Presented September 4, 2025 at the 2025 APSF Stoelting Conference on “Transforming Maternal Care: Innovations and Collaborations to Reduce Morbidity and Mortality”
SUMMARY
Melissa Bauer, DO’s presentation emphasizes that reducing maternal morbidity and mortality (MMM) from conditions like sepsis requires moving beyond hospital walls to engage patients and communities in a model of shared leadership. The project identified three key delays leading to maternal sepsis deaths—recognition, treatment, and escalation of care—and developed strategies to overcome them. These strategies include using culturally relevant, mobile-first educational tools (like QR codes and business cards) to empower patients with knowledge of warning signs and advocacy language, while simultaneously standardizing hospital screening and treatment protocols.
Key Points:
- Community-Driven Implementation
The project utilized shared leadership by creating a Maternal Sepsis Community Leadership Board (including survivors and advocates) and integrating a community leader and survivor consultant into the hospital mentorship teams [02:39, 04:35]. This approach ensures that implementation strategies address community-specific barriers and are co-created with the people impacted by the research [03:44]. - Focus on Three Deadly Delays
The intervention is structured to mitigate the three key delays leading to maternal sepsis deaths: Recognition, Treatment, and Escalation of Care [00:31, 06:39]. The project found that over 90% of the focus needed to be on recognition, as delays here preclude effective treatment and escalation [06:51]. - Sepsis Screening Standardization
Hospitals are advised to use a pregnancy-adjusted screening tool from 20 weeks gestation through 3 days postpartum, and a non-pregnancy-adjusted tool outside this window [08:31, 08:50]. This prevents missed diagnoses (non-adjusted criteria during pregnancy) and alarm fatigue, while preventing omissions of diagnosis postpartum when heart rate returns to normal [09:09, 09:15]. - Non-Traditional Warning Signs
Provider education must emphasize that most patients do not have risk factors and that no fever does not equal no sepsis (25% of deaths occurred without fever) [09:59, 10:16]. Furthermore, patient complaints of “fatigue” must be thoroughly investigated to identify life-limiting weakness, which is an important symptom [18:57, 19:20]. - Patient Education and Accessibility
Patients overwhelmingly preferred receiving health information on their phones rather than paper packets [13:13, 13:21]. The team developed a scannable badge buddy/business card with a QR code linking to standardized, translated ACOG/AIM warning signs and patient resources to bypass hospital discharge barriers and ensure widespread community dissemination [13:37, 14:37]. - Empowering Patient Advocacy
Given that many patients felt unheard or dismissed (e.g., told “you just had a baby”) [18:29, 18:42], a guide with advocacy language and actions was co-created with the community to give patients the specific words and steps needed to seek care and be taken seriously [17:18, 17:24]. - Standardized Treatment Protocols
Treatment focus includes establishing efficient processes for rapid antibiotic administration (e.g., in Pixus, using order sets) and providing proper IV fluid resuscitation (30 mL/kg over 3 hours) [20:20, 20:54]. The presentation stresses the importance of using a chart for ideal body weight to overcome provider resistance to fluid volumes [21:01, 21:17].
ABOUT THE SPEAKER(S)
Melissa Bauer, DO
Associate Professor of Anesthesiology and Population Health Sciences,
Duke University Medical Center
Melissa Bauer is dual fellowship trained in critical care and obstetric anesthesiology and an Associate Professor of Anesthesiology and Population Health Sciences at Duke University Medical Center. Dr. Bauer is independently funded by the National Institutes of Health (Eunice Kennedy Shriver National Institute of Child Health and Development) to work to reduce maternal mortality and morbidity from maternal sepsis. Her research is centered on the early identification and treatment of maternal sepsis and using patient and community engagement to improve maternal care.
