How Certified Registered Nurse Anesthetists are working to improve maternal health
(BPT) - Did you know around 700 women die in the U.S. every year from pregnancy-related complications? The Kaiser Family Foundation recently reported on the status of maternal health, finding many areas of the healthcare system needing improvement to help ensure healthier pregnancies, safer delivery and better postpartum care. Because it has been determined that over 8 in 10 (84%) pregnancy-related deaths are actually preventable, many healthcare organizations, hospitals and lawmakers are seeking ways to improve maternal care. Confronting this issue directly, the American Association of Nurse Anesthesiology (AANA) has updated their practice guidelines for care before, during and after childbirth, using the most up-to-date science-based evidence to ensure that effective standardized protocols are in place nationwide.
The singular care provided by Certified Registered Nurse Anesthetists
Certified Registered Nurse Anesthetists (CRNAs) are highly educated, trained and qualified anesthesia experts who provide 50 million anesthetics per year in the U.S., in every setting where anesthesia is delivered. They are the primary providers of anesthesia care in rural settings, enabling facilities in medically underserved areas to offer obstetrical, surgical, pain management and trauma stabilization services. Using their unique ability to combine the scientific rigor of the field of anesthesiology with the compassionate care integral to nursing, CRNAs aim to provide the highest quality overall care, and these new guidelines will help ensure that even in stressful life-threatening emergencies, each patient receives a consistent level of care — whether in a big city hospital or a small rural community.
AANA's updated guidelines cover topics including physiologic changes during pregnancy, pre-anesthesia assessment and evaluation, patient education, preparing a plan of care, pain management and anesthesia options during labor, delivery and postpartum care, as well as complications and emergency care. AANA's recommendations highlight care for high-risk patients, including those with hypertensive disorders such as preeclampsia and obstetric complications, plus emergencies such as maternal hemorrhage and amniotic fluid embolism.
"AANA's new guidelines offer obstetric anesthesia providers current practice recommendations to support delivery of high-quality maternal care, thereby improving patient safety and patient outcomes," said Beth Ann Clayton, DNP, CRNA, FAANA, FAAN, professor of Clinical Nursing and the Nurse Anesthesia program director at the University of Cincinnati. "In an emergency, if clinicians do not have a protocol available, they may miss a step. These guidelines are in place to facilitate effective care decisions and enhance coordination among the anesthesia, obstetric and pediatric professionals to create an optimal environment for safe maternal and neonatal care."
Addressing racial disparities
When it comes to maternal care, recent research shows that women of color, especially Black patients and those in underserved communities, are at an even higher risk of maternal mortality. For example, the Centers for Disease Control and Prevention (CDC) found that Black women experience pregnancy-related mortality rates about three times higher than white women. That number increases with maternal age: Black women between ages 30-34 have a four times higher rate of maternal mortality than white women.
Some research shows that Black women have higher morbidity rates partially because they are at significantly higher risk for serious pregnancy complications such as preeclampsia. However, other factors leading to these racial and ethnic disparities include barriers to care due to lack of health insurance as well as hospital and obstetric unit closings in rural and underserved communities, plus inadequate treatment due to racism — from poor communication to outright mistreatment — as evidenced in research such as the Kaiser Family Foundation report.
Acknowledging that maternal health disparities exist, CRNAs aim to reduce maternal deaths, using prevention strategies to reduce racial and ethnic disparities in pregnancy-related mortality. These inequities are some of the main hurdles to good maternal care that AANA has worked to address with their updated guidelines.
"These new guidelines and their protocols promote equity of care. For example, when a patient has preeclampsia, direct steps for hypertension management can be taken," said Clayton. "The document also highlights how CRNAs help drive change to reduce maternal-related deaths, implementing prevention strategies to reduce racial and ethnic disparities."
CRNAs provide equitable, compassionate, holistic, patient-centered anesthesia, pain management and related care encompassing each patient's unique needs and preferences. Learn more about their efforts to improve care for every patient at AANA.com.