Nurses lack knowledge of postpartum health risks

US maternal mortality highest among industrialized nations

By Trévon Austin
25 August 2017

An estimated 700 to 900 women die in the US every year from pregnancy- and childbirth-related causes, the highest rate among industrialized nations. Another 65,000 nearly die, according to the Centers for Disease Control and Prevention (CDC).

A study released last week published in MCN: The American Journal of Maternal/Child Nursing indicates that postpartum nurses are not being properly educated on the dangers mothers face after giving birth. Lacking sufficient education, the nurses are unable to play the critical role in identifying potential warning signs of postpartum complications and taking precautionary measures.

A recent CDC Foundation analysis of data from four states found that close to 60 percent of maternal deaths were preventable. By failing to properly alert mothers to postpartum risks, nurses may be missing an opportunity to reduce the abysmal maternal mortality rate.

MCN researchers surveyed 372 postpartum nurses around the United States. According to the study, only 15 percent of respondents were aware of the current maternal mortality rate and 12 percent accurately reported the correct percentage of deaths occurring during the postpartum period. Eighty-eight percent of nurses could not identify the three leading causes of maternal mortality: postpartum bleeding (15 percent), complications from unsafe abortion (15 percent), and hypertensive disorders of pregnancy (10 percent).

On the day that mothers were discharged, 67 percent of respondents reported spending less than 10 minutes focusing on potential warning signs, such as painful swelling, headaches, heavy bleeding and breathing problems that could indicate potentially life-threatening complications. Furthermore, 19 percent of nurses believed maternal mortality was declining. “If [nurses] aren’t aware that there’s been a rise in maternal mortality, then it makes it less urgent to explain to women what the warning signs are,” says study co-author Debra Bingham, who heads the Institute for Perinatal Quality Improvement and teaches at the University of Maryland School of Nursing.

The importance of postpartum education is stressed by both experts and the nurses surveyed. The data reported that 95 percent of RNs reported a correlation between postpartum education and mortality. However, only 72 percent strongly agreed it was their responsibility to provide this education. Nurse respondents who were over the age of 40 were significantly more likely to report feeling very competent when providing education on all the postpartum complication variables measured, indicating a decline in the quality of education for nurses.

This post-delivery education is particularly important because a mother typically doesn’t see a doctor for four to six weeks after she leaves the hospital. A statement from the American College of Obstetricians and Gynecologists says that up to 40 percent of new mothers, overwhelmed with caring for an infant and often lacking in maternity leave, child care, transportation and other kinds of support, never go back for their follow-up appointments.

This revelation is obviously correlated with the decline in access to adequate health care for all Americans. Approximately 11.3 percent of adults in the US are without any form of health care. Throughout the United States, researchers have pointed to heart problems and other chronic medical conditions such as diabetes, to explain the rise in pregnancy-related deaths. The rise in these conditions coincides with a decline in the quality of health care and its accessibility, especially among low-income families.

This trend is reflected in Texas, the state with the highest maternal mortality rate and the highest uninsured rate in the United States. In the previous legislative session, Texas lawmakers rejected a federally-funded expansion of Medicaid that would have covered 1.1 million more Texans. More than half of all births in Texas are covered by Medicaid, indicating the irresponsible and disastrous nature of lawmakers’ decision to defund Medicaid, but increase funds for border patrol.

Actions of the Trump administration and Congress will only exacerbate this situation. The Wall Street Journal reported this week that the president is preparing to roll back an Obamacare rule requiring all employers to provide insurance coverage of all contraceptive methods without co-pays.

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