Multimedia MCH Resources Bibliography

Annotation: This Naloxone toolkit is designed for nurses, obstetrical providers, and pharmacists to address unintentional overdose, which is the leading cause of pregnancy-related death in Ohio, particularly in the postpartum period. Developed with input from patient partners, including those with lived experience with substance use and postpartum patients without such history, the toolkit aims to foster systems and culture change by integrating Naloxone education and access into postpartum discharge processes to prevent overdose-related maternal mortality. The resource provides guidance for clinicians on how to normalize conversations about Naloxone and offers a discussion guide, emphasizing the use of non-stigmatizing and person-first language to reduce stigma and increase patient comfort. Key sections include a toolkit implementation checklist for hospitals, educational points to cover with patients, an overview of the clinical pharmacology of Naloxone, and a detailed navigation guide for accessing free Naloxone kits in Ohio via mail-order, pharmacies, and distribution sites.

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Keywords: Drug abuse, Pharmacotherapy, Postpartum care, Resources for professionals, Substance abuse treatment

Annotation: This clinical checklist, presented in both video and text formats by a nurse practitioner, provides tips and guidance for healthcare teams and maternal and child health (MCH) professionals speaking with new parents about sex and intimacy after delivery. The resource explains how providers can improve the traditional six-week postpartum visit by addressing their own biases and using the recommended "B" assessment (covering Brain, Breasts, Belly, and Bottom) to gather necessary historical and mental health information. The checklist advocates for redefining the statement "you can resume sex" to be more inclusive and person-centered, discussing non-penetrative intimacy, and referring patients to experts like pelvic floor physical therapists. This Clinical Tool addresses important postpartum recovery topics including Mental Health/Hormones and Family Planning/Contraception, and also lists external resources for sexual wellness.

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Keywords: Contraception, Family planning, Guidelines, Postpartum care, Resources for professionals, Sexual behavior, Sexuality

Annotation: This web page from the Lifeline for Moms program at UMass Chan Medical School provides resources to help obstetric settings integrate perinatal mental health care into their everyday workflow. The main resource is an Overview Guide, available in two versions: a self-guided version and a remote support version that includes additional materials for virtual meetings with Lifeline for Moms consultants. The Guide includes assessment documents, tools for scheduling implementation and creating practice goals, workflow documents, screeners and scorers for depression, anxiety, PTSD, and self-harm, and resources for developing referral directories and patient handouts. The page also offers an Obstetric Care Clinician Packet with reference materials and patient handouts, as well as a 4-part online training module for obstetric care clinicians and staff. Individual files for each component of the Guide are available for download.

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Keywords: Mental health, Obstetrical care, Perinatal care, Resources for professionals, Service integration

Annotation: This multiyear initiative and collection of tools and resources from the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC) seeks to enhance the identification and management of pregnancy-related emergencies in nonobstetric settings, addressing missed opportunities identified by maternal mortality review committees among practitioners in emergency departments, EMS/911, and urgent care facilities. The resources help enhance readiness to identify and respond to life-threatening complications that can occur during pregnancy or up to one year postpartum, including (1) cardiovascular conditions such as cardiomyopathy, (2) hypertensive emergencies like preeclampsia, eclampsia, and stroke, and (3) conditions related to mental health such as suicide and overdose. ACOG provides tailored resources for each setting, offering algorithms and pregnancy status signs (in English and Spanish) for Emergency Departments, model guidelines for EMS covering conditions like postpartum hemorrhage and elevated blood pressure, and algorithms and guidelines for Urgent Care focusing on acute hypertension and cardiovascular disease. Additionally, the initiative compiles supporting resources from other organizations covering maternal mortality education, mental health (including the National Maternal Mental Health Hotline and 988 Suicide and Crisis Lifeline), and substance use disorders.

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Keywords: Emergency medical services, Guidelines, Models, Obstetric emergencies, Perinatal care, Resources for professionals, Therapeutics

Annotation: This workbook provides guidance for implementing evidence-based practices to improve care for pregnant and postpartum individuals with cardiovascular disease (CVD). It summarizes the evidence on the significant risks of CVD in pregnancy, which can exacerbate pre-existing conditions or lead to new disorders due to the hemodynamic changes of pregnancy. The workbook presents data from Missouri's Pregnancy-Associated Mortality Review, finding that CVD accounted for 30% of pregnancy-related deaths from 2017-2021, with most deemed preventable and Black women disproportionately impacted. To address this crisis, the AIM Cardiac Conditions in Obstetric Care patient safety bundle components are provided, with detailed strategies for implementing universal cardiac risk screening, rapid response protocols, cardio-obstetric teams, care coordination, patient education, and equity-focused data monitoring. Emphasis is placed on early recognition, diagnosis, and treatment to prevent complications and death. Resources and references are included for further training and implementation.

