UC nursing faculty takes aim at rising maternal morbidity and mortality rates

Professor hopes to use her expertise to positively impact sobering statistics

A University of Cincinnati College of Nursing Professor is taking on a disturbing statistic: The number of women who die during childbirth in the United States more than doubled in a recent three-decade span.

Beth Ann Clayton, associate professor in the UC College of Nursing has been named to the National Quality Forum’s (NQF) Maternal Morbidity and Mortality Committee (MMMC). Clayton was nominated by the American Association of Nurse Anesthetists (AANA) and will serve as one of 25 health care experts on the committee.

According to the American Action Forum, the maternal mortality rate in the United States has increased significantly from 7.2 deaths per 100,000 live births in 1987 to 16.7 deaths per 100,000 live births in 2016, and the data indicate that more than half of these deaths are preventable.

“The NQF’s timeline indicates that we initially review current evidence regarding maternal morbidity and mortality,” Clayton says of the 24-month project. “Unfortunately, the United States is ranked 55th in the world in maternal care. The reasons for the overall increase in pregnancy-related mortality are unclear; however, it is essential that we look for opportunities to improve care.

“Women are dying during childbirth at too high of a rate. The MMMC committee plans to assess the current state of maternal morbidity and mortality measurements and provide recommendations for specific innovative, actionable approaches to improve maternal health outcomes.”
The NQF is a not-for-profit, nonpartisan, membership-based organization with a mission of leading national collaboration to improve health and health care quality by providing performance measures to evaluate how well services are being delivered. The goal is to improve quality of care by enhancing transparency in health care and ensuring multidimensional accountability.

Maternal mortality, as defined by the World Health Organization, refers to “the death of a woman while pregnant or within forty-two days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”

Clayton, a certified registered nurse anesthetist, has been providing obstetric anesthesia care in a variety of clinical settings for over 20 years. In addition, through the AANA Foundation, she led the obstetric anesthesia closed malpractice claims analysis. This work identified patterns of injuries, precipitating events and provided recommended interventions to improve care. Following this research, she was a primary author for the national “AANA Analgesia and Anesthesia for the Obstetric Patient Practice Guidelines” which provides clinicians a standardized approach to decrease maternal morbidity and mortality.

“I am looking forward to sharing my direct patient care experience in obstetric anesthesia practice and education,” says Clayton. “The NQF committee has a wide array of experts, but many individuals are not practicing clinicians, and that’s a unique perspective I bring to the table. I am ‘boots on the ground.’”

The 24-month NQF NMMC project, funded by the U.S. Department of Health and Human Services, will complete an environmental scan and a recommendations report. Throughout the project, which is scheduled to wrap up in 2022, the NQF will solicit input from its multistakeholder audience at key points.

Clayton says the College of Nursing is leading several Doctorate of Nursing Practice (DNP) projects related to maternal mortality and morbidity. For example, senior nurse anesthesia student Candace Holloway is looking at the role race plays in the United States, where black women are three to four times more likely to die due to pregnancy-related complications.

To improve obstetrical patient outcomes and combat health disparities at the local level, under the guidance of Clayton, DNP, and Gordon Gillespie, PhD, associate dean for research at the College of Nursing, Holloway is conducting a strategic needs assessment investigating if the presence of maternal health disparities exists at UC Medical Center. A retrospective chart review of obstetric patients from January 2017 to January 2020 is being completed to gather demographics and frequency of maternal complications. The data will be analyzed to calculate relative risk ratios and determine the presence of health disparities. This information will guide implementation of interventions to educate health care providers and improve the delivery of care.

Clayton, who is the nurse anesthesia program director, says serving on the MMMC is exciting and describes it as a great opportunity to represent her profession and UC.

“It is nice to be acknowledged, but my goal is to improve maternal care and teach the next generation of clinicians how to make sustainable impacts through quality improvement initiatives,” Clayton says. “We teach our students that your career will be more rewarding if you contribute to the improvement of population health. The key is to find how you do that.”

Lead photo of Beth Ann Clayton and Candace Holloway/Photo/Colleen Kelley/UC Creative + Brand