AIM | Alliance For Innovation On Maternal Health

Shanayl Bennett (Reed)

Shanayl Bennett is a dedicated community health worker and birth doula with a passion for empowering families through education and support. With a background in Community Health Work, Family Planning, Fertility Advocacy, Pregnancy and Infant Loss Awareness, and Lactation Counseling works to bridge the gap between the health system and the communities they serve. Shanayl’s current work includes being a part of the PCAB ( Patient Community Advisory Board) for OBI and is currently the Director of Community Engagement at The Michigan Chamber for Reproductive Justice. She believes in the importance of informed choices and advocates for holistic approaches to health through the State of Birth Justice Coalition were the MI Momnibus package has been created. In her free time, she enjoys dancing and reading . Shanayl is always seeking to learn and grow in the field and is hoping to become a change agent in the maternal health space.

Susan Kendig

Susan Kendig is a Women’s Health Integration Specialist with SSM Health – Maternal Services, St. Louis, Missouri and serves as Director of Policy, National Association of Nurse Practitioners in Women’s Health. Prior to joining SSM Health she was a teaching professor at the University of Missouri-St. Louis, where she led the Women’s Health Nurse Practitioner program for almost two decades. Sue has held appointments to CMS Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) and served on the National Quality Forum Measures Application Partnership (NQF MAP) Medicaid Adult Workgroup and NQF’s Social Determinants of Health Data Integration Workgroup. Statewide she held appointments to the Missouri Commission on Patient Safety, and the Missouri Task Force on Prematurity and Infant Mortality and is the current Missouri Women’s Health Council Vice Chairperson. She served on the national Council on Patient Safety in Women’s Health Care for seven years and is an active member of the Alliance for Innovation in Maternal Health (AIM) national partners group and Executive Committee. Sue is a member of the Women’s Preventive Services Advisory Panel, which guides a HRSA funded collaborative interdisciplinary effort to develop, review, update and disseminate recommendations for women’s preventive health care services.

New York

In New York, the rate of opioid overdose deaths for women aged 18 -44 tripled between 2010 and 2016. In response, the New York State Perinatal Quality Collaborative (NYSPQC) implemented the AIM Obstetric Care for Women with Opioid Use Disorder Patient Safety Bundle through the NYS Opioid Use Disorder in Pregnancy & Neonatal Abstinence Syndrome Project. The NYSPQC provides participating birthing facilities with education, data collection and analysis, and other clinical and quality improvement support. The project began as a pilot in September 2018 with 15 birthing hospitals participating and expanded in December 2020. As of the project close in June 2023, 41 of the state’s 119 birthing facilities were participating. The percentage of birthing facilities that had a unit standard policy to screen every person giving birth for substance use disorder increased from 20% in January 2019 to 93% in May 2023 among the 15 hospitals participating in the pilot phase and from 40% in December 2020 to 96% to in May 2023 among the 26 hospitals participating in the expansion phase. Additionally, the percentage of pregnant and postpartum people with opioid use disorder with existing referral or linkage to medication-assisted treatment or behavioral health treatment on admission increased from 73% to 91% among pilot phase hospitals and from 64% to 1 00% among expansion phase hospitals, between December 2020 and May 2023.

Hawaii

In June 2021, in response to high rates of severe maternal morbidity (SMM) due to hemorrhage, the Hawaii Perinatal Collaborative, in partnership with the Healthcare Association of Hawaii (HAH), began implementation of the AIM Obstetric Hemorrhage Patient Safety Bundle in 10 of the state’s 12 birthing facilities. Between April 2021 and June 2022, the proportion of patients who had their blood loss measured from birth through the recovery period using quantitative and cumulative techniques increased from 49.0% to 67.0%. Among participating birthing facilities, the rate of SMM among people who experienced an obstetric hemorrhage, excluding those who received blood transfusions alone, decreased from 9.0% in 2019 to 7.1% in 2021, a reduction of 21.1%. HAH continues to assist facilities with quarterly reporting of data, learning opportunities, and quality improvement support.

Washington

The Washington State Maternal Mortality Review Panel findings for 2014 through 2016 showed that over a third of pregnancy-related deaths were due to mental health conditions, including suicide and overdose. In April 2022, the Washington State Hospital Association (WSHA), in partnership with the Department of Health, began implementation of the AIM Opioid Use Disorder Patient Safety Bundle with 47 of the state’s 56 birthing facilities. From April to December of 2022, the percentage of facilities that had a unit standard policy and procedure to universally screen every person giving birth for substance use disorder using a validated verbal screening tool increased from 30% to 50%. WSHA and the Department of Health continue to support participating hospitals by focusing efforts on capturing current data to further evaluate progress within this initiative.

Utah

In Utah, substance use disorder contributed to 35% of maternal deaths between 2015 and 2016. In March 2020, the Utah Women and Newborns Quality Collaborative (UWNQC) began implementing the AIM Opioid Use Disorder (now Substance Use Disorder) Patient Safety Bundle. At the kick-off training, 25 of 46 birthing facilities in Utah and six birthing facilities in Wyoming participated. From March 2020 to October 2022, the percentage of pregnant and postpartum people who were screened for substance use conditions using a validated verbal screening tool in participating hospitals increased from 46% to 87%. UWNQC continues to work with participating hospitals on patient safety bundle implementation strategies.

Louisiana

In 2017, Louisiana’s Pregnancy-Associated Mortality Review Report identified substance use as one of the leading causes of pregnancy-associated deaths among pregnant and postpartum people. In September 2021, the Louisiana Perinatal Quality Collaborative (LaPQC) began implementation of the AIM Obstetric Care for Women with Opioid Use Disorder Patient Safety Bundle among 11 of the state’s 47 birthing facilities. Between January and December 2022, universal screening increased from 70% to 72%; referral to treatment for those who screened positive increased from 36% to 48%; and referral to medication for opioid use disorder (MOUD) increased from 29% to 34%. The LaPQC continues to work with participating facilities to provide evidence-informed, respectful care to pregnant and postpartum patients with substance use conditions and their families.

Illinois

In ILPQC participating hospitals, the rate of nulliparous, term, singleton, vertex (NTSV) cesarean births was 25% in 2019, higher than the Healthy People 2030 target of 23.6%. In December 2020, ILPQC began implementation of the AIM Safe Reduction of Primary Cesarean Birth Patient Safety Bundle with 94 of the state’s 102 birthing facilities. Between December 2020 and December 2023, the collaborative’s NTSV cesarean birth rate declined from 24.9% to 22.8%. In December of 2023, due to hospital closures and other factors precluding ongoing participation, there were 74 teams actively participating in the bundle. ILPQC plans to continue implementation of the bundle through 2024 to support facility teams who have not yet achieved initiative goals in reducing their NTSV cesarean birth rates and associated racial and ethnic disparities and maintaining systems and cultural changes to promote safe vaginal births through a small group coaching model.

Rhode Island

In Rhode Island, hemorrhage is a key contributor to maternal morbidity. In July 2020, the Hospital Association of Rhode Island and the National Perinatal Information Center began implementation of the AIM Obstetric Hemorrhage Patient Safety Bundle with four of the five birthing facilities in the state. Between July 2020 and January 2022, the percentage of obstetric physicians and midwives receiving obstetric hemorrhage education increased from 5% to 50%, and the percentage of obstetric nurses receiving the same education increased from 10% to 90%. Rhode Island continues to support participating birthing facilities by providing virtual monthly collaborative meetings, focused hospital coaching calls, and sharing of best practices.

Montana

Obstetric hemorrhage is a leading cause of severe maternal morbidity in Montana. To strengthen capacity of birthing facility teams to respond to obstetric hemorrhages using evidence-informed practices, the Montana Perinatal Quality Collaborative (MPQC) began implementation of the AIM Obstetric Hemorrhage Patient Safety Bundle in October 2021 with 17 of the state’s 26 birthing facilities. Between July 2021 and September 2022, the percentage of birthing facilities conducting hemorrhage risk assessments increased from 59.0% to 87.2%. During the same period, the percentage of participating birthing facilities who had policies and procedures in place to measure blood loss during the birth admission using quantitative and cumulative techniques increased from 23.5% to 68.9%. The MPQC continues to support hospitals in their quality improvement work and will assess and monitor rates of severe maternal morbidity as data are available.

Massachusetts

Maternal deaths due to obstetric hemorrhage are largely preventable in the U.S., including Massachusetts. Alarmingly, Black pregnant and postpartum people who experience obstetric hemorrhage have disparate rates of severe maternal morbidity (SMM). The Perinatal-Neonatal Quality Improvement Network of Massachusetts (PNQIN) began implementation of the AIM Obstetric Hemorrhage Patient Safety Bundle in June 2021 with 21 of the state’s 40 birthing facilities. Between April 2021 and June 2022, the percentage of patients who had their blood loss measured from birth through the recovery period using quantitative and cumulative techniques increased by 33%, from 60% to 80%. During the same time, MA observed a decrease of 8.1% in SMM excluding blood transfusions among birthing people with an obstetric hemorrhage, from 6.2% to 5.7%. SMM decreased for all racial groups with the greatest decrease observed among Black patients. PNQIN continues to collect process and structure measures data for the patient safety bundle, focusing on collecting data disaggregated by race and ethnicity to assess inequities in care and disparities in outcomes.

