Presented September 3, 2025 at the 2025 APSF Stoelting Conference on “Transforming Maternal Care: Innovations and Collaborations to Reduce Morbidity and Mortality”
SUMMARY
Elliott Main, MD’s presentation outlines the critical need for transforming maternal care in the U.S. by addressing persistently high rates of maternal mortality (MM) and severe maternal morbidity (SMM). He stresses that progress requires multidisciplinary collaboration, especially with anesthesiology, and system-level change through national safety initiatives. The core focus is on implementing evidence-based protocols to combat the leading causes of SMM—hemorrhage and preeclampsia—while urgently confronting profound racial disparities and system failures characterized by “denial, delay, and dismissal” of patient concerns. The presentation calls for expanding the scope of care to address mortality up to one year postpartum, which is increasingly driven by indirect medical causes and mental health crises.
Key Points
- Severe Racial Disparities
Black women in the U.S. face a 3.5 to 4-fold higher rate of maternal mortality compared to white women, highlighting the most significant national disgrace in healthcare quality [24:33]. - SMM Etiology
Approximately 70% of Severe Maternal Morbidity (SMM) cases are related to obstetric hemorrhage and preeclampsia/severe hypertension, making them primary targets for in-hospital quality improvement [12:27]. - Systemic Deficiencies
Maternal mortality reviews in high-risk cases identified significant provider opportunities (up to 95% of cases), commonly categorized as the “three deadly deeds”: denial, delay, and dismissal of patient symptoms [13:39, 14:09]. - Quality Improvement Strategy
Large-scale improvements are driven by the national adoption of AIM (Alliance for Innovation on Maternal Health) safety bundles and CMQCC toolkits, which standardize response for readiness, recognition, and response to obstetric emergencies [15:13, 16:03]. - Critical Timeliness
Delay is a major driver of adverse outcomes. A 10-minute delay in anesthesiologist involvement, for example, is associated with a 1.6 odds ratio increase in severity; severe range hypertension treatment must be initiated within 30–60 minutes [18:52, 19:26]. - Expanded Mortality Window
The concept of pregnancy-related mortality must expand beyond the traditional 42 days to one year postpartum, recognizing that major drivers in this extended period include cardiovascular disease, substance use, suicide, and trauma [30:32].
ABOUT THE SPEAKER(S)
Elliott Main, MD
Professor of Obstetrics and Gynecology,
Stanford University, Dunlevie Division of Maternal Fetal Medicine
Elliott Main, MD founded and directed the California Maternal Quality Care Collaborative for 16 years to 2023 and served as the Chair of the California Maternal Mortality Review Committee during those years. Nationally, Main was the co-founder and currently the lead for QI Implementation for AIM, the national project, funded thru HRSA and based at ACOG, for supporting state Perinatal Quality Collaboratives in their efforts to reduce maternal mortality and severe morbidity. Main is Professor of Obstetrics and Gynecology at Stanford University in the Dunlevie Division of Maternal Fetal Medicine. He has served or chaired national committees on Maternal Quality Measurement for ACOG, the AMA, The Joint Commission, Leap Frog and CMS. He has authored over 180 articles on maternal mortality, improving obstetric outcomes, obstetric quality measures and perinatal collaboratives. Main has received the ACOG Distinguished Service Award for his work in quality improvement and in 2025, he received the National Quality Forum/The Joint Commission John M. Eisenberg Patient Safety and Quality Award for Individual Achievement.