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Keywords: Cardiovascular diseases, Evidence-based medicine, Guidelines, Maternal morbidity, Maternal mortality, Missouri, Obstetrical complications, Perinatal care, Postpartum care, Prevention, Quality improvement, Resources for professionals, State initiatives

Annotation: This workbook provides guidance on addressing fatal injuries, particularly intimate partner violence (IPV), homicide, suicide, and motor vehicle collisions (MVCs), as significant contributors to maternal mortality. It summarizes the evidence on the heightened risks of homicide and suicide for pregnant and postpartum women, with disparities among adolescents, Black women, and those with mental health conditions or IPV history. Environmental factors like poverty, lack of support, and firearm access also play a role. The workbook presents concerning data from Missouri's Pregnancy-Associated Mortality Review on injury-related deaths, finding that homicides and suicides, often involving firearms and IPV, accounted for a significant portion of pregnancy-related mortality. Younger women, Black women, Medicaid participants, and those in metropolitan areas were disproportionately impacted. MVCs were a leading cause of deaths not directly related to pregnancy. Key recommendations are provided for healthcare providers and community organizations to improve screening, intervention, support, and prevention efforts around mental health, IPV, and vehicle safety to reduce maternal injury deaths. Resources and references are included for further training and implementation.

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Keywords: Data, Guidelines, Injury prevention, Maternal mortality, Missouri, Risk factors, State initiatives

Annotation: This resource kit provides comprehensive guidance for optimizing transfers from community birth settings (planned home births or freestanding birth centers) to hospitals when higher levels of care are needed. The document outlines best practices, tools, and resources for developing collaborative systems of care between community birth providers, emergency medical services, and hospital teams. Key sections cover readiness planning, recognition and prevention strategies, response protocols, reporting/systems learning approaches, and respectful care practices. The kit emphasizes health equity, trauma-informed care, and the importance of standardized communication protocols during transfers. It includes numerous practical examples, templates, and educational resources to support quality improvement initiatives. It aims to facilitate safe and respectful transfers by promoting integration and coordination between community and hospital-based maternity care providers.

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Keywords: Access to care, Birthing Centers, Childbirth, Guidelines, Health care systems, Home childbirth, Maternity hospitals, Obstetrical care, Perinatal health, Risk factors, Service coordination

Annotation: This toolkit is designed to support the preparation of maternity and pediatric caregivers to overcome barriers and deliver safe, effective, and coordinated care for mothers and newborns affected by Opioid Use Disorder (OID.

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Keywords: Addiction, Guidelines, Infant health, Maternal health, Resources for professionals, Substance use disorders, Therapeutics

Annotation: This resource workbook for healthcare providers addresses evidence-based care practices for maternal-infant dyads affected by substance use disorder. The workbook presents key evidence-based practices including universal screening with validated tools following the screening, brief intervention and referral to treatment process, medications for opioid use disorder such as buprenorphine and methadone for pregnant and postpartum people, and the Eat, Sleep, Console model of care for infants experiencing neonatal abstinence syndrome. It emphasizes that substance use disorder is a chronic medical condition requiring evidence-based treatment and highlights the importance of trauma-informed, anti-racist care to address stigma and discrimination. The workbook includes the Alliance for Innovation on Maternal Health Care for Pregnant and Postpartum People with Substance Use Disorder patient safety bundle components organized into readiness, recognition and prevention, response, reporting and systems learning, and respectful care categories. It presents outcomes from the Missouri Neonatal Abstinence Syndrome Collaborative showing a 23.9% reduction in transfer rates for infants diagnosed with or at risk for withdrawal, and discusses Missouri's maternal mortality data indicating that mental health conditions including substance use disorder were the primary cause of pregnancy-related deaths from 2018 to 2020. Resources include screening tools, educational materials, guidance documents for urine drug testing and plans of safe care, and training opportunities specific to Missouri providers.