Indiana

The Indiana Department of Health (IDOH), in collaboration with the state’s Maternal Mortality Review Committee, the Indiana Hospital Association, and the Indiana Perinatal Quality Improvement Collaborative, began implementation of the AIM Obstetric Hemorrhage Patient Safety Bundle in December 2019 with 80 of the state’s birthing facilities. Between July 2022 and June of 2023, the percentage of people who had their blood loss measured through quantitative and cumulative techniques remained high and increased from 86.5% to 89.0%. During the same time, the percentage of patients who received a hemorrhage risk assessment for the duration of their birth hospitalization also remained high and increased from 88.6% to 90.2%. As of April 2024, 99% of the state’s birthing facilities participate in bundle implementation. IDOH continues to support bundle implementation at participating facilities with obstetric services and works to continuously recruit new facilities to engage in implementing the AIM Obstetric Hemorrhage Patient Safety Bundle.

West Virginia

In 2020, the West Virginia Perinatal Partnership began implementation of the AIM Severe Hypertension in Pregnancy Patient Safety Bundle. Between October 2022 and September 2023, the percentage of patients who experienced persistent severe hypertension during their birth admission and had a postpartum blood pressure and symptoms check scheduled before their hospital discharge increased from 17.5% to 36.7%. Additionally, the proportion of nurses who received education on respectful, equitable, and supportive care increased from 67.2% in October 2022 to 79.2% in September 2023. The WV Perinatal Partnership continues to coordinate the implementation of the patient safety bundle, with additional focus on identifying potential disparities through improved data collection and analysis of race, ethnicity, and socioeconomic status, and improving clinician education on respectful, non – judgmental care.

New Jersey

Between 2014 and 2016, hypertensive disorders in pregnancy were among the leading causes of severe maternal morbidity and mortality in New Jersey. In January 2017, the New Jersey Perinatal Quality Collaborative (NJPQC) began implementing AIM’s Severe Hypertension in Pregnancy Patient Safety Bundle in 39 of the 48 birthing facilities in New Jersey. Between 2018 and 2019, the first two years data were collected, the proportion of providers who received education on severe hypertension and preeclampsia increased from 46.8% to 64.3%. Between 2016 and 2022, the statewide rate of severe maternal morbidity excluding blood transfusions among people with preeclampsia, eclampsia, and HELLP syndrome declined from 8.5% to 6.0%, a reduction of 29.4%. The NJPQC continues to work with their birthing facilities to fully implement the AIM Severe Hypertension in Pregnancy Patient Safety Bundle through expanded education and other technical assistance opportunities.

Ohio

In Ohio, preeclampsia and eclampsia were found to be the leading causes of pregnancy-related death between 2008 and 2016, with 85% of those deaths determined by review to have been preventable. In 2020, Ohio began implementation of the AIM Severe Hypertension in Pregnancy Patient Safety Bundle in 30 of the state’s 91 birthing facilities. Between October 2020 and September 2021, the percentage of pregnant and postpartum people with persistent severe hypertension who were treated within one hour increased from 56.8% to 71.4%, an increase of 25.7%, with no statistically significant differences observed across racial and ethnic groups. As of April 2024, Ohio has reached 81 of its 91 birthing facilities through the AIM Severe Hypertension in Pregnancy bundle. The Ohio Hospital Association and Ohio Department of Health continue to work with birthing facilities to expand the bundle to all hospitals in the state and sustain improvements among those already participating in patient safety bundle implementation.

Nebraska

In July 2019, the Nebraska Perinatal Quality Improvement Collaborative (NPQIC) began implementing the AIM Severe Hypertension in Pregnancy Patient Safety Bundle in 28 of the state’s 52 birthing facilities. Between July 2019 and June 2022, the proportion of obstetric physicians and midwives who completed education on severe hypertension and preeclampsia increased from 51.1% to 93.4%. Nursing education increased from 69.6% to 92.9% during the same period. Between 2019 and April 2021 -June 2022, the rate of SMM excluding blood transfusions alone among patients with preeclampsia, eclampsia, and HELLP syndrome decreased by 37.3%, from 5.1% to 3.2% among participating facilities. NPQIC continues to work with participating birthing facilities to implement the patient safety bundle and educate all birthing facilities in the state on implementing best practices for the timely treatment of persistent severe hypertension.

Michigan

In Michigan, complications from sepsis, hemorrhage, and hypertension are the leading causes of maternal mortality and severe maternal morbidity (SMM). Between November 2015 and September 2023, more than 64% of birthing hospitals in the state participated in the implementation of AIM’s Severe Hypertension in Pregnancy Patient Safety Bundle, with the MI AIM Collaborative providing technical assistance, conducting site visits, facilitating education, and offering data support to collect structure and process data. Between 2011-2015 and 2016-2021, the statewide SMM rate excluding blood transfusions alone among patients with preeclampsia/eclampsia decreased from 7.7% to 6.6%, an overall reduction of 14.3%. The MI AIM Collaborative has a goal of engaging all Michigan birthing hospitals in quality improvement efforts that address drivers of maternal mortality and SMM to improve health outcomes for all.

Indiana

The Indiana Department of Health (IDOH), in collaboration with the state’s Maternal Mortality Review Committee, the Indiana Hospital Association, and the Indiana Perinatal Quality Improvement Collaborative, began implementation of the AIM Severe Hypertension in Pregnancy Patient Safety Bundle in March 2021 with seven of Indiana’s birthing facilities. Between January 2021 and June 2023, the percentage of obstetric physicians and midwives who received education on severe hypertension and preeclampsia increased from 54.9% to 82.9% and the percentage of obstetric nurses w ho received education on severe hypertension and preeclampsia increased from 78.4% to 92.7%. IDOH continues to support bundle implementation at participating facilities through the development of supporting resources and facilitation of webinars and trainings. As of February 2024, all of Indiana’s 77 birthing facilities are participating in implementation of the AIM Severe Hypertension in Pregnancy Patient Safety Bundle. IDOH continues to support bundle implementation at participating facilities.

Hawaii

In July 2021, in response to high rates of severe maternal morbidity (SMM) due to severe hypertension in pregnancy, the Hawaii Perinatal Collaborative, in partnership with the Healthcare Association of Hawaii (HAH), began implementation of the AIM Severe Hypertension in Pregnancy Patient Safety Bundle in 10 of the state’s 12 birthing facilities. Between July 2021 and September 2022, in participating facilities, the percentage of pregnant and postpartum people with persistent severe hypertension who were treated within one hour increased from 46.3% to 63.9%, an increase of 38%. HAH continues to assist facilities with quarterly reporting of data, learning opportunities, and quality improvement support.

District of Columbia

In Washington, DC, 16% of birthing patients had gestational or pre-existing hypertension in 2016 through 2019. In August 2021, the District of Columbia Perinatal Quality Collaborative (DCPQC) began implementing AIM’s Severe Hypertension in Pregnancy Patient Safety Bundle in all five of the district’s birthing facilities. The percentage of birthing facilities that have patient education materials on urgent postpartum warning signs increased from 0% in October 2021 to 80% in July 2023. Between October 2021 and October 2023, the proportion of women receiving timely treatment for persistent severe hypertension increased from 36% to 85%. The DCPQC continues to work with birthing facilities to implement AIM patient safety bundles through structured communities of learning that incorporate quality improvement support and sharing of clinical best practices resources.

Arizona

In December 2020, the severe maternal morbidity (SMM) rate in Arizona among people with hypertensive disorders of pregnancy was reported to be three times as high as the rate among people without hypertensive disorders of pregnancy. In April 2021, Arizona began implementing the AIM Severe Hypertension in Pregnancy Patient Safety Bundle with 32 of the state’s 42 birthing facilities. After bundle implementation, in participating facilities the percentage of pregnant and postpartum people with persistent severe hypertension who were treated within one hour increased by 38% between 2021 and 2023 (55% in April-June 2021 and 76% in October-December 2023). Among people with persistent severe hypertension who were not treated within one hour, the percentage who were debriefed by their care team increased from 11% to 57% between April-June 2021 and October-December 2023. Arizona continues to support facilities through learning sessions, data support, and opportunities to meet and discuss topics of interest such as health equity and quality improvement.

Urgent Maternal Warning Signs

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Grace Lim, MD, MSc

Grace Lim Bio: Dr. Lim is a board-certified obstetric (OB) anesthesiologist and physician scientist who is passionate about eliminating pain and suffering in special populations, optimizing perioperative medication use, and creating innovative and personalized approaches to care. She accomplishes these goals using a mix of clinical and translational approaches. Her methods focus on individualized and population-based approaches to gain a holistic understanding of a health problem from both a population and personalized perspective.

