Episode #278 Transforming Maternal Care Through Equity, Science, And Tech

Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Alli Bechtel, and I am your host. Thank you for joining us for another show. We are kicking off an exciting series today. That’s right. It’s time to talk about the 2025 APSF Stoelting Conference: “Transforming Maternal Care: Innovations and Collaborations to Reduce Morbidity and Mortality.” If you weren’t able to attend the Stoelting conference this year, then we hope that you will enjoy this podcast  series and you can also check out recording from the conference on YouTube. Check out the show notes for more information.

Before we dive further into the episode today, we’d like to recognize Nihon Kohden, a major corporate supporter of APSF. Nihon Kohden has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, Nihon Kohden – we wouldn’t be able to do all that we do without you!”

Now, it’s time to get back into the conference and focus on transforming maternal care. Thank you to our industry sponsors for supporting the 2025 APSF Stoelting Conference: BD, Medtronic, Solventum, and Intelliguard

The next session focuses on Inequities in Care Delivery and Outcomes. Our first speaker is Jill Mhyre, a Professor and Chair of Anesthesiology at the University of Arkansas for Medical Sciences to talk about Disparities in outcomes. Let’s start with the definition of health disparities which are “largely preventable health differences that adversely affect populations who experience greater challenges to optimal health and are closely tied to social determinants of health and influence policy and resource utilization in our health systems. These populations include racial and ethnic minority populations, underserved rural, socioeconomic, disabilities, and sexual minority groups. These populations are at increased risk for maternal morbidity and mortality. There is a 3-fold increased risk for black mothers compared to white mothers. There is also an increased risk depending on where you live with higher risk in some states in the South and rural areas. There has been an increase in maternity care deserts in the US with decreasing number of delivering hospitals. This leads to decreased prenatal care for patients who may not be able to or want to travel to a major center and have concerns about separation from their family.

Let’s review the 2024 article “Structural Racism and Use of Labor Neuraxial Analgesia Among Non-Hispanic Black Birthing People.” You can find the citation in the show notes. This cross-sectional study annualized 2017 US Natality data for non-Hispanic Black and White birthing people and determined that there was reduced use of neuraxial labor analgesia for Non-Hispanic black patients due to structural racism which involves a system where public policies, institutional practices, cultural representations, and other norms work together to maintain and perpetuate racial group inequities in housing, education, employment, earnings, benefits, credit, media, health care, or criminal justice. The author in this study advocate for interventions to address structural racism in anesthesia care for the benefit of black and white patients especially in areas with the highest racism index. They highlight the 2021 ASA recommendations for reducing maternal peripartum racial and ethnic disparities in anesthesia care including the following:

• accurate documentation of race and ethnicity and primary spoken language
• creation of disparities dashboards to track changes over time
• education of anesthesia professionals on racial and ethnic disparities in anesthesia care and the roles of bias, institutional, and structural racism
• development of best practices for shared decision-making when discussing labor neuraxial analgesia
• and diversifying the anesthesia workforce in their department

We hope that you will check out this the entire statement. See the show notes for more details.

Another important consideration is the increased use of general anesthesia for c-section for black and Hispanic patients. This same increase is not seen when patients have a labor epidural in place. There is an opportunity here to partner with patients and obstetricians to figure out who needs a C-section, participate in shared decision making, help patients understand the benefits of epidural analgesia, rounding on catheters to make sure patients are receiving high quality labor analgesia which is in the most important predictor for successful conversion to C-section anesthesia. Once you are in the operating theatre for a c-section, it is important to continue to evaluate patients for pain since vulnerable populations may have intraoperative pain that is dismissed or not prevented. There are times when it may be necessary to convert to general anesthesia and tools such as pulse oximetry and video laryngoscopy have improved safety in this setting.

Here are the key takeaways from Jill’s talk.

• Disparities in mortality and severe maternal morbidity are persistent.
• In OB anesthesia, we see the following:
• Lower use of neuraxial labor analgesia
• High use of general anesthesia for c-section delivery
• Lower quality of peripartum pain management
• While local and statewide initiatives to implement standardized care show promise to reduce health disparities, contraction of federal support for research and healthcare delivery, accelerating rural hospital closures, and state restrictions on bodily autonomy threaten to exacerbate them.