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Keywords: Guidelines, Infant health, Maternal health, Missouri, State initiatives, Substance use disorders

Annotation: This workbook serves as a resource for health care providers addressing maternal sepsis recognition and treatment in pregnant and postpartum patients. The workbook presents evidence on maternal sepsis as the body's life-threatening response to infection, noting that between 2017 and 2019, infection was the fourth leading cause of pregnancy-related death in the United States, with Black women having more than twice the risk of maternal sepsis compared to white women. Included are key challenges in maternal sepsis recognition and recommended procedural approaches. The workbook details the complete Alliance for Innovation on Maternal Health Sepsis in Obstetric Care Patient Safety Bundle components, covering readiness requirements including multidisciplinary team protocols and rapid response procedures, recognition and prevention measures such as evidence-based sepsis screening tools and infection prevention protocols, response protocols emphasizing early antibiotic administration within one hour and source control measures, and reporting and systems learning processes including multidisciplinary case reviews and bias consideration. The workbook addresses Missouri-specific data showing infections as the fifth leading cause of pregnancy-related deaths from 2018-2020, with sepsis as the fourth leading indicator for severe maternal morbidity and significant racial disparities noted, and includes extensive resources for sepsis evaluation flow charts, screening tools, simulation training scenarios, order sets, and patient education materials.

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Keywords: Emergency health services, Guidelines, Infectious complications complications, Missouri, Protocols, Resources for professionals, Sepsis, State initiatives

Annotation: This workbook addresses obstetric emergency triage and care for health care providers, particularly those in nonobstetric settings and maternity care deserts. The workbook presents evidence on the critical access challenges facing pregnant and postpartum patients, noting that one in 12 women live in areas with low or no access to maternal health care and that 41.7% of Missouri counties are defined as maternity care deserts compared to 32.6% nationally. It outlines comprehensive strategies for hospitals without obstetric services, including implementation of education and simulation drills for emergency deliveries and maternal emergencies such as hypertension, sepsis, and hemorrhage, creation of emergency medication kits, use of algorithms and early warning systems, and establishment of partnerships with tertiary medical centers for consultation and transfer agreements. The workbook details the complete Alliance for Innovation on Maternal Health Emergency Triage and Care Patient Safety Bundle components, covering readiness requirements such as rapid response team identification, recognition and prevention measures including pregnancy screening protocols, response protocols for routine births in nonobstetric settings and obstetric emergencies, and reporting and systems learning processes including huddles and debriefs. It emphasizes trauma-informed care principles and respectful, equitable care for all patients, and includes extensive resources for obstetric triage tools, emergency protocols, simulation training materials, transport guidelines, telehealth consultation resources, and patient education materials. The workbook specifically addresses Missouri's challenges with rural hospital closures and provides evidence-based practices to ensure continual readiness for obstetric patients in all hospital settings.

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Keywords: Access to care, Emergency health services, Missouri, Obstetrical care, Resources for professionals, Rural health, State initiatives, Triage

Annotation: The workbook outlines evidence-based practices for improving recognition of and response to obstetric hemorrhage, including hemorrhage risk assessments categorized as low, medium, and high risk that should be completed on admission, during labor, and post-delivery. It emphasizes the critical importance of quantification of blood loss using volumetric containers, weighing scales, or computerized image recognition rather than estimation, as postpartum hemorrhage occurs in about 40% of low-risk birthing people. The workbook presents the Alliance for Innovation on Maternal Health Patient Safety Bundle components, which include stage-based management plans, hemorrhage supply carts, immediate access to hemorrhage medications, standardized education for obstetric teams, multidisciplinary drills, and case review processes. It addresses Missouri-specific data showing obstetric hemorrhage as the fourth leading cause of pregnancy-related deaths from 2018-2020, with significant racial disparities in transfusion rates, and notes that between 54% to 90% of hemorrhage-related deaths are preventable. The workbook includes extensive resources for implementation including assessment tools, quantification worksheets, stage-based guidelines, simulation training materials, and patient debriefing forms, and provides trauma-informed guidance for supporting patients and families after hemorrhage events.

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Keywords: Emergency medical services, Hemorrhage, Missouri, Obstetric care, Obstetric complications, Postpartum hemorrhage, Quality improvement, State MCH Programs

Annotation: This resource workbook for healthcare providers addresses integrating mental health care into obstetric settings to improve outcomes for pregnant and postpartum people. It presents evidence-based guidance including universal screening recommendations for depression, anxiety, bipolar disorder, and post-traumatic stress disorder at multiple points during the perinatal period, with particular emphasis on screening for bipolar disorder prior to initiating antidepressant treatment due to risks of mania, psychosis, and suicide. The workbook advocates for behavioral health therapy as the priority treatment for mild to moderate conditions and stresses the importance of trauma-informed care, anti-racism training, and addressing social drivers of health to create safe environments for disclosure and treatment. It includes the Alliance for Innovation on Maternal Health Perinatal Mental Health Conditions patient safety bundle components organized into readiness, recognition and prevention, response, reporting and systems learning, and respectful care categories. The publication highlights Missouri data showing mental health conditions as the leading cause of pregnancy-related deaths from 2018 to 2020, with suicide deaths doubling and all mental health-related deaths found to be preventable. Resources include screening tools, provider toolkits, educational materials, and information about the Missouri Maternal Health Access Project, a statewide perinatal psychiatry access program.