Dr. Lim’s clinical practice and research work are dedicated to improving pain management and post-birth recovery by identifying safe and effective therapies. These efforts include the widespread implementation of enhanced recovery after cesarean protocols, nitrous oxide labor analgesia, hemorrhage bundles, and postpartum analgesia bundles across UPMC maternity hospitals.

Cresta Jones, MD, FACOG, FASAM

Cresta Jones Bio: Dr. Jones is an associate professor in the department of Obstetrics, Gynecology and Women’s Health at the University of Minnesota Medical School, and is board certified in Ob/Gyn, Maternal Fetal Medicine and Addiction Medicine. She focuses her primary clinical and research efforts on perinatal substance use disorders and reducing maternal mortality and stigma surrounding substance use disorders. She has led regional and national courses on optimal care with perinatal substance use disorders.

Dr. Lauren Arrington, DNP, CNM, FACNM

Lauren Arrington is an Assistant Professor in the Doctor of Nursing Practice and Nurse-Midwifery/Women’s Health Nurse Practitioner Programs at the Georgetown University School of Nursing. She is a commissioner for the Accreditation Commission for Midwifery Education and an associate editor for the Journal of Midwifery and Women’s Health. Dr. Arrington co-leads the Maryland Maternal Health Innovation Program’s Maternal Health Equity Toolkit and Community of Learning and developed the 5D Cycle for Health Equity to facilitate community-engaged quality improvement. Dr. Arrington practices midwifery at the University of Maryland St. Joseph Medical Center. Her work focuses on operationalizing health equity in maternal health and beyond.

Shanell Brown

Shanell (she/her) has an Associate’s in Pre-Nursing from Pierce College and a Bachelor of Science in Nursing from Seattle University. Immediately after obtaining her BSN, she decided to take the public health route and work for Tacoma Pierce County Health Department. Shanell gained experience in Maternal Child Health as a Health Promotion Coordinator and then a Nurse Home Visitor for the Black Infant Health program for three years. Shanell is currently a graduate student at the University of Washington Bothell to obtain her Master’s in Nursing, tailoring her courses to public health. She is passionate about public health, social justice, and health equity. Shanell is committed to working to reduce maternal child health disparities and advocate for BIPOC. Shanell enjoys singing, video games, traveling, and trying new restaurants.

Kelly Gibson, MD

Dr. Kelly Gibson is the Division Director for Maternal Fetal Medicine and the Associate Director of Obstetric Informatics at The MetroHealth System in Cleveland, Ohio and an Associate Professor at Case Western Reserve University. Dr. Gibson is a member of the SMFM Board of Directors. She is a founding member and past chair of the Clinical Informatics Committee and member of the Patient Safety and Quality Committee for SMFM. She is the current principal investigator for the NICHD Eunice Kennedy Shriver Maternal Fetal Medicine Research Network for the Case site. Dr. Gibson is a clinical advisor for the Ohio Alliance for Innovation in Maternal Health (AIM) Hypertension Project and is a member of the Ohio Pregnancy-Associated Mortality Review Board. Her research and clinical focus are on clinical quality, implementation of safety bundles, and large clinical trials.

Elliott Main, MD

Dr. Elliott Main founded and directed the California Maternal Quality Care Collaborative for 16 years to 2023 and served as the Chair of the California Maternal Mortality Review Committee during those years. Dr. Main is Professor of Obstetrics and Gynecology at Stanford University and currently leads two NIH grants supporting large-scale maternal QI projects. He has served or chaired national committees on Maternal Quality Measurement for ACOG, the AMA, The Joint Commission, Leap Frog and CMS. He has authored over 150 articles on maternal mortality, improving obstetric outcomes, obstetric quality measures and perinatal collaboratives. Nationally, Dr. Main is the Director for Quality improvement Implementation for AIM. In 2013, Dr. Main received the ACOG Distinguished Service Award for his work in quality improvement.

Catherine Albright, MD, MS

Dr. Catherine Albright is an associate professor of Maternal-Fetal Medicine at the University of Washington (UW) in Seattle. Her clinical and research interests are in high-risk maternal care, especially related to sepsis in pregnancy as well as cardio- obstetrics. She developed and validated the Sepsis in Obstetrics Score, the first disease-severity score developed and validated in pregnancy. She co-directs the UW Cardio-OB program and has multiple ongoing research projects related to this patient population. She currently is involved in the Washington State Maternal Mortality Review Panel as well as local and regional perinatal quality efforts. She has been especially focused on ensuring that UW has a robust maternal early warning system for early recognition of maternal decompensation.

Barbara O’Brien, MSN, RN

Barbara O’Brien is the Director of the Oklahoma Perinatal Quality Improvement Collaborative (OPQIC). Her work with OPQIC supports achieving a vision of a culture of safety, excellence, and equity in perinatal care in Oklahoma. This is achieved through public-private partnerships to implement best practices for the care of women and infants using quality improvement science.

Amber Weiseth, DNP, MSN, RNC-OB

Dr. Amber Weiseth, DNP, MSN, RNC-OB is a Research Scientist at Harvard T.H. Chan School of Public Health and the Director for the Delivery Decisions Initiative (DDI) at Ariadne Labs. In this role, she leads a research and advocacy portfolio focused on improving dignity and safety in childbirth and reducing racial and ethnic disparities. Amber has been an obstetric nurse for 20 years, specializing in maternal-child health, quality improvement, and systems innovation. Prior to joining Ariadne Labs, Amber served as Assistant Director for Maternal-Infant Health Initiatives at the Washington State Hospital Association where she led safety and quality improvement in the state’s birthing hospitals.

Alison Haddock, MD

Dr. Alison Haddock is a board-certified emergency physician and tenured Associate Professor at Baylor College of Medicine with appointments in the Department of Emergency Medicine, the Department of Education, Innovation and Technology, and the Center for Ethics and Health Policy. She was recently elected President-Elect of the American College of Emergency Physicians and will serve as President starting in October 2024. She holds a Bachelor of Science from Duke University and MD from Cornell Medical College, and completed her emergency medicine residency at the University of Michigan. She served as the emergency medicine/ACEP representative to the ACOG Pregnancy & Heart Disease Presidential Task Force and subsequently as co-chair of the Alliance for Innovation on Maternal Health (AIM) Patient Safety Bundle: Cardiac Conditions in Obstetrical Care.

Tiffany Messerall, DNP, APRN, WHNP-BC, RNC-OB

Tiffany Messerall, a board-certified women’s health nurse practitioner, is the Evidence-Based Practice Lead for OhioHealth in Columbus, Ohio, and a current postdoctoral fellow at The Ohio State University. Dr. Messerall holds a Bachelor of Science in zoology and a Master of Science in neuroendocrinology from Miami University. She earned a Bachelor of Science in nursing, a Master of Science in nursing with a specialty in women’s health, and her Doctor of Nursing Practice in women’s health from the University of South Alabama. Dr. Messerall served as the organizational lead for implementation of the AIM Severe Hypertension in Pregnancy patient safety bundle. She has been actively involved with the AIM National Team on the development of the AIM Sepsis in Obstetrical Care Patient Safety Bundle and the Institute for Healthcare Improvement Sepsis in OB Change Package. Dr. Messerall serves in leadership roles for several national organizations. In 2022, Tiffany was nominated to the inaugural cohort of AIM Clinical Champions.

Nancy Byatt, DO, MS, MBA, DFAPA, FACLP

Dr. Byatt is a perinatal psychiatrist and physician-scientist focused on improving systems of care to promote the mental health of parents and children. Her passion for her work is deeply rooted in her experiences as a clinician, researcher, daughter, and mother. She is a Professor with Tenure of Psychiatry, Ob/Gyn, and Population and Quantitative Health Sciences at UMass Chan Medical School. She developed the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. MCPAP for Moms is a statewide program that has 1) increased access to mental health care for thousands of perinatal individuals 2) become a national model for perinatal mental health care, and 3) impacted state and national policies and funding. She is the Founding Executive Director of the Lifeline for Families Center and Lifeline for Moms Program at UMass Chan Medical School.

Tiffany Moore Simas, MD, MPH, MEd

Dr. Moore Simas is the Donna M. and Robert J. Manning Chair of the Department of Obstetrics & Gynecology, and Professor of Ob/Gyn, Pediatrics, Psychiatry and Population & Quantitative Health Sciences at UMass Chan Medical School/UMassMemorial Health. Dr. Moore Simas is an academic specialist in general Ob/Gyn, physician-scientist, educator, advocate, and leader. She is the founding Obstetric Engagement Liaison of the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms, a first in nation state-wide program that enhances the capacity of obstetric care clinicians to address perinatal mental health and substance use disorders. Dr. Moore Simas is obstetric director of Lifeline for Moms, a program founded to provide technical assistance for others developing Perinatal Psychiatry Access Programs, like MCPAP for Moms, and as a research home to further advance innovations in integrating obstetric and mental health care. She serves her profession nationally as the Society of Academic Specialists in General Ob/Gyn’s (SASGOG) President Elect, on ACOG’s Maternal Mental Health Expert Work Group (Co-Chair) and Clinical Practice Guidelines OB Committee, and as an American Board of Ob/Gyn (ABOG) oral examiner. She has served on the Alliance in Innovation in Maternal Health’s (AIM) Perinatal Mental Health Conditions (PMHC) and Postpartum Discharge Transitions (PPDT) Safety Bundle Work Groups, developed the PMHC Change Package with the Institute of Healthcare Innovations (IHI) as lead faculty, and will be leading her state’s perinatal quality collaborative (PQC) in implementing the AIM PMHC bundle.

