing the social justice and cultural competence training needed to accomplish the goal of having each learner reach their full potential. After earning a Masters in special education, Connie taught an Inclusion pre-K in a large urban school district for several years. The experience gave her a front row seat to structural inequities impacting children of all ages. She returned to the healthcare workforce with a renewed passion for creating platforms and systems that promote diversity, equity, and inclusion for all. As the Nurse Educator for a 60 bed NICU, Connie revised the nursing orientation program to embed family voice at all levels, ensure equitable representation for diverse peoples and families, and provide a wide range of perspectives for learners to engage with. Connie is currently a staff nurse in the NICU at Beth Israel Deaconess Medical Center (BIDMC) in Boston, an instructor in the Life Support Program at Boston Children’s Hospital, and a Co-Chair of the multidisciplinary Neonatal Health Equity and Justice Subcommittee for the BIDMC NICU.

Lauren has worked in Women’s Health for thirty years as a nurse and midwife and spent the first half of her career as a direct care provider, developing models of midwifery care and managing clinical teams. Her in-depth clinical experience coupled with her quality improvement and implementation science knowledge has supported contributions to health equity, maternal and infant health, health policy within the perinatal health space. Lauren has lead initiatives at the state level, collaborated with State PQCs across the country, local and national MCH organizations and thought leaders to co-create programs specifically focused on mitigating contributory risk factors of health inequities and negative health outcomes for the perinatal and newborn populations. An accomplished executive nurse leader and national birth equity consultant and coach, Lauren inspires teams to accomplish essential equity-focused goals by identifying opportunities and QI solutions to improve care delivery for all birthing people. Lauren is an active member of AWHONN and is currently the vice Chair of the Diversity, Equity and Inclusion Committee.

To learn more about the requirements to become SPEAK UP Faculty, visit this page. 

•  Inpatient Antepartum Nursing (RNC-IAP) - Maternal and Fetal Physiology and Assessment (Code 1)
• Inpatient Obstetric Nursing (RNC-OB®) - Fetal Assessment (Code 1)
• Women's Health Care Nurse Practitioner (WHNP-BC®) - Normal Physiology and Wellness Management (Code 1)
• Electronic Fetal Monitoring (C-EFM®) (Code 11)

We encourage all perinatal health professionals who support people in labor to become skilled in IA so that more people in labor will have more freedom in movement. You can learn more about the IA course here.

The bipartisan legislation continues "crucial federal support for the state-based maternal mortality review committees (MMRCs) that review pregnancy-related deaths to identify causes and make recommendations for the prevention of future mortalities."

The letter states, "With our nation’s maternal mortality rate on the rise, we urge you to swiftly pass the Preventing Maternal Deaths Reauthorization Act. It is critical that Congress does everything in its power to address the maternal mortality crisis and work towards solutions to prevent future, unnecessary deaths."

Read the full letter here.

"Three Missed Critical Nursing Care Processes on Labor and Delivery Units During the COVID-19 Pandemic" was written by Joyce K. Edmonds, Ph.D., M.P.H., RN, Stacey Iobst, Ph.D., RNC-OB, CNE, Erin George, MSN, CNM and PQI CEO & Founder Debra Bingham, DrPH, RN, FAAN.

Read the article for free through July 7, 2023 at this link.

This scholarly work is also featured in a PQI Innovation Webinar and is available here. 

Governors, First Spouses, industry leaders, and invited speakers are coming together to identify ways for states and territories to "ensure citizens have access to high quality maternal and infant care, including various Maternal Infant Health Medicaid policies that states can look to implement".

Debra Bingham, DrPH, RN, FAAN is an invited speaker. Other invited speakers include Kara Zivin, PhD, MS, MA, MFA, Health Services and Policy Researcher; Leseliey Welch, Co-founder of Birth Detroit and Birth Center Equity; and Stacy A. Bohlen, Sault St. Marie Chippewa, Chief Executive Officer, National Indian Health Board. The moderator of the discussion is Monica Beltran, Program Officer, W.K. Kellogg Foundation.

Governors attending this convening include New Jersey Governor Phil Murphy and Michigan Governor Gretchen Whitmer. In addition to First Lady Murphy, other First Spouses attending will be North Carolina First Lady Kristin Cooper and North Dakota First Lady Kathryn Burgum.

Read the full letter here.

Read the FTA report here.

More information about David and his work can be found here.

This education was developed by PQI to ensure perinatal health professionals have access to essential resources to support the moms and babies in their care. The Interactive Simulation-Based Education, v2, provides interactive and evidence-based training giving practitioners the education they need to perform and interpret IA confidently. IA is an important assessment tool for staff, and a promising strategy to reduce cesarean birth rates.

