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Quality of Maternal Healthcare in Indian Health Service Hospitals

Maternal mortality and morbidity are increasing in the United States, and up to 60 percent of maternal deaths may be preventable.[1], [2], [3] The American College of Obstetricians and Gynecologists issues guidance on safe practices during labor and delivery intended to help reduce maternal mortality and other complications. Failure to follow recommended practices is not necessarily improper and does not always cause patient harm, but it may indicate substandard quality of care. We will use medical record reviews by an obstetrician/gynecologist specializing in patient safety to identify and describe examples of potentially substandard care during labor and delivery in IHS hospitals. These anecdotes may help IHS to target hospital improvement efforts. We will also identify factors that may be related to the potentially substandard care.


[1] Callaghan, WM, "Severe Maternal Morbidity Among Delivery and Postpartum Hospitalizations in the United States." Obstetrics and Gynecology, Nov. 2012. Accessed at https://journals.lww.com/greenjournal/Fulltext/2012/11000/Severe_Maternal_Morbidity_Among_Delivery_and.8.aspx#pdf-link on June 18, 2019.

[2] American College of Obstetricians and Gynecologists, "Obstetric Care Consensus," Sept. 2016 (reaffirmed 2018). Accessed at https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Severe-Maternal-Morbidity-Screening-and-Review?IsMobileSet=false on December 12, 2018.

[3] Centers for Disease Control and Prevention Foundation, "Building U.S. Capacity to Review and Prevent Maternal Deaths: Report from Nine Maternal Mortality Review Committees." Accessed at https://www.cdcfoundation.org/sites/default/files/files/ReportfromNineMMRCs.pdf on June 18, 2019.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
July 2019 Indian Health Service Quality of Maternal Healthcare in Indian Health Service Hospitals Office of Evaluation and Inspections OEI-06-19-00190 2020