Emily Chew, MPH

Emily Chew, MPH is the Senior Advisor for Women’s Health and Gender Research at the Agency for Healthcare Research and Quality (AHRQ) Office of Extramural Research, Education and Priority Populations (OEREP). Prior to joining OEREP, Emily served as a Health Scientist Administrator at AHRQ in the Center for Quality Improvement and Patient Safety, leading PSNet and women’s health patient safety initiatives; as well as the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau. Emily’s background is in women’s health, public health, community health, and HIV/AIDS.

Allison Kight, MPH

Allison Kight brings her expertise and dedication to promoting the health and wellbeing of others in her role as Manager of Social Impact Projects for The Reilly Group. With years of experience working with federal and state governments, and professional, advocacy, and community organizations, she is a talented coalition builder and excels at forging connections between a wide range of partners. Her specialties include collective impact work and removing barriers to care and treatment through unified action with a wide range of stakeholders. Allison has helped state organizations achieve their health policy goals through coaching, facilitation, and expertise.

Jennifer McKeever, MPG, MSW

Jennifer McKeever is a creative, relationship-oriented leader with over 20 years of experience advancing programs and policy that promote health and wellbeing as a human right. As a natural coach, convener, and community-builder, she specializes in creating teams, systems, and processes to successfully implement large-scale public health initiatives. Having worked at local, state, and national non-profits and government organizations, Jennifer brings her knowledge and expertise to work with The Reilly Group in building partnerships, policy and advocacy coalitions, and social impact initiatives. As Director of Policy and Advocacy Networks, Jennifer is working with the team on Mind the Gap, which aims to turn the tide on the crisis of undiagnosed and untreated perinatal mental health conditions in America.

Colleen Reilly, MPP

Colleen Reilly is the President and CEO of The Reilly Group (TRG), a public affairs firm based in Washington, D.C. She has more than twenty-five years of experience in communications, public affairs, and health. Having worked in senior positions in government, non-profit organizations, media, and the private sector, she uses this multi-dimensional experience to develop and implement collective impact initiatives and programs with the TRG team that have resulted in developing policy, building partnerships and collaborations, increasing capacity, expanding education, and achieving quality improvement. Ms. Reilly is the architect of and serves as the lead for the Mind the Gap National Initiative to ensure maternal and maternal mental health are national priorities. The Initiative includes a coalition of 30+ national organization partners and state policy teams working together to improve health access and outcomes. Ms. Reilly is a recognized expert on maternal, women’s and mental health issues and has worked with groups, coalitions, and teams at the community, state and national level. Prior to founding The Reilly Group, Ms. Reilly served in senior positions at the U.S. Department of Health and Human Services, the Public Health Service Office of Women’s Health, Health Resources and Services Administration, and the National Mental Health Association.

Amy Ushry, MPH, BSN, RN, CCM

Amy Ushry is a Senior Nurse Program Manager at the American College of Obstetricians and Gynecologists (ACOG). In her role, Ms. Ushry has managed projects addressing preventable maternal mortality and severe maternal morbidity, perinatal substance use disorders, health equity, and respectful care. She also supports the Alliance for Innovation on Maternal Health (AIM)’s patient safety bundle work with specialization in the Care for Pregnant and Postpartum People with Substance Use Disorder bundle and Perinatal Mental Health Conditions bundle. Ms. Ushry has a background in public health nursing and holds a Bachelor of Arts in public health, Bachelor of Science in nursing, Master of Public Health, and board certification in case management.

Debra Bingham, DrPH, RN, FAAN

Debra Bingham, DrPH, RN, FAAN is the Chief Executive Officer for the Institute for Perinatal Quality Improvement (PQI), perinatal consultant, and a retired Associate Professor of Healthcare Quality and Safety from the University of Maryland School of Nursing (UMSON). Bingham is working to expand the utilization of implementation science and improvement science theories, frameworks, methods and tools in an effort to eliminate preventable perinatal morbidity and mortality and eliminate perinatal racial disparities. Prior to founding PQI and working at UMSON Bingham was the first executive director of the California Maternal Quality Care Collaborative (CMQCC). She then went on to become a Vice President at the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). At PQI, Bingham developed, co-authored, and launched the SPEAK UP Against Racism Action Pathway. Bingham also provides consultation to various types of organizations. She is the author of numerous peer-reviewed publications and toolkits. She and her husband are the proud parents of four children, 13 grandchildren and five great-grandchildren.

Nell Tharpe, CNM, CRNFA, MS, FACNM

Nell received her certificate in Midwifery from State University of New York (SUNY Downstate) and her MS in Midwifery from Philadelphia University. A Certified Nurse-Midwife since 1986, Nell has been actively involved in women’s health care as a labor and birth nurse, a nurse-midwife, a midwifery educator and author, and a maternal child health consultant in public health. Nell is committed to using the Quality Improvement Process to enhance perinatal health equity and quality in every health care setting. Her passion is bridging the gap between clinical practice and emerging evidence. With a focus on improving health care, Nell believes we must first acknowledge the harmful effects of systemic racism and bias, and then actively work to create communities and health care systems where people can thrive. Nell is currently adjunct faculty at Rutgers University and is lead editor and the original author of the award-winning text Clinical Practice Guidelines for Midwifery & Women’s Health.

Renée Byfield, MS, RN, FNP, C-EFM

Renée Byfield, MS, RN, FNP, C-EFM is the Program Director of the SPEAK UP Implicit and Explicit Racial Bias Education for the Institute for Perinatal Quality Improvement (PQI). Renée Byfield helps to advance PQI’s mission by expanding the use of quality improvement science to eliminate preventable perinatal morbidity and mortality and end perinatal disparities. Ms. Byfield is dedicated to pursuing health equity and teaching professionals to disrupt, dismantle, and eradicate racism. Specializing in obstetric and newborn care, Ms. Byfield has diverse experience in nursing leadership, education, perinatal patient safety and quality improvement in hospital, academia, and ambulatory settings. In 2018, she received recognition for nursing excellence from the March of Dimes among other distinctions in her field. Ms. Byfield holds a Master’s in Science degree as a Family Nurse Practitioner from Pace University. She is the CEO and developer of her own natural skin care line named after her children, Selah Knoelle Body Butters.

Jay Naliboff, MD

Dr. Jay Naliboff came to Maine in 1982 after Medical School at UCSD, OB/Gyn residency at SUNY Upstate Medical Center in Syracuse, NY, and two years in the Indian Health Service in Claremore Oklahoma. He practiced at Franklin Memorial Hospital for thirty-five years as an OB/Gyn, the last three years as Chief Medical Officer. He was active in ACOG, serving as Maine Section Treasurer, Vice Chair, and Chair, and a founding member of the Maine Maternal, Fetal, and Infant Mortality Review Panel. He also chaired the Maine Medical Assessment Foundation OB/Gyn Study Group. He and his wife Jane, a writer and photographer, raised three daughters and currently live in Chesterville. He is currently on the Executive Committee of the Perinatal Quality Improvement Collaborative for Maine (PQC4ME) when he’s not fly fishing or playing in his rock band.

Janet Perkins, MD

Dr. Perkins-Howland is the medical director for perinatal optimization and simulation at Wentworth-Douglass Hospital in Dover New Hampshire. Dr. Perkins-Howland completed her medical education and residency at the University of Illinois, where she delivered the first triplets at Good Samaritan Hospital. She is involved in the New England Perinatal Quality Improvement Network, sitting on their planning committee and often times speaking at their conferences. Dr. Perkins is also engaged with the New Hampshire MMRC and the Mass General-Brigham Clinical Community Committee. Outside of works, Dr. Perkins-Howland is involved in marathon running, and has completed over 50 marathons in five countries!

Jessica Bacon, CNM

Jess Bacon, MSN, CNM is a certified nurse-midwife practicing in New Hampshire. She received her BSN in 2000 and her MSN at Frontier Nursing University in 2012. She is expected to complete her DNP at Frontier in 2024. She has a strong interest in substance use disorder and is an advocate for removing barriers to treatment. Jess splits her time between a community hospital where she focuses on Perinatal Optimization and OB Simulation and a residential facility for pregnant and postpartum people with substance use disorder. She is the President of the NH Affiliate of ACNM, a member of the steering committee for the Northern New England Perinatal Quality Improvement Network (NNEPQIN), and co-chair of NNEPQINs Perinatal Community Advisory Council.