PQI's Interactive Simulation-Based Education is now available for purchase in both the PQI Store and the AWHONN store. The education is a fantastic resource for perinatal nurses. 

Below are some comments from individuals who have completed the education:

"[I] want this program to be available and used in all hospital settings."

"I love the practical application of the course, and that it required you to practice and actually listen during the course."

"This was a great program. I loved the interactive IA simulation case studies towards the end. It gave it a more practical knowledge base."

"This training was very helpful and concise! I learned a lot!"

"This training was informative, comprehensive, and easy to complete."

"The program was incredibly user friendly, very informative and useful."

The main purpose of the grant is to expand PQI’s SPEAK UP Implicit and Explicit Bias Training program in Georgia. The SPEAK UP program includes interactive workshops, grounded in quality improvement methods, that outline strategies to help individuals and groups dismantle racism, provide quality equitable care, and reduce perinatal health disparities. The program boasts an impressive 1,200+ Champions – as participants that complete the training are called – nationwide. PQI is excited to add 150 more individuals to the 140 SPEAK UP Champions already in the state of Georgia.

Funding from the grant will support additional SPEAK UP efforts in Georgia, including but not limited to:

• a select number of Georgia SPEAK UP Champions will progress in their equity work by receiving the opportunity to complete the SPEAK UP Ambassador course and the Birth Equity modules
• all Georgia Champions will be encouraged to receive guidance during four SPEAK UP Champion check-in conference calls
• increased recruitment of individuals in Georgia to participate in PQI's 28-Day Anti-Racist Challenge
• a robust evaluation of the SPEAK UP Program in Georgia

“As a Foundation focused on reducing health disparities, we recognize the importance and urgency of increasing access to equitable and high-quality maternal and child health services,” said Foundation President Kristy Klein Davis. She continued, “The Institute for Perinatal Quality Improvement and the March of Dimes are shining a light on these important issues, and we’re excited to see their future accomplishments in this work.”

PQI is honored to support Healthcare Georgia Foundation in this important effort. Read their official statement here.

About Healthcare Georgia Foundation

Healthcare Georgia Foundation is a statewide, charitable organization with a vision of health equity in Georgia where all people attain their fullest potential for health and well-being. Through strategic grantmaking, our mission is to enable, improve, and advance the health and well-being of all Georgians. For more information, visit healthcaregeorgia.org.

The Institute for Perinatal Quality Improvement (PQI) is responding to the Call to Action by publicly announcing three major initiatives in 2022.

PQI’s SPEAK UP Against Racism Faculty Course Launch in 2022. PQI’s SPEAK UP Against Racism Program is a quality improvement approach that supports individuals and teams to improve and eliminate inequities in structures and processes that contribute to disparities in perinatal outcomes. The SPEAK UP Against Racism Action Pathway multi-step train-the-trainer approach requires dedicated commitment and continued anti-racist actions of all perinatal health professionals to ensure equity throughout all levels of the healthcare system. A select number of individuals who meet the program criteria will be chosen to become SPEAK UP Faculty. PQI will launch the Faculty course in 2022.

SPEAK UP 28-Day Anti-Racism National Challenge Launches on February 1, 2022. The daily activities included in the FREE 28-Day Anti-Racism SPEAK UP Challenge are designed to enhance participants’ insights and provide tools to support anti-racism efforts. Each day during the challenge there is a quote meant for reflection (Reflect), a learning activity (Learn), and a recommended action (Act). The Reflect - Learn - Act for each day during weeks 1 and 4 focus on the letters in SPEAK UP acronym. The Reflect - Learn - Act for each day during weeks 2 and 3 focus on the letters in RESPECT acronym. This content is curated specifically for perinatal health professionals. In 2022 the Institute for Perinatal Quality Improvement (PQI) invites everyone interested in eliminating perinatal disparities to register to join the challenge. Register Here: SPEAK UP 28-Day Anti-Racism Challenge

Safely Promote Freedom of Movement in Labor: Freedom of movement has been successfully used as part of comprehensive efforts to eliminate overuse of cesarean births. Overuse of cesarean births is correlated with increases in maternal infections, hemorrhage, blood clots, and other serious complications for the newborn and the person who gave birth. PQI is working to increase laboring people's access to freedom of movement by expanding perinatal health providers' ability to perform intermittent auscultation. Starting 1/1/22 PQI will offer a 20% discount to the first 1,000 learners of the Intermittent Auscultation Simulation-Based online education module. The eligible learners will receive the discount by entering at checkout the promotional code: MaternalHealth2022

To mark the first-ever federal Maternal Health Day of Action, Vice President Kamala Harris is hosting a summit from 10:00 AM - 1:00 PM ET. More information about the Administration's commitments as well as private sector initiatives can be found in the White House Fact Sheet.

