New standards sought for birthing hospitals

Proposal aims to prevent lapses in maternity care

Proposed requirements come in wake of ongoing USA TODAY investigation

Maternity hospitals across the country would be required to do more to prevent deadly deliveries under standards proposed this week by the nation’s largest hospital accreditation group.

If adopted, about 2,700 birthing hospitals would be required by the Joint Commission to take specific actions related to severe bleeding and dangerously high blood pressure. For years, these measures have been recommended to protect mothers – but too often they are ignored, helping drive the USA’s status as the most dangerous place to give birth among developed nations.

Hospitals that failed to follow the requirements could lose their Joint Commission accreditation.

“Having a stick, if you will, having benchmark requirements for their accreditation will really drive hospitals with limited resources to put these in place,” said Barbara Levy, vice president for health policy at the American College of Obstetricians and Gynecologists.

The proposed accreditation requirements come in the wake of an ongoing USA TODAY investigation of the role that substandard hospital care plays in preventable deaths and injuries – and the lack of national requirements for maternity units to follow established safety practices and publicly report their childbirth complication rates.

“It’s a tribute to you, a tribute to the media and you in particular,” said Levy of USA TODAY’s Deadly Deliveries investigation.

Every year in the USA, about 700 women die and 50,000 suffer severe injuries related to childbirth. The problem is particularly acute among black mothers, who die at three to four times the rate of white mothers. Reviews found that about half of the mothers who died could have been saved with better care.

Hemorrhage and severe hypertension are two of the leading preventable causes of maternal deaths and injuries. Women bleed to death or need hysterectomies to save their lives when doctors and nurses fail to recognize that normal bleeding has become life-threatening. They suffer strokes because of delays in receiving pressure-lowering drugs.

David Baker, the Joint Commission’s executive vice president for health care quality evaluation, said adding the requirements could make a difference in addressing these two childbirth complications that are responsible for about 40% of mothers’ deaths.

“This is really a national problem as you have shown in your work,” Baker said. “Based on our analyses, we thought there were things that every hospital in the United States could do to try to decrease women’s risk from having death from either maternal hemorrhage or severe blood pressure.”

Wednesday, the Joint Commission – which voluntarily accredits about 70% of the nation’s hospitals – began taking public comments on the proposed requirements.

Baker said he expects a final decision to be made shortly after the comment period closes May 29. If adopted, the requirements would take effect within six to 12 months, he said.

The standards would require hospitals to assess mothers for hemorrhage risks, have procedures that identify when bleeding becomes dangerous and ensure it is treated appropriately with medications that are immediately available on the obstetric unit.

Hospitals would have to develop procedures to accurately measure blood pressure and set criteria to identify and treat patients whose pressures cross into the danger zone. Hospital staff would have to conduct drills for responding to hemorrhage and blood pressure emergencies at least annually.

Emergency department staff – not just maternity staff – would need to be trained on how to treat pregnant and recently delivered moms with dangerously high blood pressure.

“Historically, the weakest link has been the emergency departments,” said Eleni Tsigas, chief executive officer of the Preeclampsia Foundation, which provides resources for mothers with severe hypertension disorders. “That alone could be huge,” she said.