In December 2018, the federal government signed the Preventing Maternal Deaths Act which allocates federal grants to states to investigate pregnancy-related deaths. This five-year initiative has sparked an increased discussion on how to best support mothers during pregnancy, labor and delivery, and post-partum.

Dr. Emily Amarosa

Dr. Caroline Scoones

Although surgical deliveries are certainly a component of this concerning trend, the risks associated with maternal deaths are more complicated than just the increase of cesarean sections. The crumbling primary care system has resulted in more women beginning pregnancy with unidentified or untreated health issues, which can present complications. With mothers having children at a later age, these health issues can be further exacerbated during pregnancy. These underlying health issues are significant contributors to maternal deaths as these conditions can result in hemorrhaging, blood pressure disorders (including preeclampsia), cardiac disease, blood clots and more.

At Harbour Women's Health, our team focuses on preventative care and quality initiatives to provide a thorough and detailed approach to ensure a healthy pregnancy, delivery and post-partum period for each patient. From the first obstetric appointment, the providers follow established protocols to identify any potential complications so that the patient receives complete care. Our team then works with patients to develop their optimal pregnancy plan, including a healthy diet and regular exercise, which can prevent the development of new pregnancy-related complications, such as gestational diabetes.

If potential complications are identified which require specialized care, our goal is to provide access to this care as soon as possible to best support the pregnancy. Harbour Women's Health has established collaborations with related medical professionals, including endocrinology, cardiology and maternal fetal medicine/ high risk pregnancy. In addition, an obstetrician specializing in high-risk pregnancy works in our Portsmouth office twice each month to meet with these unique patients.

Harbour Women's Health is dedicated to facilitating natural deliveries as often as possible and maintains a conservative approach to surgery. However, an induction may be recommended if a significant potential medical complication is identified. Before recommending a C-section, our providers use evidence-based protocols following national guidelines to analyze whether a vaginal delivery is still possible. If a C-section is deemed necessary, the surgical delivery is audited to ensure that it was in the patient's best interest.

Our team performs deliveries at Portsmouth Regional Hospital, which upholds its own quality and safety protocols to prevent maternal complications. These initiatives include weekly meetings addressing prenatal concerns and risk factors as well as coordinating infant care with consultants. Patients are screened on admission for risk factors, such as sepsis, hemorrhage and blood pressure, using best practice protocols like California Collaboratives. This toolkit was developed by California Maternal Quality Care Collaborative (CMQCC) to help obstetricians and hospitals have a timely and swift response to hemorrhaging during labor and delivery and have already demonstrated a profoundly positive impact on the California maternal death rate. Should an unexpected complication or emergency arise, Seacoast Family Care Services at Portsmouth Regional Hospital has immediate access to critical services, including: a fully-functional blood bank; a cardiovascular health center; intensive care unit (ICU); access to trauma surgeons; and, a close and communicative relationship with maternal fetal medicine specialists.

Following delivery, the post-partum period is an extremely vulnerable time for obstetric patients, especially those with medical issues during labor and delivery. At Harbour Women's Health, we recognize the need to mitigate post-partum readmissions and exceed industry standards with our preventative-solutions approach. Our providers strive to schedule post-partum patients two weeks following hospital discharge with high-risk patients scheduled within days of discharge.

While signing the Preventing Maternal Deaths Act is a step in the right direction, this is just the first step to decreasing the number of surgical deliveries, maternal health complications and ultimately, maternal death. While this initiative in underway, obstetrics professionals must be vigilant to provide their patients with reliable experience, preventative care and inclusive support to identify and mitigate complications during and after delivery. We owe it to our patients to provide the personalized care each mom needs with the quality of care each woman deserves.

Dr. Emily Amarosa and Dr. Caroline Scoones are OB/GYNs at Harbour Women's Health located in Portsmouth. The practice was voted First Place for Best OB/GYN in 2017, 2018 and 2019 in the Best of the Seacoast and is proud to have two providers named as New Hampshire Magazine 2019 Top Doctors.

For over 50 years, Harbour Women's Health has provided compassionate, experienced care for high- and low-risk pregnancies as well as the full range of gynecologic services. Our practice offers obstetrics and gynecology physicians, a fellowship-trained Urogynecologist, North American Menopause Society (NAMS) certified practitioners, and Women's Health Nurse Practitioners care for patients. Harbour Women's Health has been awarded Patient-Centered Specialty Practice Recognition by the National Committee for Quality Assurance and has achieved Safety Certification in Outpatient Practice Excellence from the American Congress of Obstetricians and Gynecologists. Call 431-6011 for more information.

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