Updates (December 12, 2021)

The first Maternal Health Summit was held at the White House Tuesday, December 7th. The event included testimonials and plans for the $3-billion in funding from the Build Back Better Act.

The plan to reduce maternal mortality and morbidity is comprehensive (Fact Sheet here), and an especially exciting area is the proposal for a new maternal hospital designation as “Birthing-Friendly”. Specifically, the proposal states:

• Create a new designation of the quality of maternal health services for our nation’s hospitals: CMS is planning to propose the establishment of a “Birthing-Friendly” hospital designation, which would be the first-ever hospital quality designation by HHS specifically focused on maternity care. This designation is intended to be awarded to those hospitals that participate in a collaborative program aimed at improving maternal outcomes and implementing patient safety practices. CMS would add the designation to their “Care Compare” website to allow consumers to choose hospitals that have implemented best practices.

Use the following links to social media and announcements from Tuesday’s Maternal Health Day of Action:

• Clip from the VP’s remarks at the Summit: Facebook, Twitter, Instagram

• Share this thread from Domestic Policy Advisor, Rohini Kosoglu, who provided coverage from the WH Maternal Health Summit.

You are invited to submit your comments during the public comment period. For information on the measure and instructions for how to submit a comment, please visit:https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/PC-Currently-Accepting-Comments.html. 

Please submit your comments via email at CMSMaternalMeasures@yale.edu by 11:59 PM (EST) on December 18, 2021. Please note that at the end of the public comment period, all comments will be posted on the Centers for Medicare & Medicaid Services (CMS) website.

• HHS Press Release
• New Jersey FamilyCare Comprehensive Demonstration

Dr. Debra Bingham, Executive Director of the Institute for Perinatal Quality Improvement, was a member of the multi-stakeholder Maternal Morbidity and Mortality committee convened by NQF to support the development of these recommendations. The primary purpose of the project was to build a set of recommendations outlining how to enhance maternal morbidity and mortality measurement in the United States in an effort to achieve larger goals of improving health outcomes in maternity care.

This effort was needed because, as outlined by NQF: "Maternal morbidity and mortality are primary indicators of women’s health and the quality of healthcare globally. As of 2018, the U.S. maternal mortality ratio is 17.4 maternal deaths (per 100,000 live births), which is much higher than that of other high-income countries, with more than 700 women dying annually from pregnancy-related causes. Measurement- focused efforts have been gradual in the U.S., starting with the revision of a number of maternal mortality measurement tools. Although not all causes of the rising rates of maternal morbidity and mortality are clear, it is evident that racial disparities are pervasive." NQF further outlines the breath of the work conducted by this committee: "The Committee considered a multifaceted range of influencing factors in its recommendations, including clinical care, health equity, state and federal policies, and social determinants of health. The Committee produced two measurement frameworks, one for morbidity and one for mortality, to identify gaps in maternal morbidity and mortality measurement and guide the development of key measurement recommendations. These recommendations will help to build the foundation for improving maternal health outcomes within the U.S. healthcare delivery system."

TIAC is a joint project among the Texas Perinatal Services, PQI, and Primary Maternity Care to increase the safe use of intermittent auscultation(IA). The pilot project targets hospitals and birth centers in Texas with the goal to serve as a replicable model for statewide and multi-state collaboratives.

Safe and effective implementation of IA requires focused, sustained efforts to overcome barriers and ingrained practices. Some of the recommended steps to overcome IA implementation barriers include high-quality training, standardized communication and documentation, and electronic health record systems configuration. TIAC will focus on these aspects with partnering hospitals and birth centers.

 You can learn more by going to the Texas Perinatal Services website.

Institute for Perinatal Quality Improvement (PQI), among nearly 70 national organizations, signed on in support of the Kaine/Marshall Dear Colleague Letter regarding FY22 appropriations for programs to improve maternal health.

The letter includes the following information:

"In light of the current national crisis our nation faces in maternal health, the letter and its signers are encouraging decision makers to prioritize the highest possible funding level for Fiscal Year 2022.

The below programs that seek to prevent maternal deaths, eliminate inequities in maternal health outcomes, and improve maternal health overall.

Title V Maternal and Child Health (MCH) Services Block Grant – The Title V MCH Services Block Grant administered by the Health Resources and Services Administration (HRSA) is the only federal program of its kind devoted solely to improving the health of all women and children in the United States. This flexible and cost-effective funding source is used by states, territories, and other jurisdictions to address their most critical maternal and child health needs. This includes supporting statewide maternal mortality reviews - the gold standard in maternal mortality surveillance - and implementing strategies to translate recommendations made by maternal mortality review committees to meaningful action. Title V also supports the Alliance for Innovation on Maternal Health program, a data-driven maternal safety and quality improvement initiative, and State Maternal Health Innovation Grants, a demonstration program to implement evidence-based interventions to address critical gaps in maternity care service. 