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Keywords: Mental health, Missouri, Obstetrical care, Perinatal care, Service integration, State Initiatives

Annotation: This workbook provides guidance for implementing evidence-based practices to improve postpartum care during the transition from hospital discharge to outpatient follow-up. It summarizes trends in U.S. maternal mortality, with more than 50% of pregnancy-related deaths occurring in the postpartum period. The workbook outlines ACOG's updated recommendations for postpartum care as an ongoing process through 12 weeks after birth, including an initial visit within 3 weeks and a comprehensive visit by 12 weeks. It presents Missouri-specific data on the timing and causes of pregnancy-related deaths, low postpartum visit attendance rates, and shortages of obstetric and mental health providers. Key objectives and strategies are provided for improving postpartum transitions, such as implementing discharge templates and processes, increasing postpartum visit attendance, screening for medical and mental health conditions, providing linkages to specialist and community-based care, and leveraging Medicaid coverage extensions. The AIM Postpartum Discharge Transition Bundle components and resources for implementation are included.

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Keywords: Guidelines, Health care disparities, Missouri, Patient discharge, Postpartum care, Quality improvement, State initiatives

Annotation: This workbook provides guidance for implementing preconception and interconception care, which focuses on optimizing the health of individuals before and between pregnancies to improve maternal and infant outcomes. It summarizes the evidence on the importance of addressing modifiable risk factors prior to pregnancy, such as chronic disease management, nutritional status, substance exposure, and preventive health services. The workbook highlights concerning trends in maternal morbidity and mortality in the U.S., with stark racial disparities, and presents Missouri-specific data on conditions like hypertension, diabetes, and obesity that contribute to adverse outcomes. Evidence-based recommendations are provided for key components of preconception and interconception care across health care settings, including family planning, preventive screenings, chronic disease management, breastfeeding support, and depression screening. The workbook offers clinical tools and resources for providers to implement this care to promote optimal health for birthing people.

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Keywords: Guidelines, Health care disparities, Missouri, Preconception care, Prevention, Primary care, Risk factors, State initiatives

Annotation: This workbook provides guidance for implementing strategies to safely reduce primary cesarean births. It summarizes the evidence on the rising cesarean rates in the U.S., which have increased risks for maternal morbidity and mortality, neonatal complications, and disparities, particularly among Black and Indigenous populations. Key strategies are outlined for promoting vaginal births and reducing medically unnecessary cesareans, including improving education and shared decision-making, supporting intended vaginal births through evidence-based practices, managing labor abnormalities, using data to drive practice changes, and integrating midwives and doulas into birth care teams. The workbook highlights concerning data on cesarean rates and disparities in Missouri and provides action steps for implementation of the AIM Safe Reduction of Primary Cesarean Birth Bundle among Missouri maternal health stakeholders. Resources and references are included for further education and training on supporting vaginal birth.

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Keywords: Cesarean section, Guidelines, Health care disparities, Missouri , Obstetrical complications, Resources for professionals, Risk factors, Safety, State initiatives, Trends, Vaginal birth

Annotation: This workbook provides guidance for implementing the Alliance for Innovation on Maternal Health (AIM) patient safety bundle on severe hypertension in pregnancy. It summarizes the evidence on hypertensive disorders of pregnancy, including classifications, diagnostic criteria, and treatment recommendations from ACOG, with a focus on timely treatment of severe hypertension (≥160/110 mm Hg) with first-line antihypertensive medications within 30-60 minutes to prevent maternal stroke. The workbook discusses considerations in diagnosing and managing preeclampsia, which can progress rapidly and become life-threatening without prompt intervention. It highlights data on hypertensive disorders from the Missouri Pregnancy-Associated Mortality Review and provides action steps for implementation of the AIM bundle among Missouri maternal health stakeholders. Resources and references are included for further education and training.

