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Patients not adequately educated on postpartum complications

Many postpartum nurses did not have up-to-date information regarding maternal mortality after childbirth, and as a result did not provide comprehensive education about reducing maternal mortality and complications to new mothers before they were discharged from the hospital, according to findings published in The American Journal of Maternal/Child Nursing.

“In the Listening to Mothers Survey, when asked about their postbirth experiences, women described having inadequate support and being unsure of how to navigate fluctuating hormones, disrupted sleep, recovery from birth and newborn care and feeding,” Patricia D. Suplee, PhD, RNC-OB, from Rutgers University School of Nursing, and colleagues wrote. “Women reported they needed more guidance on common postpartum health concerns. These findings may suggest that there is an information gap; women may not be able to determine if the symptoms they notice after birth are normal and expected, or abnormal requiring urgent or emergency medical attention.”

Suplee and colleagues sought to evaluate the knowledge of postpartum nurses on maternal morbidity and mortality and how efficiently they share information about identifying potential warning signs of postpartum complications with women before discharge. A total of 372 registered nurses (RNs) who cared for women postpartum were enrolled in the study. They completed an electronic survey that assessed their knowledge on rates, trends and leading causes of maternal mortality and their teaching skills, including when teaching occurs, length of time and how confident they are about teaching the content. The researchers generated descriptive statistics to describe sample demographics. They also performed bivariate analyses to determine the relationships between demographic variables, knowledge of maternal morbidity and mortality and teaching.

Data showed that the current rate of maternal mortality in the United States and the percentage of deaths that occurred during the postpartum period were accurately reported by 15% and 12% of RNs, respectively. The leading three causes of maternal mortality could not be identified by 83% of participants. Sixty-seven percent of RNs taught the potential warning signs of postpartum complications to women for less than 10 minutes on the day of discharge.

“We found that 46% of the nurses surveyed were not aware of the rising rates of maternal mortality in the United States, in fact 19% thought the rate was decreasing,” Suplee told Healio Internal Medicine.

Most RNs (95%) recognized an association between postpartum education and mortality, but 72% strongly believed that they were responsible for providing this education.

“Although most nurses felt it was their responsibility, many of them did not report providing consistent messaging to all women,” Suplee said in an interview. “The problem of maternal mortality is multifactorial including the way data is captured and reported; however improving the education of nurses and women themselves is something tangible we feel can be addressed. The public needs to know that almost 700 women die each year in the US according to the CDC as a result of pregnancy or a pregnancy complication – this is not acceptable.”

In addition, the researchers found that feeling very competent in providing education on all of the postpartum complication variables measured was significantly more likely for RNs older than 40 years (P < .001-.003).

“Because it is impossible to accurately predict which women will suffer from a postbirth complication, we recommend all women be provided education on postbirth warning signs,” Suplee and colleagues concluded. “Nurses caring for women during the postpartum period are responsible for providing comprehensive information at the appropriate literacy level and evidence-based patient teaching so all women can recognize and respond quickly to obtain needed care.

“This study identified gaps in knowledge of nurses on maternal mortality and in delivery of consistent education to all postpartum women about potential postpartum complications. More research is needed that focuses on best practices for providing postpartum education on postbirth warning signs and how to more effectively integrate this education into postpartum discharge teaching. Currently, it is not known whether providing education on postpartum complications will lead to changing rates of maternal morbidity or mortality in the postpartum period, another area worth exploring.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.