The Louisiana Department of Health is reporting additional progress in reducing severe maternal morbidity among birthing persons who experience hemorrhage and severe hypertension in facilities that are part of the Louisiana Perinatal Quality Collaborative (LaPQC). The LaPQC’s final report on Reducing Maternal Morbidity, issued today, shows that severe maternal morbidity among hemorrhage was reduced by nearly 35% and severe maternal morbidity among hypertension was reduced by almost 12%.
The Reducing Maternal Morbidity Initiative was designed to reduce the occurrence of two recognized contributors to maternal morbidity and mortality: preventable hypertension and/or hemorrhage, while also reducing disparities in outcomes.
This data shows that Louisiana has made significant progress toward ensuring safe, equitable and dignified births for all birthing persons in Louisiana. The final report covers work that began in 2018 with the launch of the Louisiana Department of Health’s Louisiana Perinatal Quality Collaborative, which is authorized under the Louisiana Commission on Perinatal Care and Prevention of Infant Mortality. The LaPQC has been working with 42 birthing facilities, including hospitals, using quality improvement science to create sustainable change that improves maternal outcomes.
The report shows that the goal of a 20% reduction in severe maternal morbidity among hemorrhage was surpassed, with an actual reduction of almost 35%. However, though severe maternal morbidity among hypertension was also reduced by almost 12%, the goal of a 20% reduction was not reached. The differences between outcomes in severe maternal morbidity among hemorrhage and hypertension may be due to Louisiana’s longer history of engaging quality improvement work to reduce outcomes related to hemorrhage. Improvement work related to hypertension began over two years after work related to hemorrhage, so processes that reduce severe maternal morbidity among hemorrhage are more engrained in birthing facilities.
“What is evident through the Reducing Maternal Morbidity Initiative is that intentional, consistent and sustained improvement in processes have led to better recognition and response to hemorrhage and hypertension,” said Dr. Veronica Gillispie-Bell, the medical director of the LaPQC. “This progress is encouraging, especially given the challenges of the pandemic, though we clearly have more work to do in reducing racial disparities. We appreciate the hard work and continued commitment of our hospitals to making Louisiana a safer, healthier place for all birthing persons.”
Black-white disparity remains
Additionally, the report shows that there were overall decreases in disparity for severe maternal morbidity related to both hemorrhage and to hypertension. However, severe maternal morbidity Black-white disparity still exists. While non-Hispanic Black birthing persons are still more likely to experience severe maternal morbidity among hemorrhage, this measure decreased among non-Hispanic Black birthing persons by almost 50% in comparison to a 16% decrease among non-Hispanic white birthing persons.
And while there was an improvement in reducing severe maternal morbidity related to hypertension among non-Hispanic white birthing persons, there was a slight increase (approximately 8%) for non-Hispanic Black birthing persons.
“We have much more work ahead of us to make health disparities a thing of the past, but these results are encouraging,” Gillispie-Bell said.
Louisiana has become a model in the country for working to improve maternal outcomes, linking public health data to drive very specific transformational change. Since August 2018, the LaPQC has grown to 42 birthing facilities, meaning that 9 out of every 10 births in Louisiana occurred in a LaPQC participating facility by the end of the Reducing Maternal Morbidity Initiatives.
Structured, continuous quality improvement work in birthing facilities is an important and necessary component to assure that Louisiana birthing persons experience safe, equitable and dignified birth. Programs like the LaPQC are successful in supporting these changes. The work continues, and in January 2021, the LaPQC launched the Safe Births Initiative that continues improvement work related to hemorrhage and hypertension, while also serving as a vehicle for a new focus on reducing Louisiana’s low-risk first-time Cesarean delivery rate.
For more information about the LaPQC, visit https://partnersforfamilyhealth.org/lapqc.