Inequities in care delivery are persistent and prevalent with complex interactions between social determinants of health upstream from our clinical encounters. Going forward, we need to partner with our patients.

Our next speaker is Meghan Lane-Fall, Professor and Chair of Anesthesiology at Columbia University Vagelos College of Physicians and Surgeons. Her talk is “Implementation Science, what is it and why does it matter for maternal health?” Implementation science is the bridge between evidence and practice for when we know what we ought to do and we know that we don’t do that. Meghan takes us through a stepwise algorithm. The first stop is ‘Has the practice of interest shown efficacy? Does it work?’ If the answer is no, then efficacy research is needed. If the answer is Yes, then we move on to the next question. ‘Has the practice of interest shown effectiveness?’ If no, then effectiveness research is needed. If partial, then it’s time to move onto hybrid effectiveness/implementation trials. If Yes, then you can move on to mixed methods studies to understand context, design implementation strategies, and test the implementation strategies. This is the important step where we know that it works, but people aren’t doing it yet. Implementation strategies can be thought of as the stuff we do to get people to go the practice of interest. These strategies may include patient education, advocacy phrases, peer-review publications to improve knowledge, team training, building relationships between institutions, and policy level interventions like joint commission and bundles for some examples.

Check out the article, “Scoping implementation science for the beginner: locating yourself on the “subway line” of translational research” for more information and I will include a link in the show notes.

Another important consideration when it comes to implementation science is how do we acquire the resources to do the things that we want to do? It is vital to identify the return on investment and it may involve partnering with industry teammates and identifying C-suite partners. When it comes to maternal patient safety, the argument starts with the understanding the Labor and Delivery is the riskiest place in the hospital, but it could be the safety place. This is where we need implementation science to help bridge the gap between evidence and practice to improve maternal patient safety going forward.

Our next speaker is Mahesh Vaidyanathan, an assistant professor of anaesthesiology at Northwestern University Feinberg School of Medicine, to talk about Opportunities for technology to improve monitoring and care and address disparities. An important consideration is that level of care can change drastically depending on county and location. This means that there is an opportunity to use technology to be a force-multiplier to support equitable care anywhere in the world. We are moving into a future where we have the ability to consume data and rapidly reproduce it in real time and de-identified which allows for sharing knowledge and care around the country and around the world.

Mahesh offers several examples of using technology to improve care. One example of a technology that can be used in low and middle income countries is ultrasound scanning with AI to give diagnoses. It works by following a scanning protocol and then letting the AI and software to give findings related to gestational age, location of placenta, and number of births. This is being developed now and takes the burden off of having an expert in the room and even on relying on having an expert available. Another example is building an algorithm to try to predict when a fetal heart rate deceleration is going to happen so that clinicians can take action before it is too late. The future of how we harness healthcare data and share it around the world may lead to important advances in patient safety around the world.

Our final speaker for this session is Micheal Mestek, Vice President of Clinical Research and Medical Science at Medtronic, to talk about equitable monitoring with pulse oximetry. The risk for maternal mortality is real. Despite having one of the most technologically advanced healthcare systems in the world, the US continues to have unacceptably high rates of maternal mortality and more than 80% of pregnancy-related deaths are preventable. Michael provides an overview for a pregnant patient might interact with monitors and technology throughout the peripartum period. Technology needs to be accurate and work for all patients. We have learned that pulse oximetry readings are influenced by skin pigmentation, perfusion index, and hypoxemia with implications for accuracy in darker skin and low perfusion cases. Medtronic has made a commitment to improve the performance of their technology. An area where this is crucial is with oxygen saturation and heart rate monitoring during the neonatal transition period. Inequity occurs when subtle differences add up starting from the base technology performance, then onto sensor selection and position, plus patient perfusion and patient skin pigmentation. An important consideration is that education can be helpful to address sensor selection and positioning. The next step for Medtronic is a vision for equitable delivery of care with research in the Medtronic Physiology Lab as well as enhanced guidelines and standards, collaboration with regulators, researchers, and clinicians, and investment in innovation and education. 6 words drive the Medtronic company: Alleviate pain, restore health, and extend health. These 6 words are also vital when it comes to maternal care and keeping patients safe throughout the peripartum period.

Thank you so much for tuning in to the third episode in our series on the 2025 APSF Stoelting Conference.  If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

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Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2025, The Anesthesia Patient Safety Foundation