Adventist HealthCare Shady Grove Medical Center is working to improve health outcomes for women during their pregnancies and after they give birth. Over the summer, it became the first hospital in Montgomery County to earn the Maryland Patient Safety Center’s B.I.R.T.H. Equity Maryland designation. B.I.R.T.H. stands for Breaking Inequality Reimagining Transformative Healthcare.
Purpose of Training
Since February of last year, more than one hundred emergency room doctors, nurses, and physician assistants at Shady Grove Medical Center in Rockville and the Germantown Emergency Center in Germantown have undergone specialized training. The goal of the yearlong program is to help educate non-obstetrics/gynecologists in recognizing the early warning signs of pregnancy complications both during and after women give birth. Another major component of the program is to train emergency room personnel to recognize and mitigate bias in their treatment.
“As an Emergency Room nurse, I do not look at a patient the same way as a Labor and Delivery nurse. Higher blood pressures are very common in the ER, but they are the first warning sign of problems for a postpartum mother,” said Stacey Quinlan, the nurse manager for the Germantown Emergency Center.
Troubling Signs For Pregnant Women
She said pregnant women experiencing symptoms of dizziness, blurry vision, and headaches should raise red flags for doctors and nurses. A woman could be experiencing a condition known as preeclampsia both during their pregnancy or after they give birth. Preeclampsia left untreated could lead to seizures and even death.
“If we are not asking the right questions, we may treat somebody as this is just another migraine or sinus pressure. So we need to be more mindful to make sure in the emergency room we are asking the right questions such as have you recently delivered a baby? Even if a woman has miscarried, those are important details to know,” Quinlan said.
“So it is about educating people on those early warning signs. It’s also about educating people about their biases. Are we treating somebody differently? Are we not looking at something that we should be especially with our African American population,” Quinlan added.
Possible Complications
Pregnancy-related issues rank fifth among teens and women as the reason why they visit the Emergency Department. Post-partum complications in the first six weeks after delivery affect up to 12% of all births. The most common complaints are fever, stomach pain, headache, vaginal bleeding, wound concerns, and high blood pressure.
While most pregnancies end without a problem, the Centers for Disease Control and Prevention (CDC) reported 817 women across the country died of maternal causes in 2022.
There are no current figures for Maryland. However, the state’s maternal mortality rate was 10% below the national level between 2016 and 2020.
The CDC says 80% of pregnancy related deaths are preventable. Racial disparities exist among women who experience problems during pregnancy and after they deliver. Statistics show black women are two times more likely than white women to have severe complications of pregnancy and are three to four times more likely to die from pregnancy related issues.
Benefits of B.I.R.T.H. Program
Quinlan said the B.I.R.T.H. program trains emergency room personnel to look at each patient individually and focus on her needs. Some patients are fearful when they come into the emergency room and do not trust doctors. She said it is important for medical staff to make their patients feel comfortable.
“One of the greatest things this program has done in my eyes, it has connected the Emergency Services line and the Maternal Child Health line. They are now communicating and working together,” Quinlan said.
“We can get patients to the right place as soon as possible. You do not want a postpartum mother having symptoms sitting in the Emergency Room sitting next to a Covid-19 patient or an RSV patient. We want to get her to an OB doctor. So this program has helped open up doors. The two service lines are now working together for the best of the patient,” Quinlan explained.
Reducing Maternal Morbidity
While Shady Grove is the only medical center in Montgomery County with this training, Quinlan hopes other hospitals will get involved and take advantage of the B.I.R.T.H. Equity Maryland program.
The State Legislature established the Maryland Patient Safety Center in 2003. The Maryland Healthcare Commission reauthorized the Patient Safety Center through April of next year. One of the group’s goals is to reduce the rate of maternal morbidity across the state by 20% by 2026. The Patient Safety Center hopes its B.I.R.T.H. program will play a part in that effort.
