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New Alerts from The Joint Commission Focus on Maternal Health to Help Reduce Mortality and Morbidity

The United States is facing a maternal health crisis with the highest mortality rate for pregnant and postpartum patients among developed countries.1 The Joint Commission published two new resources to help reduce mortality and morbidity in pregnant and postpartum patients: Sentinel Event Alert, Issue 66: Eliminating racial and ethnic disparities causing mortality and morbidity in pregnant and postpartum patients and Quick Safety, Issue 67: Mental health conditions leading cause of pregnancy-related deaths. 

Higher pregnancy-related mortality and morbidity rates for people of color demonstrate how racial and ethnic disparities are a patient safety and quality issue. These higher rates may be due to several factors such as structural racism, implicit biases and their impact on access to care and quality of care, and prevalence of chronic diseases. 

The Sentinel Event Alert emphasizes how the social determinants of health – the social and economic conditions that affect health status and outcomes – impact pregnancy-related morbidity and mortality. Determinants may include housing and food insecurity; lack of access to healthcare, insurance or transportation; low income and/or education; and racism, stereotyping and discrimination.

Recommended safety actions for healthcare organizations to provide prenatal, perinatal and postpartum care in an environment that supports diversity, equity and inclusion are highlighted in the alert, including:

  • Encouraging access to prenatal care. 
  • During prenatal care, screening patients for hypertension, risk of hemorrhage and other medical and socioeconomic factors. 
  • Providing support and options that meet the needs and expectations of patients, including those who wish to deliver in a home or birthing center environment, while managing their risk of pregnancy complications. 
  • Preparing for the possibility of hemorrhage and other complications. 
  • Implementing performance standards and improvement initiatives in every unit. 
  • Addressing unconscious biases of healthcare providers toward people of color through universal training. 

Additionally, the Quick Safety advisory provides an overview of how mental health conditions are the leading cause of pregnancy-related deaths. A recent report from the Centers for Disease Control and Prevention (CDC) indicated issues related to mental health, such as depression, anxiety, death by suicide and substance use disorders (SUDs) are the most frequent underlying cause for maternal death, followed by clinical conditions.  

The advisory provides risk factors for perinatal depression and postpartum depression, and risk factors for pregnancy- and postpartum-related suicidality. Several safety actions to consider are included in the alert, including:

  • Screening patients at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool. 
  • Closely monitoring, evaluating and assessing pregnant patients with current depression or anxiety, a history of perinatal mood disorders, risk factors for perinatal mood disorders or suicidal thoughts. 
  • When indicated, being prepared to initiate medical therapy and/or refer patients to appropriate behavioral health resources. 
  • Having systems in place to ensure follow-up for further assessment/screening, diagnosis and treatment. 
  • In the interpregnancy period, as part of the well woman exam, screening for depression and SUDs, and offering referral and resources as indicated. 
  • Establishing a clinical workflow that improves the identification of suicidal thoughts and behaviors, and training staff in the workflow. 

Helpful resources and references are included in both the Sentinel Event Alert and Quick Safety advisory. 

“We must address the maternal health crisis immediately, especially as the COVID-19 pandemic exacerbated racial disparities in pregnancy-related outcomes,” says Ana Pujols McKee, MD, FACP, executive vice president, chief medical officer, and chief diversity, equity and inclusion officer, The Joint Commission. “During 2020, death rates for Black and Hispanic pregnant or postpartum patients rose significantly, while the rates for their white counterparts rose only slightly. To be clear, an increase in rates of harm is not acceptable for any group. The Joint Commission is committed to working with healthcare organizations and the larger healthcare community to help make pregnancy and the postpartum period safer for all.”

The Joint Commission is further addressing maternal health through a collaboration with the American College of Obstetricians and Gynecologists (ACOG) which includes the Maternal Levels of Care (MLC) Verification program and Advanced Certification in Perinatal Care (ACPC). 

1 Hoyert DL. Maternal mortality rates in the United States, 2020. NCHS Health E-Stats. 2022. 

2 Centers for Disease Control and Prevention. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017–2019 | CDC.