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Keywords: Guidelines, Hypertension, Maternal health, Missouri, Perinatal care, Pregnancy induced hypertension, Prenatal care, Resources for professionals, State initiatives

Annotation: This toolkit from the Oregon Perinatal Collaborative provides guidance for clinical and non-clinical teams caring for pregnant and postpartum individuals with hypertensive disorders to improve processes, outcomes, and clinical decision-making, and to promote quality and equity in care. Organized around the "5 R's" framework (Readiness, Recognition & Prevention, Response, Reporting & Systems Learning, and Respectful, Equitable, and Supportive Care), the toolkit offers specific recommendations and resources for various settings, including hospitals, emergency departments, prenatal/postpartum clinics, public health home visiting, doulas, and community midwives. Quality improvement tools and operational considerations are included to support implementation. The toolkit was developed with input from a focus group of Black, Indigenous, and Pacific Islander individuals who experienced pregnancy-related severe hypertension or preeclampsia in Oregon, and their insights and recommendations are summarized in the appendix. Additional resources, such as diagnostic criteria for hypertensive disorders, are also provided.

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Keywords: Hypertension, Oregon, Postpartum care, Prenatal care, Quality improvement, State initiatives

Annotation: This patient safety bundle was revised in 2023 to incorporate respectful care concepts, revise existing elements, include new elements related to evidence-informed practices, and update data collection plans. The bundle provides actionable steps to support labor and care processes that can be adapted to a variety of facilities and resource levels to improve quality of care and safely reduce cesarean births. Implementation details and resources, a data collection plan, an evidence-informed "change package," and learning modules are included on the website. Some materials are available in English, Spanish, and French.

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• Printable Patient Safety Bundle

Keywords: Cesarean section, Childbirth, Data collection, Measures, Obstetrical care, Prevention, Protocols, Quality improvement, Resources for professionals, Safety, Vaginal birth

Annotation: This toolkit provides actionable information, algorithms, and clinical guidance to support detection, assessment, and treatment of perinatal mood and anxiety disorders. Included is a summary of perinatal mental health conditions; patient screening and treatment guidance; a how-to guide on integrating mental health care into obstetric practice; and educational resources for providers, patients, and families. The toolkit was developed by the UMass Chan Medical School and reviewed by members of the American College of Obstetricians and Gynecologists' Maternal Mental Health Expert Work Group.

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Keywords: Mental health, Obstetrical care, Perinatal care, Service integration

Annotation: This report presents the results of the Levels of Care Assessment Tool (LOCATe) implemented in Montana in 2021 to assess maternal and neonatal care capabilities in birthing facilities and support strategies to improve risk-appropriate care. LOCATe aligns with guidelines from the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatricsto match hospital capabilities with patient risk. The report summarizes Montana's LOCATe results, with 96% of birthing facilities participating. Key findings include: 80% of facilities assessed at Level I or II for neonatal care; 68% assessed at Level I or lower for maternal care; facilities had discrepancies between self-reported and assessed levels; 44% lacked maternal transport plans; and protocols existed for maternal emergencies but drills were lacking. The report provides five recommendations to improve risk-appropriate care: 1) Develop perinatal regionalization through stakeholder coordination; 2) Cultivate relationships between facilities through education and learning collaboratives; 3) Establish maternal transport plans and agreements; 4) Enhance care through evidence-based practices and statewide safety bundles; 5) Measure impact through data and review committees.

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Keywords: Gestational age, High risk pregnancy, Montana , Perinatal care, Reproductive health, Risk appropriate care, Rural health, State initiatives, Statistical data

Annotation: This evidence-to-action brief focuses on Action 1.4 of the White House Blueprint for Addressing the Maternal Health Crisis, which aims to strengthen risk-appropriate care in rural and urban areas by encouraging states to implement the CDC Levels of Care Assessment Tool (LOCATe). The document explains that LOCATe is a web-based, standardized assessment of birthing facilities that allows states to see the distribution of levels of care throughout the state, supporting perinatal regionalization to ensure pregnant people receive care in facilities with appropriate capabilities. It presents maternal mortality data showing significant racial disparities, with non-Hispanic Black women being 2.6 times more likely to experience maternal death compared to non-Hispanic White women in 2021, and highlights that more than 2.2 million women of childbearing age live in maternity care deserts. The document includes examples of state maternal health innovations and evidence-based strategies, emphasizing that risk-appropriate care implementation should occur alongside efforts to address unconscious racial bias in healthcare to effectively reduce severe maternal morbidity and mortality.

