Grant Abstract: Stanford PRIHSM: PReventing Inequities in Hemorrhage-related Severe Maternal Morbid

Grant Number: 5U54HD113142-04
PI Name: El-Sayed
Project Title: Stanford PRIHSM: PReventing Inequities in Hemorrhage-related Severe Maternal Morbid

Abstract: Alabama has become “ground zero” for some of the highest rates of poor maternal and infant outcomes in the nation. Maternity care deserts (MCDs) in Alabama, defined as “no hospitals providing obstetric care, no birth centers, no OB/GYNs, and no certified nurse midwives” are increasing due to hospital closures, a lack of health insurance coverage, and perinatal healthcare workforce shortages. Over the past 30 years, Alabama counties have witnessed a significant loss of hospital facilities resulting in ~70% of counties being MCDs or having inadequate maternity care access and quality, many of which are underserved and/or rural. In the last three years alone, five labor and delivery units have closed their doors. Across a state made up of 67 counties, there are only 42 facilities with obstetric services. Further, Alabama has the third lowest number of obstetric clinicians per 10,000 births, and has also seen a significant reduction in the EMS and first responder workforce. There is a compelling need for innovative solutions to address these limited resources, which can be developed through the partnership of academic medical centers dedicated to improving maternal health. As such Stanford PRIHSM, one of 12 Maternal Health Research Centers of Excellence (PRIHSM), proposes to partner with the University of Alabama at Birmingham (UAB) on two key initiatives to address barriers to optimal care of pregnant women in the Southern U.S. The first challenge is adapting large scale efforts to increase anemia screening and treatment originally designed for large healthcare systems, into smaller, lower resourced clinics. With support from this Administrative Supplement, we propose to adapt and implement our anemia prevention Toolkit, which we have successfully piloted in California, to meet the needs of underserved areas in Alabama, including rural prenatal clinics and Federally Qualified Health Centers. Implementing this project in two states with differing maternal health systems and challenges will help us to identify both universal strategies, as well as geographic or site-specific approaches related to anemia prevention, ensuring generalizability to all environments. The second challenge we will address is the increasing number of labor and delivery unit closures and MDCs in Alabama. Our goal is to augment UAB’s efforts to equip hospitals that do not see a large volume of obstetric deliveries to safely care for patients experiencing unexpected obstetric emergencies, such as postpartum hemorrhage or preeclampsia. We will work with UAB colleagues to develop an enhanced curriculum that provides a combination of virtual and in-person simulation-based training to two sites in Alabama. Given Stanford and UAB’s long-standing collaborative history, as well as a mutual desire to share best maternal health practices between our institutions, we are well positioned to expand the geographic reach of PRIHSM’s efforts to combat postpartum hemorrhage and hemorrhage related maternal morbidity and mortality to pregnant women in areas of high need.

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