Provider Resources - Urgent Maternal Warning Signs

Always ask whether your patient is pregnant or was pregnant in the last year. 

Severe maternal morbidity and pregnancy-related deaths can happen anytime during pregnancy and for a year after. Being pregnant or postpartum may not be something your patient will share, particularly in an emergency. But, knowing their status could be the difference in making an accurate and timely diagnosis.

Listen to women and hear their concerns.

Many women feel that their concerns during and after pregnancy are not heard. Although health care settings are often busy, take a few moments to actively listen to what is being said. It can make all the difference to better understand your patient’s needs and provide quality care. 
Building trust with your patient and engaging them in their care can lead to positive outcomes. Encourage patients to share any concerns they may have. Ask questions to better understand your patient and things that may be affecting their lives. Engage in an open conversation to make sure any issues are adequately addressed. Provide all patients with non-judgmental, respectful care (PDF).

Active listening helps build trust through shared knowledge. Active listening involves: 

• Receptive body language
• Practicing empathy
• Repeating back questions or concerns
• Asking clarifying questions to make sure you understand

Tell your patients and community about the urgent maternal warning signs, and when to get medical care right away. 

During prenatal and postpartum encounters, discuss the urgent maternal warning signs with your patients and their support people. Stress the importance of getting immediate medical care if signs occur. Consider using the Teach-Back Method to check that your patients understand the information and what it means for their health. Provide patients with educational resources about the urgent maternal warning signs. Encourage them to discuss the urgent maternal warning signs with their partner, family, and friends. Help your patients and their loved ones know to look for urgent maternal warning signs during pregnancy and for a year after. Remind them, if something doesn’t feel right, get help. It could help save her life. 

Educate your patients about pregnancy-related health concerns.

Some healthy women will experience pregnancy related-health concerns. But there are also factors that increase the risk for pregnancy complications. Educate your pregnant and postpartum patients about maternal risk factors, urgent maternal warning signs, and when to look for help. 

During the days and weeks after pregnancy, a patient may not consider that her health concern could be pregnancy-related. It’s important to make sure she understands the importance of attending to her own health, in addition to the health of her newborn. While her new baby needs a lot of attention and care, it’s important for her to remain aware of her body and prioritize taking care of herself, too. 

Encourage your patient to monitor her health during and after pregnancy. Tell her to get help if something doesn’t feel right. And, to always tell every medical professional that she is pregnant or was pregnant in the last year.  

Help patients understand and manage chronic conditions or conditions that may arise during pregnancy, like hypertension, diabetes, or depression.

Consider ways to connect moms to additional care when needed. This includes emergency care, referrals to other medical professionals, and other support services. 

Discuss planning for the transition to ongoing well-woman care and, if indicated, specialty care with long-term follow-up for conditions that developed in pregnancy. See for example, the American College of Obstetricians and Gynecologists’ (ACOG) Committee Opinion 736 Optimizing Postpartum Care and ACOG Postpartum Toolkit (PDF).

Address health disparities.

In joint biennial reports, the Texas Maternal Mortality and Morbidity Review Committee (MMMRC) and Texas Department of State Health Services consistently find disparities in maternal mortality and morbidity, with Black women disproportionately impacted. Nationally, Black women are three times more likely to die from pregnancy-related complications than White women. And American Indian and Alaska Native women are two times more likely to die from pregnancy-related complications than White women. 

To improve patient-centered care and decrease inequities in reproductive health care, the American College of Obstetricians and Gynecologists (ACOG) makes the following recommendations for obstetricians, gynecologists and other health care providers.

• Ask about and document social and structural determinants of health that may influence a patient’s health and use of health care
• Refer to social services to help improve patients’ abilities to fulfill these needs
• Provide access to interpreter services for all patient interactions when patient language is not the clinicians’ language
• Recognize that stereotyping patients using presumed cultural beliefs can negatively affect patient interactions, especially when patients’ behaviors are attributed solely to individual choices without recognizing the role of social and structural factors

Help address disparities in health care and health outcomes. Take trainings on diversity, shared decision making, cultural competency, and how to prevent biases from affecting your quality of care.

The U.S. Department of Health & Human Services provides free 2-hour e-learning courses on Culturally and Linguistically Appropriate Services (CLAS) in Maternal Health for physicians, nurses, and other health care professionals to apply the National CLAS Standards in their daily practice. 

Engage your patients in every decision about their medical care. 

When your patient is engaged in her health care, it can lead to improvements in safety `and quality. Take steps to make her feel understood and valued during her visit with you. A shared decision-making approach acknowledges and leverages patients’ expertise in their bodies as well as the aspects of their life that may affect their ability to carry out health decisions.

Providers can use the five-step SHARE Approach to engage patients in their health care decision-making. The process was developed by The Agency for Healthcare Research and Quality. Providers explore and compare the benefits, harms, and risks of each option through meaningful communication about what matters most to the patient.

Recognize and address pregnancy-related complications before they become serious.

To prevent serious outcomes, it is essential to timely identify and treat maternal health complications. Delays in recognizing risk factors and escalating care can result in severe maternal morbidity and even pregnancy-related death. To address maternal mortality, providers can improve their standard method to assess clinical warning signs, provide accurate diagnoses, implement optimal treatment, and coordinate care with multidisciplinary teams.

Health care providers can engage peers in regional, state, and national efforts to improve maternal health and safety.

Opportunities include: 

• Join your hospital’s efforts to implement the Alliance for Innovation on Maternal Health’s (AIM) maternal patient safety bundles. DSHS’ TexasAIM program provides support and learning collaboratives with Texas’ birthing hospitals to make health care safer for every Texas mother
• Participate in projects by the Texas Collaborative for Healthy Mothers and Babies (TCHMB) and attend the TCHMB Annual Summit 
• Contact your Trauma Service Area’s Regional Advisory Council (RAC) to get involved in Perinatal Care Region (PCR) improvement efforts. PCRs are established as a component of Maternal Levels of Care Designation, and are integrated into each RAC
• Learn about recommendations for eliminating preventable maternal mortality and morbidity in Texas by reading the MMMRC and DSHS biennial joint reports located at the bottom of this web page
• For more strategies and actions you can take to improve maternal health and reduce maternal mortality and morbidity, read the Surgeon General’s Call to Action to Improve Maternal Health (PDF)