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Keywords: Birthing centers, Data, Health facilities, Maternal morbidity, Maternal mortality, Perinatal care, Prevention, Regional factors, Rural health, Standards, Urban health

Annotation: This patient safety bundle provides actionable steps that can be adapted to a variety of facilities and resource levels to improve quality of care and outcomes for patients with cardiac conditions (disorders of the cardiovascular system). It provides guidance for health care teams to develop coordinated, multidisciplinary care for pregnant and postpartum patients with cardiovascular conditions and to respond to cardio-obstetric emeregencies. The bundle is organized into five domains: 1) Readiness , 2) Recognition and Prevention , 3) Response , 4) Reporting and Systems Learning , and 5) Respectful Care . Components include implementation details and resources, a data collection plan, an evidence-informed "change package," and learning modules.

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Keywords: Cardiovascular diseases, Data collection, Evidence-based medicine, Health care quality indicators, Health metrics, Maternal morbidity, Maternal mortality, Measures, Obstetrical complications, Perinatal care, Postpartum care, Prevention, Protocols, Quality improvement, Resources for professionals, Safety

Annotation: The Obstetric Hemorrhage Patient Safety Bundle provides actionable steps that can be adapted to a variety of facilities and resource levels to improve quality of care and outcomes for patients experiencing an obstetric hemorrhage. Included are evidence-based protocols on risk assessment, quantitative blood loss measurement, standardized emergency management plans, hemorrhage carts with necessary supplies, and multidisciplinary team drills. The bundle was revised in 2022 to incorporate respectful care considerations, revise existing elements, related to evidence-informed practices, and update data collection plans. It emphasizes the importance of addressing racial and ethnic disparities in obstetric hemorrhage outcomes through policy review and disaggregated data monitoring. Components include implementation details and resources, a data collection plan, an evidence-informed "change package," and learning modules.

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Keywords: Data collection, Evidence-based medicine, Health care quality indicators, Health metrics, Maternal morbidity, Maternal mortality, Measures, Obstetrical complications, Postpartum care, Postpartum hemorrhage, Prevention, Protocols, Quality improvement, Resources for professionals, Safety

Annotation: The "Sepsis in Obstetric Care" patient safety bundle provides guidance for health care teams to develop coordinated, multidisciplinary care for pregnant and postpartum people by preventing infection and recognizing and treating infection early to prevent progression to sepsis. Included are actionable steps that can be adapted to a variety of facilities and resource levels to improve quality of care and outcomes for patients experiencing sepsis. The bundle is organized into five domains: Readiness, Recognition and Prevention, Response, Reporting and Systems Learning, and Respectful, Equitable, and Supportive Care. Individual components include implementation details and resources, a data collection plan, an evidence-informed "change package," and learning modules.

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Keywords: Data collection, Evidence-based medicine, Health care quality indicators, Health metrics, Maternal morbidity, Maternal mortality, Measures, Mental health, Obstetrical complications, Perinatal care, Postpartum care, Prevention, Protocols, Quality improvement, Resources for professionals, Safety

Annotation: This patient safety bundle provides actionable steps that can be adapted to a variety of facilities and resource levels to improve quality of care and outcomes for patients experiencing hypertensive disorders of pregnancy. The bundle was revised in 2022 to incorporate respectful care concepts, revise existing elements, include new elements related to evidence-informed practices, and update data collections plans. Components include implementation details and resources, a data collection plan, an evidence-informed "change package, " and learning modules.

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Keywords: Data collection, Evidence-based medicine, Health care quality indicators, Health metrics, Hypertension, Maternal morbidity, Maternal mortality, Measures, Obstetrical complications, Perinatal care, Postpartum care, Prevention, Prevention, Protocols, Quality improvement, Resources for professionals, Safety, Screening

Annotation: This report describes strategies for implementing regionalized risk-appropriate maternal care across the United States through a levels of maternal care (LoMC) classification system. It examines key implementation components including facility assessment and verification, establishment of regional care networks, maternal transport systems, quality improvement processes, and data monitoring approaches. The report highlights challenges faced by rural facilities, the role of telemedicine, and the importance of addressing health equity in maternal care systems. Using case studies from various states and health systems, it provides specific recommendations for building sustainable LoMC systems nationally, including establishing a coordinating center, expanding funding mechanisms, and improving payment structures for obstetrical care.

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Keywords: Classification, Perinatal care, Reproductive health, Risk appropriate care, Risk factors

Annotation: This is a 2022 update to this toolkit idesigned to assist maternity care providers, clinical staff, hospitals, and health care organizations in facilitating timely recognition and an organized, swift response to postpartum hemorrhage. Contents include care guidelines and accompanying professional education tools.