Sarah Carrigan, MPH

Sarah David Carrigan, MPH, is a Health Communications Specialist in the Division of Reproductive Health (DRH) within the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) at the Centers for Disease Control and Prevention (CDC). She currently serves as the Hear Her campaign lead, overseeing strategy and implementation of the multi-segment campaign that works toward improving maternal health outcomes by raising awareness of the urgent maternal warning signs and improving communication between healthcare providers and patients. Sarah has worked in public health program management and communications across a range of health topics at the CDC, including HIV/AIDS, antimicrobial resistance, and Zika. Prior to her work at CDC, Sarah worked with Memorial Health University Medical Center in Savannah, GA, Boston University, the Ruel Foundation, and the Ugandan American Partnership Organization on economic development and public health programs. Sarah has an MPH in International Health program design and management. She has a passion for health equity, public health problem solving, and good food. Sarah is based in Atlanta, GA, where she lives with her chef husband, 3-year old son, and two mischievous dogs.

Mindy Wara

Mindy Wara is the owner of Mindy Wara Studio, where she offers brand development; marketing strategy; and social media management services alongside her creative works. Marrying her love of storytelling, art, education, and advocacy, Mindy primarily works with perinatal and reproductive health organizations to define their stories, showcase their impact, and build digital communities. A few of the organizations Mindy has served include: The Touchstone Institute, Minnesota Perinatal Quality Collaborative (MNPQC), Wisconsin Perinatal Quality Collaborative (WisPQC), Wisconsin Association for Perinatal Care, the Perinatal Foundation, Shades of You, Shades of Me; NARAL Pro-Choice America; and the National Organization for Women. Her accomplishments include founding the Artist-Mama Collective, being nominated for the ATHENA Leadership Award, exhibiting at the Parallel Artist-Mother Art Show, and raising a curious and kind son with her husband. Mindy’s dedication to amplifying perinatal health work is rooted in her own experiences with perinatal mental health challenges as the mother to a now thriving NICU graduate.

Michele Kulhanek, MSN, RNC-OB, C-EFM, C-ONQS

Michele Kulhanek is currently the system Perinatal Safety Officer for PeaceHealth. Michele came to PeaceHealth in May from Washington State Hospital Association where she was the Director of Safety & Quality for Maternal-Infant Health. She was responsible for creating, leading, implementing and achieving results to improve outcomes for Washington state’s birthing hospitals. She is passionate about quality improvement in perinatal care, birthing people, newborns, families, and the providers who care for this population. As an experienced labor and delivery nurse, Michele has worked both at the bedside and in leadership in a variety of settings, from a community hospital to a high risk obstetrical academic medical center. She maintains certification in quality and safety, as well as in-patient obstetrics and electronic fetal monitoring. Michele has experience as an obstetrical and neonatal clinical instructor for a BSN program and she is also a fetal monitoring instructor.

Linda Kenney

As a result of a personal experience with a near fatal medical event many years ago, Linda identified the need for support services in cases of adverse medical events and outlined an agenda for change. For more than twenty years, she has been encouraging organizations to tackle the challenges that impair effective communication, apology, and support programs for patients, families, and clinicians following medical errors and unanticipated outcomes. Linda serves as a patient representative on numerous task forces and is on the board of the Massachusetts Coalition for the Prevention of Medical Errors.

Jackie Ewuoso, MPH, PMP

Jackie Ewuoso manages the Betsy Lehman Center’s peer support programs and other patient safety initiatives. She has several years of experience in community health addressing social determinants of health and working in chronic disease prevention. Before coming to the Betsy Lehman Center, Jackie was a public health prevention specialist at the Worcester Division of Public Health and the Central Massachusetts Public Health Alliance. In this position, she managed community health grants aimed at addressing chronic diseases by increasing access to healthy food and opportunities for physical activity. She coordinated projects and initiatives focused on policy, systems and environmental change as a way to increase healthy eating and active living in the city of Worcester and six surrounding towns. Jackie holds a Master in Public Health from Boston University and a Bachelor of Arts in Psychology from the University of Illinois at Chicago.

Stephanie Radke, MD, MPH

Dr. Stephanie Radke is a board-certified Obstetrician-Gynecologist and Clinical Associate Professor at the University of Iowa. She is a native Iowan and graduate of Luther College in Decorah, Iowa, and the University of Iowa’s Carver College of Medicine. She completed her residency in Obstetrics and Gynecology at the University of California Davis Medical Center. She was in community private practice in Sacramento, California, for 3 years prior to returning to the University of Iowa to join the faculty in 2016. Her professional interests include promoting better maternal health outcomes and advancing health equity via quality improvement collaboratives. She is funded on a Maternal Health Innovation award held by the Iowa Department of Health and Human Services and directs the Iowa Maternal Quality Care Collaborative and Iowa AIM Program.

Patricia Suplee, Ph.D., RNC-OB, FAAN

Dr. Patricia D. Suplee PhD, RNC-OB, FAAN is an Associate Professor at Rutgers University, School of Nursing-Camden. As a seasoned researcher, scholar, and educator, Dr. Suplee’s career has focused on improving maternal child health outcomes and translating evidence into clinical practice especially during the postpartum period. Her collaborative work as CO-PI on AWHONN’s Empowering Women to Obtain Needed Care project led to the development of Post-Birth educational tools that have received national attention. The POST-BIRTH Warning Signs educational tool has been incorporated into postpartum discharge teaching throughout the U.S. and has been cited as an exemplar by the CDC, HRSA, and the Joint Commission. In a follow-up project supported by Merck for Mothers and AWHONN and completed in 2022, she has continued this important work. Dr. Suplee was an appointed member to three interdisciplinary national committees responsible for the development of three AIMS Patient Safety Bundles currently used as best postpartum care practice models. In addition, she was an appointed member of the HHS Office of Minority Health, Think Cultural Health team to advise the development of an e-learning program for physicians, nurses, and health care providers about culturally and linguistically appropriate services in maternal health care. She is currently Chair of NJ AWHONN, is a member of the NJ Maternal Care Quality Collaborative and NJ Maternal Mortality Review team that analyzes cases, identifies gaps in care, and makes recommendations to decrease maternal mortality rates. Dr. Suplee publishes and presents nationally, is a reviewer for several journals, and has mentored numerous faculty colleagues, clinicians, and students over the last three decades.

Hannah Newton

Hannah Newton has worked in the Resource Center at King County 211 in Seattle since 2005 and has been the Department Manager since 2017. She additionally coordinates resource data and statewide data projects for Washington 211. She is certified as a Database Curator by the Alliance of Information & Referral Systems.

Skyler Young

Skyler Young has worked in business and software development for over 10 years. Most recently, he cofounded Connect 211, an Open Source search engine that helps connect communities to the resources they need. This is a tight collaboration between 211 call centers and other non-profits or agencies that can use 211s’ high quality data for their own audience.

Lisa Nathan, MD, MPH

Lisa Nathan recently joined Columbia University’s Department of OBYGN as an Associate Professor of Obstetrics & Gynecology and the Chief of Obstetrics, Sloane Hospital for Women, Columbia University Irving Medical Center. She completed her OBGYN residency training at Montefiore/Einstein and stayed on to work for several years as an academic generalist. During this time, she founded the Global Women’s Health Program for the Department with grant support from the Einstein Global Health Center and the US Fulbright African Regional Research Program. Dr Nathan also founded Einstein’s Departmental Health Equity Task Force. The goal of this task force was to create a Departmental culture and workforce that understands the concepts of health disparities and structural racism, recognizes the ways in which society and the health system promote them, and works proactively to dismantle them. In addition to her clinical and administrative duties, Dr Nathan is also active within ACOG, where she is a member of the Safe Motherhood Initiative Steering Committee. She was the Chair of the Maternal Sepsis Bundle workgroup and is a current member of the Health Equity Subcommittee. She also serves as a consultant to the New York City Department of Health, where she serves as the Co-Chair of the Maternal Mortality Review Committee. In this role, she reviews events leading to maternal mortality for the majority of cases occurring in New York City. These reviews form the basis for the development of recommendations for city and state level initiatives to combat the root causes of the high maternal mortality rates in New York City.

Dena Goffman, MD

Dr. Goffman is currently the Vice Chair for Quality and Patient Safety and Ellen Jacobson Levine and Eugene Jacobson Professor in Obstetrics and Gynecology at Columbia University and the Associate Chief Quality Officer for Obstetrics for the New York-Presbyterian health system. She was recently appointed the Associate Dean for Professionalism for Columbia University Irving Medical Center. She has a strong interest in improving patient safety and quality in obstetrics and decreasing severe maternal morbidity and mortality. Much of her work has focused on the use of simulation, team training and implementation of evidence-based guidelines to achieve this goal.

