TMC PULSE

12 t m c » p u l s e | m a r c h 2 0 1 9 Making childbirth safer for women around the globe is the mission of LISA M. HOLLIER, M.D., president and interim CEO of The American College of Obstetricians and Gynecologists. A professor in the OB-GYN department at Baylor College of Medicine, Hollier (pronounced OH-lee-ay) is chief medical officer for OB-GYN at the Texas Children's Health Plan and medical director of OB-GYN at The Center for Children and Women. She also chairs the Maternal Mortality and Morbidity Task Force, a multidisciplinary group within the Texas Department of State Health Services. Hollier has spent most of her career working with underserved populations. Spotlight Q | How did you end up so focused on maternal mortality? Was there some moment or incident that crystallized your interest and commitment? A | When I was a resident in Dallas, a woman came into the hospital. She'd had a totally uncom- plicated pregnancy. She was young—early 20s. I was about the same age. She came in with the worst headache of her life. She got to the labor room and, unfortunately, she lost consciousness. When she lost consciousness, her baby's heart rate just plummeted. So they scooped her up, rushed her to the delivery room, did an emergency Caesarean delivery and delivered a baby girl. Her daughter was fine but the mom did not wake up. She went to the intensive care unit after her delivery and that's where I took over her care. She had suffered a massive intracranial hemorrhage. I worked alongside multidisciplinary teams and really there was nothing we could do. She passed away. And one of the pictures that has stuck with me in my career was actually her husband, when he was leaving the hospital with their baby. It's supposed to be the happiest day, but he was alone and he was going to raise their daughter alone. He was just so lost. I can still see his face. Q | Do your colleagues have similar stories? A | One of the things that struck me when I was in Washington, D.C., meeting with legislators a lot last year, was all of the doctors who were there had been through the loss of a patient that was just devastating. And it's just … we need to make it better. or states on bundles. Bundles are best practices based on four Rs: readiness, recognition, response and reporting. AIM got funding from the Health Resources and Services Administration to imple- ment these best practices. Q | How would the "four Rs" address the problem of postpartum hemorrhaging in the delivery room? A | The 'hemorrhage cart' is under the 'ready' bundle. If you prepare, then your facility is ready. Another example would be team-based training in your facility—not just the doctors, but the nurses and anesthesiologists and, in some places, your front desk staff who are manning the phones. All those people have to be aware because you might have to contact the blood bank, for example. Recognition is the next part of the bundle. How do you recognize that bleeding is happening? Blood doesn't always come out of the vagina; a mother could be bleeding in her belly. The next piece is protocols for how you respond: when everybody has practiced together they can respond quickly and in the same way every time with applicable meds that are ready on the cart. And then you just have to keep track. How did you do? Did the patient rally? Were there complications? The bundles are a set of best practices that can be modified by each facility. But in every case, it's: be ready, recognize a problem when it happens, respond quickly and appropriately and keep track of how you do. Q | What is the biggest public misconcep- tion about maternal mortality you and your colleagues have encountered? A | The biggest problem is that nobody really believed us when we started talking about the problem. We are the most incredible nation with the best medical care ever—how could we possibly have a problem with maternal mortality? In 2011, a group of us who primarily at that time were work- ing with Harris Health System and The American College of Obstetricians and Gynecologists (ACOG) first went to the state legislature and said maternal mortality is a huge problem and it's getting worse. There was a proposal for a mater- nal mortality review that never even got out of the public health committee. Nobody was talking about it. By 2013, we were able to start to raise some awareness of the issue, but there still wasn't this national outcry. By 2016, the publication of some articles in major OB-GYN journals really brought a lot of attention to a number of areas and one of those was the state of Texas. Q | What is the most important next step? A | Saying, 'Yes we have a problem' was the first step. The next step is: 'What are we going to do about it?' Q | The Alliance for Innovation on Maternal Health, or AIM, has played a major role in promoting safe and consistent maternity care. What can you tell us about it? A | AIM is a national initiative, with 24 states participating, that works with hospital systems

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