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Keywords: Guidelines, Maternal health, Postpartum care, Preventive health services, Professional education, Safety, Uterine hemorrhage

Annotation: This web-based tool helps states and other jurisdictions create standardized assessments of levels of maternal and neonatal care. CDC LOCATeSM is based on the most recent guidelines and policy statements issued by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine.

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Keywords: Gestational age, High risk pregnancy, Perinatal care, Reproductive health, Risk appropriate care, Statistical data

Annotation: This toolkit provides actionable information, algorithms, and clinical resources to help obstetric providers address perinatal mental health conditions. The toolkit includes guidance on implementing perinatal mental health screening, discussing mental health with patients, and responding to positive screens. It contains patient screening tools for depression, anxiety, and PTSD, as well as provider scoring guides. The toolkit outlines treatment options for mild, moderate, and severe illness, including medication and therapy referrals. It also includes algorithms for assessing risk of suicide and harm to baby, managing bipolar disorder and psychosis, and follow-up treatment. Patient handouts cover an action plan for mood changes, a self-care plan, and educational resources. The appendix provides a summary of perinatal mental health conditions, the PCL-C screening tool for PTSD, follow-up screening forms, and a patient safety screener.

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Keywords: Guidelines, Mental health, Obstetrical care, Perinatal care, Screening, Service integration

Annotation: This toolkit to support vaginal birth and reduce primary cesarean sections includes evidence-based tools and resources to support pregnant patients who transfer to the hospital from a community birth center and to effectively integrate midwifery care and doula support into the hospital setting. The toolkit serves as a “how to” guide to help educate and motivate maternity clinicians to apply best practices to support vaginal birth. Included are strategies to (1) improve the culture of care, awareness, and education for cesarean reduction; (2) support intended Vaginal Birth; (3) manage labor abnormalities and safely reduce cesarean births; and (4) use data to drive reduction in cesareans. Twenty appendices include checklists, guidelines, partograms, performance measures, and assessment tools for healthcare providers.

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• Summary

Keywords: Birthing Centers, California , Cesarean section, Childbirth, Doulas, Hospitals Quality assurance, Labor, Midwives, Model programs, Pregnant women, Prevention, Vaginal birth

Annotation: This toolkit provides guidance to hospitals and obstetric providers in developing individualized policies, protocols, practices, and materials related to hospital-facilitated postpartum care and education for pregnant and postpartum women with emphasis on high-risk women. The document presents evidence-based strategies to improve maternal health outcomes through hospital-facilitated continuum of postpartum care by coordinating and providing respectful, timely, and risk-appropriate coordinated care and services. It addresses the development of standardized approaches to promote recommended screening, prevention, treatment, and education services through a multidisciplinary team approach that includes administration, nursing, obstetric providers, neonatology, social work/case managers, community providers, and emergency department staff. The toolkit is organized by three key drivers: screening and arranging early postpartum visits, comprehensive patient education, and clinician engagement and education, with each section providing links to resources that hospitals can adapt for local use.

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Keywords: Florida, Perinatal care, Postpartum care, Protocols, Quality Improvement: Policy development, Resources for professionals, Standards, State initiatives

Annotation: The bundle provides actionable steps that can be adapted to a variety of facilities and resource levels to improve quality of care and outcomes for patients with substance use conditions. It includes: Implementation tools and resources, a data collection plan (with outcome measures), a change package, and learning modules.

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Keywords: Guidelines, Postpartum care, Prenatal care, Substance use disorders, Therapeutics

Annotation: The Postpartum Discharge Patient Safety Bundle was revised in 2021 to incorporate respectful concepts and data collection tools. The bundle provides actionable steps that can be adapted to a variety of facilities and resource levels to improve quality of care and outcomes during a critical period in which patients are at risk for maternal morbidity and mortality. It emphasizes the importance of establishing systems for scheduling timely postpartum visits, screening for risk factors, providing standardized discharge education about warning signs including mental health concerns, and ensuring patients receive a comprehensive discharge summary. It also highlights the importance of coordinated clinical pathways between inpatient and outpatient settings, trauma-informed care, and addressing biases that affect quality of care. Bundle components include implementation details and resources, a data collection plan, an evidence-informed "change package," and learning modules.

