Maternal Mortality Review Committee Makes Recommendations for Saving Lives
NASHVILLE – The Tennessee Department of Health has issued the first Maternal Mortality Review report, Tennessee Maternal Mortality Review of 2017 Maternal Deaths. This report describes the state of maternal mortality in Tennessee based on a comprehensive review of deaths of women who died while pregnant or within one year of pregnancy. The goal of this effort by the Tennessee Maternal Mortality Review Committee is to identify opportunities for preventing maternal deaths and promoting women’s health. The MMR committee determined 85 percent of all maternal deaths reviewed to be preventable.
“We dedicate this report with deepest sympathy and respect to the memory of these women who died while pregnant or within a year of their pregnancies,” said TDH Commissioner Lisa Piercey, MD, MBA, FAAP. “We are grateful to the committee members who contributed to this report by reviewing information about these deaths and developing recommendations that can save lives.”
The Tennessee Maternal Mortality Review of 2017 Maternal Deaths report is available online at http://www.tn.gov/content/dam/tn/health/documents/mch/MMR_Annual_Report_2017.pdf.
Substance Use, Mental Health and Violence Factors in Maternal Deaths
In 2017, 78 women in Tennessee died while pregnant or within one year of pregnancy. Substance use disorders and mental health conditions were often a contributing factor in these deaths. Substance use contributed to 33 percent of all pregnancy-associated deaths in 2017 and mental health conditions contributed to 18 percent of these deaths. The MMR Committee recommended increasing access to mental health and substance abuse treatment both during and for the year following pregnancy.
“These numbers are a troubling indication of the reality that our state is facing in the areas of substance abuse and mental health,” said Tennessee Department of Mental Health and Substance Abuse Services Commissioner Marie Williams. “Our department has assertively worked to increase the treatment services that are available to women who have no means to pay. With state funding and federal grants, we have worked proactively to expand access so that more women with substance use disorder and mental illness get the treatment they need and live lives of recovery.”
Violence was also noted as a significant contributing factor to maternal deaths.
“Of all deaths reviewed, 14 percent of Tennessee’s maternal deaths in 2017 were the result of homicide, highlighting the need to address critical issues of maternal mortality including intimate partner violence,” said TDH Assistant Commissioner for Family Health and Wellness Morgan McDonald, MD, FAAP, FACP, co-chair of the MMR Committee. “Health systems and the public should be aware of the increased risk of violence and the availability of resources for women during the pregnancy and post-partum time periods.”
Defining Maternal Deaths
The Maternal Mortality Review Committee determines whether a woman’s death is pregnancy-related. A death is considered pregnancy-related if it occurred during pregnancy or within one year of the end of pregnancy due to a pregnancy complication, a chain of events initiated by pregnancy or the aggravation of a condition by the effects of pregnancy. More than one-quarter (28 percent) of maternal deaths were determined to be pregnancy-related. The top causes of pregnancy-related deaths in Tennessee in 2017 included embolism, cardiovascular and coronary conditions and hemorrhage.
Sixty-three percent of Tennessee’s maternal deaths in 2017 were determined to be pregnancy-associated, but not related. A death is considered pregnancy-associated but not related if the pregnancy did not make a difference in the outcome. The top three causes of pregnancy associated, but not related deaths were overdose, motor vehicle accidents and violence.
Most Maternal Deaths are Preventable
A death is considered preventable if there was at least some chance of the death being averted by one or more reasonable changes to patient, community, provider, facility and/or systems factors.
“The high percentage of maternal deaths considered preventable underscores the importance of identifying these deaths and seeking prevention opportunities,” said Maternal Mortality Nurse Coordinator Bethany Scalise, RN.
The MMR Committee made recommendations for prevention for those deaths considered to be preventable. Recommendations include multi-disciplinary teams and coordination of care; establishment of protocols and standards of care; education; resources; public awareness and understanding of risk factors for patients and providers. The Department of Health is developing a maternity collaborative to assist with implementing these recommendations.
The Tennessee Maternal Mortality Review Program was established in 2017 as a multidisciplinary committee to review pregnancy-associated deaths and determine how they can be prevented. The Maternal Mortality Review Committee includes representation from the fields of public health, obstetrics-gynecology, maternal and fetal medicine, anesthesiology, neonatology, pediatrics, nurse-midwifery, nursing, medical examiner, mental and behavioral health, domestic violence, hospital patient safety and the Tennessee Senate and House of Representatives.
The mission of the Tennessee Department of Health is to protect, promote and improve the health and prosperity of people in Tennessee. Learn more about TDH services and programs at http://www.tn.gov/health.