Healthy Start – HRSA's Healthy Start program provides grants to support community-based strategies to improve perinatal outcomes for women and children in high-risk communities throughout the nation. In particular, the Healthy Start program seeks to reduce disparities in infant and maternal mortality by empowering at-risk women and their families to identify and access maternal and infant health services in their communities. To further support healthy maternal outcomes, since FY 2019, Healthy Start programs across the nation have had health care providers on-site to provide clinical services, such as well-woman care and maternity care services, making the Healthy Start program a critical component of federal efforts to reduce both maternal and infant mortality. 

Safe Motherhood and Infant Health – This portfolio of programs at CDC supports a broad range of activities that seek to improve the health of moms and babies and reduce disparities in maternal and infant health outcomes. This includes implementation of the Preventing Maternal Deaths Act (P.L. 115-344) through the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Program to provide funding, technical assistance, and guidance to state maternal mortality review committees. It also includes support for perinatal quality collaboratives, which are state or multi-state networks of teams working to improve the quality of care for mothers and babies. Among other activities, in 2020 CDC launched the HEAR HER Campaign, a communication campaign to increase awareness of warnings signs that could lead to pregnancy-related death or delivery complications and strengthen patient and provider communication. 

National Institutes of Health – Research is critically important to optimizing the health of women and their families in the United States and identifying the causes behind pregnancy related deaths and complications. The vast majority of research in pregnancy in the U.S. occurs at the National Institutes of Health (NIH). Broadly, 21 of 27 institutes at the NIH support at least one grant or project related to pregnancy-related research, with the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) consistently providing the greatest support of perinatal research in the United States. NICHD's work includes the Maternal-Fetal Medicine Units Network (MFMU), a network of 12 centers across the country that conduct clinical studies to improve maternal, fetal, and neonatal health. NICHD is also working to advance safe and effective therapies for pregnant and lactating women as recommended in 2019 by the federal Task Force on Research Specific to Pregnant Women and Lactating Women (authorized under P.L. 114-255). Strengthened, prioritized support for maternal health research at the NIH is crucial to fully understanding the health inequities and disparities in outcomes that the U.S. is facing.

More women die from pregnancy-related complications in the United States than in any other developed country, and the rate of maternal deaths continues to rise. According to the Centers for Disease Control and Prevention (CDC), approximately 700 pregnancy-related deaths occur in the U.S. each year and 60 percent of these deaths are preventable. Major disparities in maternal mortality exist, with Black women three to four times more likely than non-Hispanic White women to die due to pregnancy-related complications and Indigenous women more than twice as likely than non-Hispanic White women to die due to pregnancy-related complications.

Moreover, for every maternal death that occurs, more than 70 other women suffer severe complications of pregnancy or childbirth."

Current Senate co-signers include: Sens. Bennet, Cantwell, Carper, Duckworth, Feinstein, Hassan, Kaine, Klobuchar, Marshall, Menendez, Merkley, Murphy, Peters, Smith, Van Hollen, Warner, Warnock, Warren, and Wyden.

Providing strong and sustained funding for programs is critical to addressing our nation's maternal health crisis and PQI is proud to sign on to influence decisions on funding this very important and critical work that seeks to prevent maternal deaths, eliminate inequities in maternal health outcomes, and improve maternal health overall.

Learn more about this innovative project at https://www.hhs.gov/about/agencies/iea/initiatives/index.html

"I applaud LeapFrog and the leaders from 2,200 hospitals who are committed to transparency in reporting maternity care data," said Dr. Debra Bingham, Founder and Executive Director of PQI and a member of LeapFrog's Maternity Care Expert Panel. The report indicates that there needs to be much more work done to eliminate overuse of NTSV cesarean birth rates. Performing unnecessary surgery is harmful to both mothers and newborns."

The report showed progress in all three measures.

• NTSV C-Section rates, remains too high, though there was some progress in reducing these rates with 51% of hospitals achieving Leapfrog's NTSV's C-section standard of 23.9% or less compared to 42% the previous year.
• Early elective delivery rates has decreased to 1.6% from 17% in 2010. 
• Average episiotomy rates among reporting hospitals has decreased to 5.2%. Just five years ago, the rate was over 10%.

The full report, "Healthy Moms, Healthy Babies: Hospital Performance on Maternity Care Standards Based on Results of the 2020 Leapfrog Hospital Survey", can be found here. 

Download full report here

Access the Survey Results here