The rate of women dying from childbirth in the U.S. is rising steadily and is now up to more than 600 women annually. Many factors contribute to maternal deaths, but postpartum hemorrhaging is one of the leading culprits.
For hospitals, preventing and treating postpartum hemorrhaging is tricky but not impossible. The right protocols and training can dramatically improve outcomes, as changes at Morristown (N.J.) Medical Center in recent years have shown.
As a destination for high-risk pregnancies, the hospital was already prepared to deal with postpartum hemorrhaging, said Donna Poplawski, a certified registered nurse who manages its maternity center.
Then, Morristown joined the Association of Women's Health, Obstetric and Neonatal Nurses' Postpartum Hemorrhaging Project, which began in 2014, and its processes and outcomes for treating postpartum hemorrhaging improved even more.
“We're quicker to respond,” Poplawski said. “We're much better about monitoring hemorrhaging.” Time is of the essence; medical literature indicates that quick detection and more rapid treatment saves lives.
Even before AWHONN's project kicked in, Morristown had massive transfusion and fourth-stage of labor policies in place. It had a postpartum hemorrhaging protocol, and clinicians and staff also practiced in monthly drills on a talking, bleeding mannequin named Noelle. That way, in real life, if a mother started hemorrhaging, everyone knew which IVs to get out and which medicines to use, Poplawski said.
Under AWHONN's project, Morristown beefed up its response and adopted several new strategies.
One of the biggest changes in protocol was quantifying blood loss. Postpartum hemorrhaging is defined as when a woman loses at least a half liter of blood after giving birth vaginally or a full liter after giving birth through cesarean section.
But diagnosing postpartum hemorrhage is often subjective and “based on inaccurate estimates of blood loss,” the federal Agency for Healthcare Quality and Research has noted.