Presented September 3, 2025 at the 2025 APSF Stoelting Conference on “Transforming Maternal Care: Innovations and Collaborations to Reduce Morbidity and Mortality”
SUMMARY
Grace Lim, MD, MS’s presentation focuses on the next frontier of maternal safety, which extends beyond physical survival to encompass dignity, respect, autonomy, and mental health. The key objective is to transition from focusing solely on individual patient care to developing system-level solutions for quality and equity in maternal care. This involves setting a research agenda that prioritizes patient-centered outcomes (like a sense of control and lack of long-term trauma) and addressing systemic barriers to equitable care, such as the need for more scalable, standardized training and the conceptualization of new tools (“pulse oximeter”) for psychological safety.
Key Points:
- Expanded Definition of Safety
Maternal safety must evolve beyond mere physical survival to include dignity, respect, autonomy, and psychological well-being [02:12, 02:25]. This is viewed as the next critical frontier for anesthesia practice and patient safety [02:25]. - Patient-Centered Outcomes
Patients highly value a sense of control and autonomy and the experience of feeling heard, alongside effective pain management. Patient-centered goals include limited long-term trauma and successful neonatal outcomes [10:34, 15:16]. - Provider-Patient Goal Mismatch
A key finding is a quantifiable difference in priority between patients and providers during care (e.g., Cesarean delivery). Providers prioritize timely, safe care, while patients may prioritize communication and emotional support, highlighting an opportunity for better partnership [11:14, 12:31]. - Systemic Barriers and Facilitators
Systemic barriers include the lack of feasible methods for widespread prenatal anesthesia consultation in private/community settings. Facilitators include the use of risk assessment tools, evidence-based medications, and rethinking the role of support people (like doulas) in the operating room to help build patient trust [13:47, 15:00]. - Need for Scalable Solutions
Following the historical model of anesthesia safety (e.g., the pulse oximeter), there is an urgent need to develop a “pulse oximeter for psychological safety.” This means identifying simple, scalable, and standardized tools (like teaching empathy skills via the NURSE mnemonic) and new monitoring or therapeutic approaches that can be implemented across all hospitals, bridging the gap between training environments and community practice [16:47, 18:36].
ABOUT THE SPEAKER(S)
Grace Lim, MD, MS
Professor and Chief of OB & Women’s Anesthesiology
University of Pittsburg
Grace Lim, MD, MS, is a board-certified obstetric anesthesiologist and physician scientist at whose work centers on advancing patient safety in perinatal care. As Professor and Chief of OB & Women’s Anesthesiology, she has led system-wide improvements in cesarean delivery care, including Enhanced Recovery protocols and postpartum hemorrhage bundles. Dr. Lim is the principal investigator of ELEVATE, a PCORI-funded initiative aimed at optimizing anesthesia choices during cesarean delivery through patient-centered comparative effectiveness research. Her broader research portfolio, supported by NIH and PCORI, focuses on opioid-sparing strategies, labor pain mechanisms, and safe medication use in pregnancy. Nationally, she serves on the Board of Directors for the Society for Obstetric Anesthesia and Perinatology (SOAP) and holds advisory roles with ACOG, AIM, and ASA.