LaShea Haynes, M.Ed., MSN, AGCNS-BC, APRN, RNC-OB/EFM

LaShea has been practicing in the area of obstetrical/perinatal nursing for nearly 26 years. Her clinical and educational experience and expertise span labor/delivery, antepartum and mother/baby areas. LaShea has worked as a board-certified clinical nurse specialist for women’s services at a large healthcare system, she was a nursing instructor and a previous perinatal outreach educator. These roles allowed her the ability to provide continual high-risk perinatal education to various hospitals and to reach audiences across her region. This has led to her current role and success as founder and owner of her own nursing mentoring and education consulting company Perinatal Potpourri. She is also a Designated Instructor Trainer in Fetal Monitoring and Obstetric Patient Safety through AWHONN. LaShea holds two certifications through NCC and currently provides in-services and seminars nationally for Inpatient OB and EFM reviews, respectively. In addition to being an active AWHONN member, Lashea was recently elected as the Vice Chair of the AWHONN Section Advisory Committee. She was appointed to this position because of her activism and success as the 2-term elected Georgia section chair. LaShea was appointed as the lead for Georgia in the AWHONN Postpartum Hemorrhage & Empowering Women projects. She was selected as the lead facilitator in the state of Georgia to assist with the rising rate of maternal deaths because she has successfully moved her region to become more active with lectures, networking, and current trends. LaShea’s expertise in this area is demonstrated in her most recent honor, AWHONN’s highest honor the Distinguished Professional Service Award Winner of 2022 and The Award of Excellence in Education, respectively. It’s also noteworthy to mention she has won the March of Dimes 2018 Georgia Nurse of the Year Award and the 2015 AWHONN Award of Excellence in Community Service. She is an energetic speaker, whose goal is to fully engage the audience in her presentations, leaving them excited and ready to learn more.

Kay Daniels, MD

Dr. Kay Daniels is a Clinical Professor of Obstetrics and Gynecology at Stanford University School of Medicine. She is the Director of the OB simulation program at Lucile Packard Children’s Hospital at Stanford Medical Center, which trains obstetrical teams in management of obstetrical emergencies. Dr. Daniels served as the past chair of the American College of Obstetrics and Gynecology National Simulation Working Group 2010-2012 and received the 2009 Henry J Kaiser Outstanding and Innovative Contributions for Medical Education for her work in the field of simulation technique. In 2020 due to the COVID pandemic, the Stanford OB simulation team explored how to convert in person simulation to online “telesimulation” courses and are presently performing a study to evaluate the effects of this innovative training technique.

Amy Judy, MD, MPH

Amy Judy, MD, MPH is a Clinical Assistant Professor of Obstetrics and Gynecology in the Division of Maternal-Fetal Medicine at Stanford University School of Medicine. Dr. Judy is the residency program director at Stanford, as well as the co-director of the OB SIM program, and she also serves as a representative to the ACOG Simulations Working Group. Her research interests are predominantly in clinical obstetrics, with collaborative projects in obstetric simulation, hypertensive disorders of pregnancy, preterm birth, perinatal mental health, and maternal mortality and quality care improvement.

Karen Florio, DO

Dr. Florio is a board-certified OB/GYN and Maternal-Fetal medicine physician with expertise in cardiac diseases in pregnancy. She received her training at the New York Institute of Technology/New York College of Osteopathic Medicine and was accepted into OB GYN residency at New York Methodist Hospital of Cornell. After residency, she did her fellowship at Magee Women’s Hospital of the University of Pittsburgh. Following fellowship, she started her career at Saint Luke’s Hospital of Kansas City and the University of Missouri-Kansas City School of Medicine. Her past 10 years in Missouri have been spent working towards reducing the maternal mortality rate in her state. Her career focus has been on quality of care and reducing disparities, which has earned her several roles including board member on the national Equitable Maternal Health Coalition of the March of Dimes, a fellowship position in the Kansas City Quality and Value Innovation Consortium, and mentor in the UMKC Quality Improvement & Patient Safety Faculty Scholars Program. In 2014, she helped develop the region’s first cardio-obstetrics clinic where collaboratively they have cared for over 2000 pregnant women with CV disease. She has developed and published on the specific components believed necessary for optimizing obstetrics care for women with CV disease. She was recently nominated to serve on the American College of Obstetrics and Gynecology/Alliance for Innovation in Maternal Health (ACOG/AIM) board for the development of the Cardiac Conditions in Obstetric Care bundle.

Maternal Mental Health

AIM’s Patient Safety Bundles include the newly released Perinatal Mental Health Bundle.
Check out MHLIC’s Maternal Mental Health Resource Hub.
Use #AIMforInnovation and tag us @mhlic_org and @aimprogram_org.

Heart Health Month

In support of Heart Month and to continue to bring awareness of the importance of a healthy heart for pregnant people, we’re teaming up to share more about AIM’s Patient Safety Bundles.

Download and share the bundles:
Cardiac Conditions in Obstetric Care
Severe Hypertension in Pregnancy

Black Maternal Health

MHLIC and AIM are committed to making equitable, systemic, sustained changes through policy, clinical care, community engagement, data and research, and more. Let’s learn, grow, and do better.

Check out MHLIC’s Black Maternal Health Resources.

Use #AIMforInnovation and tag us @mhlic_org and @aimprogram_org.

Maternal Health Awareness Day

January 23 is Maternal Health Awareness Day, established in ACOG District III to educate the citizens of the District about promising maternal health initiatives. View events taking place in each District III Section to recognize Maternal Health Awareness Day below.

View District III’s Programs and Resources for #MHAD

Use #MHAD23 and #AIMforInnovation. Don’t forget to tag us @mhlic_org and @aimprogram_org.

California

Between July 2019 and September 2020, the California Maternal Quality Care Collaborative engaged 27 birthing facilities located in counties with high rates of neonatal abstinence syndrome to participate in its mother & Baby Substance Exposure Initiative (MBSEI) Collaborative based on AIM’s Opioid Use Disorder (OUD) patient safety bundle. These facilities represented 14% of live births in the state. Participating facilities identified and implemented best practices in areas including screening, treatment, transitions in care, and education for OUD. Among the MBSEI Collaborative hospitals, the proportion of pregnant people with OUD who received medication for opioid use disorder or behavioral health treatment increased from 45% in January 2019 to 58% in December 2020, representing a 29% increase. During the same period, the proportion of opioid-exposed newborns ≥35 weeks’ gestation who received any of their parent’s milk at discharge increased from 56% to 65%, representing a 16% increase. Long-term outcomes for birth parents and infants will continue to be assessed through other programs.

New York

In New York, the rate of opioid overdose deaths for women aged 18-44 tripled between 2010 and 2016. In response, the New York State Perinatal Quality Collaborative (NYSPQC) implemented the New York State (NYS) Opioid Use Disorder (OUD) in Pregnancy & Neonatal Abstinence Syndrome (NAS) Project based on the AIM Obstetric Care for Women with OUD patient safety bundle. The project began as a pilot in September 2018 with 14 birthing facilities participating and submitting data. The project has since expanded to include a total of 39 birthing facilities. The percentage of facilities that implemented a universal screening protocol for OUD increased from 21% in January 2019 to 73% in December 2021 among the 14 facilities participating in the pilot phase and from 33% in December 2020 to 86% in December 2021 among the 25 facilities participating in the expansion phase. The percentage of birthing people with OUD who received medication for opioid use disorder or behavioral health treatment during pregnancy increased from 72% to 93%, as reported by pilot phase facilities, and increased from 85% to 94%, as reported by expansion phase facilities. The NYSPQC continues to lead the NYS OUD in Pregnancy & NAS Project with webinars, educational opportunities, data collection and analysis, resource distribution, and clinical and quality improvement support.

Illinois

In 2016 and 2017, mental health conditions, including substance use disorder, were the leading causes of pregnancy-related deaths in the state. The Illinois Perinatal Quality Collaborative (ILPQC) launched the Mothers and Newborns affected by Opioids – Obstetric (MNO-OB) Initiative in May 2018 based on AIM’s Obstetric Care for Women with Opioid Use Disorder (OUD) patient safety bundle with all 101 of the state’s birthing facilities. Over the course of the initiative, the percentage of sampled pregnant patient records with documentation of a validated screening tool used on Labor & Delivery increased from 3% in Q4 of 2017 to 85% in Q4 of 2020. During the same period, the percentage of patients with OUD who were connected to medication for opioid use disorder by delivery discharge and linked to recovery treatment services increased from 41% to 76% and 48% to 70%, respectively, and the percentage of patients with OUD who received Narcan counseling increased from 2% to 63%. The MNO-OB sustainability phase began in January 2021, where participating facilities worked to track compliance and develop plans for missed quality improvement opportunities. ILPQC continues to support the implementation of strategies for continuing quality improvement, new hire education, and the maintenance of up-to-date maps of community resources.

Louisiana

Louisiana’s nulliparous, term, singleton, vertex (NTSV) cesarean birth rate was 33.2% in Q3 of 2020, and some individual facilities had NTSV cesarean birth rates exceeding 50% during that time. In January 2021, the Louisiana Perinatal Quality Collaborative (LaPQC) began implementing AIM’s Safe Reduction of Primary Cesarean Birth patient safety bundle in 42 of the state’s 49 birthing facilities. The LaPQC completed the Labor Culture Survey with all participating facilities and is now working to implement and stabilize processes to make labor cultures more supportive of vaginal birth. Between January 2021 and January 2022, the NTSV cesarean birth rate declined from 30.3% to 27.5% among participating facilities. The LaPQC continues to host regular data reviews and QI planning sessions with the now 44 participating facilities and host clinical trainings to support the safe reduction of low-risk cesarean births.