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Keywords: Data collection, Evidence-based medicine, Health care quality indicators, Health metrics, Maternal morbidity, Maternal mortality, Measures, Postpartum care, Prevention, Protocols, Quality improvement, Resources for professionals, Safety, Standards

Annotation: This handbook provides guidance for hospitals and health systems interested in implementing STAC, a remote patient monitoring program that helps new mothers with hypertension-related diagnoses safely monitor and treat their blood pressure from home. It describes the program, its benefits, and the research demonstrating its efficacy in reducing postpartum readmissions. The document outlines the core elements of STAC, including daily needs, equipment requirements, enrollment criteria, and the roles of physicians, nurses, and enrollment staff. It also details the processes for patient onboarding, daily nurse assessments, and program completion. The handbook includes treatment algorithms, proper blood pressure measurement techniques, and appendices with program workflows, checklists, consent forms, tip sheets, and documentation templates. Additionally, it provides a sample job description, training plans, and scripts for patient communication.

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Keywords: Hypertension, Postpartum, Remoting patient monitoring, Telemedicine

Annotation: These patient safety bundles are the core building blocks of the AIM program’s efforts to address the leading known causes of preventable severe maternal morbidity and mortality in the United States. Supported by quality metrics and measures through the AIM Data Center, each bundle provides actionable steps that can be adapted to a variety of facilities and resource levels to improve quality of care and outcomes for patients. Individual safety bundles cover the following: obstetric hemorrhage, severe hypertension in pregnancy, safe reduction of primary cesarean birth, cardiac conditions in obstetric care, care for pregnant and postpartum people with substance use disorder, perinatal mental health conditions, postpartum discharge transition, and sepsis in obstetric care. Some materials are available in English, Spanish, and French.

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Keywords: Evidence based medicine, Health care quality indicators, Health metrics, Maternal health, Maternal morbidity, Maternal mortality, Measures, Perinatal care, Postpartum care, Protocols, Quality improvement, Resources for professionals , Safety, prevention programs

Annotation: This resource kit is a collection of best practices to aid in the early recognition of changes in pregnant and postpartum patient’s vital signs and clinical conditions. Developed by the Alliance for Innovation on Maternal Health (AIM), it addresses the rising maternal mortality rates in the United States, particularly noting racial and ethnic disparities, and presents MEWS (Maternal Early Warning System) as a critical tool for early recognition of potential complications. The resource kit includes sections on readiness assessment, recognition and prevention, response protocols, reporting and systems learning, and respectful care practices. It features practical implementation tools such as trigger criteria examples, protocol templates, assessment tools, and patient education resources. The kit emphasizes multidisciplinary teamwork, healthcare professional training, EHR integration, and post-event reviews to support standardized protocols for recognizing and responding to maternal health conditions, with the goal of reducing preventable adverse outcomes and maternal mortality.

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Keywords: Maternal health, Maternal mortality, Patient education, Perinatal care, Postpartum care, Prevention, Professional training, Protocols, Risk factors, Standards

Annotation: This toolkit provides resources for implementing respectful maternity care (RMC) practices to reduce disparities in maternal health outcomes. It features a 10-Step "C.A.R.E. P.A.A.T.T.H." approach emphasizing fundamental rights of women, newborns, and families while promoting equitable access to evidence-based care. Developed by AWHONN (Association of Women's Health, Obstetric and Neonatal Nurses), the toolkit addresses how provider attitudes and implicit biases may affect care quality, particularly during intrapartum and postpartum periods. Resources include clinical practice guidelines, a role-playing video demonstration, patient-facing materials in multiple languages, and implementation tools available at different price points for members and non-members.

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Keywords: Health care disparities, Implicit bias, Maternal health, Physician patient relations, Prevention, Quality improvement, Resources for professionals

Annotation: This collection of toolkits and related resources guides hospitals and healthcare systems in adopting quality improvement strategies to enhance maternal safety and outcomes. The major topics covered by the toolkits address critical areas of maternal health: (1) Cardiovascular Disease, including improving health care response in pregnancy and postpartum; (2) Early Elective Deliveries, focusing on eliminating non-medically indicated deliveries before 39 weeks gestational age; (3) Hemorrhage, specifically improving health care response to obstetric hemorrhage; (4) Hypertensive Disorders of Pregnancy, focusing on improving health care response; (5) Sepsis, detailing improvement for diagnosis and treatment of obstetric sepsis; (6) Substance Exposure (Mother & Baby), providing resources for substance exposure; (7) Supporting Vaginal Birth, including strategies to reduce primary cesareans; and (8) Venous Thromboembolism, focusing on improving health care response to maternal venous thromboembolism.

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Keywords: California, Guidelines, Obstetrical complications, Patient safety, Postpartum care, Prenatal care, Resources for professionals, Risk management, State initiatives