Iowa

Due to Iowa’s nulliparous, term, singleton, vertex (NTSV) cesarean birth rate exceeding the Healthy People 2030 target rate of 23.6%, the Iowa Maternal Quality Care Collaborative (IMQCC) began implementation of AIM’s Safe Reduction of Primary Cesarean Birth patient safety bundle in 43 of the state’s 56 birthing facilities. Since the start of implementation in May 2021, participating facilities have received monthly education on evidence-based practices, quality improvement, and family-centered care. Provisional data show a 16% reduction in the statewide rate of NTSV cesarean births from 25.0% in Q1 2021 to 21.1% in Q1 2022. During the same time, non-participating facilities experienced an increased rate of low-risk (NTSV) cesarean births. IMQCC continues to sponsor labor support workshops, provide one-on-one and small group coaching, and support birthing facilities in collecting and interpreting institutional data to advance AIM patient safety bundle implementation work.

Florida

In 2017, Florida’s nulliparous, term, singleton, vertex (NTSV) cesarean birth rate was the highest in the nation at 31%. In 2018, the Florida Perinatal Quality Collaborative (FPQC) began implementing AIM’s Safe Reduction of Primary Cesarean Birth patient safety bundle in 46 of the state’s 113 birthing facilities receiving monthly education, labor support workshops, data reports, and technical assistance. Between January 2018 and June 2019, the NTSV cesarean birth rate decreased from 31% to 29% among participating facilities, while the rate among non-participating facilities did not change. In 2020, FPQC expanded implementation to include 76 birthing facilities representing 80% of births in the state. From Q1 of 2017 to Q3 of 2020, Florida’s statewide NTSV cesarean birth rate decreased from 31% to 29%, a reduction of 6%. Participating facilities will continue to track and benchmark their NTSV cesarean birth rates with support from FPQC.

West Virginia

In 2017, West Virginia’s rate of severe maternal morbidity (SMM) among people with preeclampsia, excluding blood transfusions alone, was 7.6%. In response, the West Virginia Perinatal Partnership recruited all 21 birthing facilities in the state to implement AIM’s Severe Hypertension in Pregnancy patient safety bundle in Q2 of 2020. To support implementation, the West Virginia Perinatal Partnership provided patient education materials to birthing facilities and implemented a home blood pressure monitoring program to encourage early recognition of severe hypertension during pregnancy and postpartum. Between Q4 2020 and Q1 2022, the percentage of facilities that had established unit policies and procedures to respond to hypertensive emergencies increased from 23.8% to 71.4%. Additionally, the statewide rate of SMM among people with preeclampsia decreased from 7.6% in 2017 to 5.4% in 2021, a reduction of 28.9%. The West Virginia Perinatal Partnership continues to support facilities in the state by providing education to rural Emergency Departments and facilitating opportunities for collaborative learning.

Tennessee

Between 2017 and 2020, hypertensive disorders contributed to half of all pregnancy-related deaths due to cardiovascular disease, which is the leading cause of maternal mortality in Tennessee. In response, the Tennessee Initiative for Perinatal Care (TIPQC) recruited 15 of the state’s 59 birthing facilities to implement AIM’s Severe Hypertension in Pregnancy patient safety bundle. Five birthing facilities began a pilot project in November 2020, and 10 additional facilities began participating in March 2021. Between Q3 2020 and Q4 2021, the percentage of patients with persistent severe hypertension who were treated within 60 minutes of episode onset at the five pilot facilities increased from 43% to 67%, a 56% increase. Between Q1 2021 and Q4 2021, the percentage of patients with persistent severe hypertension who were treated within 60 minutes of episode onset at the 10 additional participating facilities increased from 32% to 57%, a 78% increase. The TIPQC continues to support participating facilities by hosting huddles focused on project sustainability as well as data check-ins to further improve timely treatment of persistent severe hypertension.

New Jersey

Between 2014 and 2016, hypertensive disorders of pregnancy were among the leading causes of severe maternal morbidity and mortality in New Jersey. In January 2017, the New Jersey Perinatal Quality Collaborative (NJPQC) began implementing AIM’s Severe Hypertension in Pregnancy patient safety bundle in 36 of the state’s 48 birthing facilities. Between Q1 2018 and Q1 2019, treatment of persistent severe hypertension within 60 minutes of episode onset increased from 53.4% to 64.3% among the participating birthing facilities. During the same time, the percentage of participating facilities who reported having established unit policies and procedures to respond to hypertensive emergencies increased from 51.0% to 63.3%. The New Jersey Perinatal Quality Collaborative continues to work with its birthing facilities to fully implement the AIM Severe Hypertension in Pregnancy patient safety bundle through expanded education opportunities and other technical assistance opportunities.

Missouri

In 2017, preeclampsia/eclampsia was the most common cause of death during pregnancy and up to 42 days postpartum in Missouri. Missouri AIM began implementation of AIM’s Severe Hypertension in Pregnancy patient safety bundle in 36 of the state’s 62 birthing facilities in November 2019. Among the 29 birthing facilities who reported data, treatment of persistent severe hypertension within 60 minutes of episode onset increased from a median of 62% at baseline (November 2019 through January 2020) to a median of 87% post-intervention (July 2020 through December 2021). During the same period, the percentage of participating facilities who established processes for scheduling postpartum follow-up appointments for people with diagnoses of hypertension, preeclampsia, or eclampsia increased from 0% to 31%. Missouri AIM continues to support birthing facilities whose implementation of the Severe Hypertension in Pregnancy patient safety bundle was halted or stalled during the COVID-19 pandemic and provides technical assistance to address health disparities related to hypertension in pregnancy and postpartum.

Mississippi

Between 2013 and 2015, complications related to hypertension and cardiovascular disease were the leading causes of pregnancy-related death in Mississippi. In response, the Mississippi Perinatal Quality Collaborative (MSPQC) began implementation of AIM’s Severe Hypertension in Pregnancy patient safety bundle in October 2019 and recruited 37 of the state’s 41 birthing facilities to participate. Between Q4 2019 and Q1 2022, the percentage of obstetric physicians and midwives who received education on severe hypertension and preeclampsia increased from 48% to 89%, and the percentage of obstetric nurses who received similar education increased from 62% to 93%. During the same time, the percentage of participating birthing facilities that had established unit policies and procedures to respond to hypertensive emergencies increased from 24% to 88%. The MSPQC continues to work with participating facilities on patient safety bundle implementation through quarterly leadership calls and other educational opportunities.

Maryland

In Maryland, hypertensive disorders of pregnancy are the third leading cause of severe maternal morbidity and account for over 8% of pregnancy-related deaths. In January 2021, the Maryland Perinatal-Neonatal Quality Collaborative (MDPQC) began implementing AIM’s Severe Hypertension in Pregnancy patient safety bundle in all 32 of the state’s birthing hospitals. Since implementation, the percentage of clinicians receiving education on severe hypertension and preeclampsia increased from 61% to 77% in obstetric physicians and midwives and 79% to 85% in obstetric nurses from Q1 2021 to Q4 2021. Treatment of persistent severe hypertension within 60 minutes of episode onset increased from 41% to 54% during this same period. The MDPQC continues to work with birthing hospitals to fully implement the AIM Severe Hypertension in Pregnancy patient safety bundle with an additional focus on improving the rates of severe maternal morbidity (SMM) among patients with preeclampsia and reducing racial and ethnic disparities within SMM.

Louisiana

In 2018, cardiovascular concerns and conditions related to hypertension accounted for one-fourth of pregnancy-related deaths in Louisiana, and Black people were three times more likely to experience a pregnancy-related death compared to White people. In response, the Louisiana Perinatal Quality Collaborative (LaPQC) was established to address the state’s leading causes of morbidity and mortality, and in August 2018 LaPQC began implementation of AIM’s Severe Hypertension in Pregnancy patient safety bundle, eventually recruiting 43 of the state’s 49 birthing facilities. Between August 2018 and January 2022, the percentage of participating birthing facilities that had established unit policies and procedures to respond to hypertensive emergencies increased from 21% to 100%. The LaPQC continues to work with facilities to refine and improve identification of and response to severe hypertension, including assuring appropriate integration of treatment algorithms into emergency department settings.

Indiana

The Indiana Department of Health (IDOH) joined the Alliance for Innovation on Maternal Health (AIM) in 2019 and collaborated with the state’s Maternal Mortality Review Committee, the Indiana Hospital Association and the Indiana Perinatal Quality Improvement Collaborative to implement AIM’s Severe Hypertension in Pregnancy patient safety bundle. As of February 2022, Indiana has engaged 77 of the state’s 84 birthing facilities in implementation of the Severe Hypertension in Pregnancy patient safety bundle. To support participating birthing facilities in quality improvement work, IDOH designed a Maternal Hypertension Toolkit and facilitated webinars and trainings. Between Q1 2021 and Q4 2021, the percentage of participating facilities with unit policies and procedures to respond to hypertensive emergencies increased from 74.4% to 91.0%. During the same period, the percentage of obstetric physicians and midwives who received education on severe hypertension and preeclampsia increased from 55.7% to 69.2% and the percentage of obstetric nurses who received education on severe hypertension and preeclampsia increased from 79.7% to 90.6%. IDOH continues to support bundle implementation at participating facilities and works to continuously recruit new facilities to engage in quality improvement work.

Georgia

Between 2012 and 2015, preeclampsia was the fifth leading cause of pregnancy-related deaths in Georgia, and Black people died from preeclampsia at a frequency 10 times greater than their White counterparts. In response, in June 2019 the Georgia Perinatal Quality Collaborative (GaPQC) recruited 34 of the state’s 75 birthing facilities to implement AIM’s Severe Hypertension in Pregnancy patient safety bundle. Between July 2019 and March 2022, the proportion of obstetric physicians and midwives at participating facilities who completed an education program on severe hypertension increased from 34.6% to 70.9%. From July 2019 to July 2021, the proportion of participating facilities that had established unit policies and procedures to respond to hypertensive emergencies increased from 32.7% to 81.6%. GaPQC continues to engage facilities in AIM patient safety bundle implementation by sharing resources on clinical best practices, facilitating maternal health learning series for clinical teams and providing other quality improvement support.

Alaska

Hypertensive disorders in pregnancy are increasing in Alaska, and hypertensive disorders contributed to one third of the pregnancy-related deaths in Alaska between 2012 and 2016. Based on these data and feedback from key stakeholders, the Alaska Perinatal Quality Collaborative (AKPQC) launched its first initiative focused on hypertensive disorders in pregnancy in March 2019. This initiative engaged six hospitals, representing 63% of Alaska births, in implementation of the AIM Severe Hypertension in Pregnancy patient safety bundle. As a result of this initiative and efforts of participating hospitals, the AKPQC exceeded its primary goal and observed a reduction in the statewide percent of severe maternal morbidity (SMM) among people with preeclampsia, excluding blood transfusions alone, from 7.7% in 2018 to 4.1% in 2020, the lowest percentage in the most recent five years. During this period, statewide SMM among people with preeclampsia, excluding blood transfusions alone, decreased from 10.8% to 3.9% for Non-Hispanic White people and from 5.5% to 3.4% for American Indian and Alaska Native people. Additionally, between Q3 2019 and Q4 2020, the percentage of pregnant people with persistent severe hypertension who received treatment within 60 minutes of episode onset at participating birthing facilities increased from 58.0% to 70.8%. The AKPQC continued to support participating hospitals with sustainability planning and data reporting through September 2021. The AKPQC is working to support hospitals in addressing the strain of the COVID-19 pandemic on healthcare systems and overall population health, as well as direct clinical impacts on pregnant patients, in an ongoing manner.

Washington

In Washington, hemorrhage is one of the leading causes of pregnancy-related death. In response, the Washington State Hospital Association (WSHA) began implementation of AIM’s Obstetric Hemorrhage patient safety bundle with 48 of the state’s 57 birthing facilities. Between Q1 2019 and Q2 2021, the percentage of obstetric physicians and midwives receiving obstetric hemorrhage education increased from 39.8% to 57.4%, and the percentage of obstetric nurses receiving obstetric hemorrhage education increased from 74.2% to 80.9%. Hemorrhage risk assessment also increased from 57.6% to 89.6% during this time. Adapting to the evolving nature of the COVID-19 pandemic, WSHA plans to continue its partnership with birthing facilities to support implementation of elements outlined in the AIM Obstetric Hemorrhage patient safety bundle, focusing on timely data collection to identify progress and areas needing focused attention. Participating birthing facilities will be supported with on-site and virtual meetings incorporating educational webinars, sharing of best practices, assistance with hemorrhage simulation, and focus on site specific metrics.

Mississippi

In Mississippi, hemorrhage requiring blood transfusions is the leading cause of severe maternal morbidity (SMM). In response, the Mississippi Perinatal Quality Collaborative (MSPQC) began implementation of AIM’s Obstetric Hemorrhage patient safety bundle in August 2016 and recruited 39 of the state’s 41 birthing facilities to participate. To support implementation, MSPQC developed portable hemorrhage toolkits, assisted in hemorrhage cart development, and provided clinical team training on quantified blood loss. Between Q4 2016 and Q4 2020, the percentage of participating birthing facilities with a hemorrhage cart increased from 32% to 98%. During the same time, the percentage of patients whose blood loss from birth through the recovery period was measured using quantitative and cumulative techniques increased from 12% to 72%. The MSPQC will continue to provide technical assistance, training, and guidance to facilities to fully implement the Obstetric Hemorrhage patient safety bundle.

Michigan

In Michigan, hemorrhage is among the three leading causes of pregnancy-related death. Between November 2016 to December 2020, 56 of the state’s 80 birthing facilities participated in implementation of AIM’s Obstetric Hemorrhage patient safety bundle with Michigan AIM. As part of this collaborative, participating facilities received technical assistance, site visits, education, and data support. From 2011-2015 to 2016-2020, the statewide severe maternal morbidity (SMM) rate among birthing patients who experienced a hemorrhage, excluding those who only received blood transfusions, declined from 11% to 5%, an overall reduction of 55%. MI AIM continues to assist participating facilities in quality improvement efforts addressing drivers of severe maternal morbidity and mortality with the goal of engaging all birthing facilities in the state in their collaborative.

Indiana

The Indiana Department of Health (IDOH) joined the Alliance for Innovation on Maternal Health (AIM) in 2019 and collaborated with the state’s Maternal Mortality Review Committee (MMRC), the Indiana Hospital Association (IHA), and the Indiana Perinatal Quality Improvement Collaborative (IPQIC) to implement the AIM Obstetric Hemorrhage patient safety bundle. As of February 2022, Indiana has engaged 80 of the state’s 84 birthing facilities in implementation of the Obstetric Hemorrhage patient safety bundle. To support participating birthing facilities in quality improvement work, IDOH designed a Maternal Hemorrhage Toolkit and facilitated webinars and in-person trainings. Between December 2019 and December 2020, the percentage of participating facilities with a hemorrhage cart increased from 93.8% to 96.3%. Additionally, during the same time, the percentage of obstetric physicians and midwives who received education on obstetric hemorrhage increased from 66.1.4% to 74.1% and the percentage of obstetric nurses who received education increased from 88.1% to 92.2%. IDOH continues to support bundle implementation at participating facilities and works to continuously recruit new facilities to engage in quality improvement work.

Louisiana

In 2018, hemorrhage accounted for one-third of all pregnancy-related deaths in Louisiana, and Black people were 3 times more likely to experience a pregnancy-related death compared to White people. In response, the Louisiana Perinatal Quality Collaborative (LaPQC) was established to address the state’s leading causes of morbidity and mortality, and in August 2018 LaPQC began implementation of AIM’s Obstetric Hemorrhage patient safety bundle, eventually recruiting 43 of the state’s 49 birthing facilities. Between August 2018 and January 2022, the percentage of facilities with standard processes to measure patients’ blood loss using quantitative and cumulative techniques from birth through the recovery period increased from 28.6% to 93.4%. During the same time, the percentage of facilities who established a standardized process to complete a hemorrhage risk assessment at the time of admission for birth increased from 85.2% to 100%. The LaPQC continues to work with participating AIM facilities to refine readiness and response structures through the provision of support focused on drills, staff education and competencies, and debriefs.

Georgia

Between 2012 and 2015, obstetric hemorrhage was the third leading cause of pregnancy-related death in Georgia, with Black pregnant and postpartum people dying at double the frequency of White pregnant and postpartum people experiencing a hemorrhage. In April 2018, the Georgia Perinatal Quality Collaborative (GaPQC) recruited 43 of its 75 birthing hospitals to implement the AIM Obstetric Hemorrhage Patient Safety Bundle. Between April 2018 and September 2021, the proportion of hospitals that have OB hemorrhage carts readily available increased from 49.0% to 96.1%. The proportion of patients who had their blood loss measured from birth through the recovery period using quantitative and cumulative techniques also increased from 33.3% to 85.0%. The obstetric hemorrhage initiative moved to sustainability in September 2021 and the GaPQC continues to support those facilities by sharing resources on clinical best practices and providing other quality improvement support.

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ALLIANCE FOR INNOVATION ON MATERNAL HEALTH

What is theAIM TA Center?

Our Resources

Patient Safety Bundles

Resource Library

Resource Kits

AIM PSB Learning Modules

AIM For Safer Birth Podcast

AIM Vimeo Channel

What’s New

PSBs in French

New Resource

New Resource

Join Our Work

Health Resource and Services Administration (HRSA)

What is the
AIM TA Center?