Prevention of Maternal Mortality in Canada

SOGC Prevention of Maternal Mortality in Canada

Context

The SOGC has been working toward developing a systematic approach for preventing maternal mortality in Canada. Our mission is to increase awareness of the issues surrounding pregnancy-related deaths and to promote change among individuals, healthcare systems, and communities to reduce the number of those deaths.

Maternal Mortality Ratio

Identifying women at higher risk for maternal death is not easy. There have been shifts in the demographics of the child-bearing population in Canada and factors including age, medical co-morbidities, and risks and resiliencies associated with race and culture are challenging what we thought we knew about maternal mortality. Understanding causes of maternal deaths, contributing factors, the circumstances, and the complexities that surround them are more important than ever. The United Kingdom (UK) has very successfully shown that, by understanding factors that contribute to maternal mortality, programs can be developed that address specific education, training, system and policies that prevent future maternal deaths.

Contributing causes of maternal mortality in Canada 

Why does Canada need a Confidential Enquiry System into maternal deaths?

A Canadian Confidential Enquiry System into maternal mortality will improve Canada’s maternal death statistics, and more importantly, generate system and practice information required to understand how deaths might be prevented in the future, inform provincial/territorial and national networks , and identify trends and emerging issues.

Identifying every single maternal death is a critical factor to improving Canada’s surveillance programs – if deaths are not identified as “maternal”, they will not be included in existing federal and provincial/territorial surveillance systems. More complete ascertainment, by implementing a confidential enquiry component to maternal death reviews, will provide accurate prevalence and allow us to determine trends, to identify priorities for recommendations and to report on the effectiveness of interventions.

Advocates and experts across Canada have been working together to gather momentum and support for a Canadian Confidential Enquiry System into maternal deaths. You can see some of the activities at the links below: 

Published Papers:

Presentations and Advocacy Activities:

In the News:

Canada’s Maternal Mortality Review Committee Toolkit

Provinces and territories have a critical role to play in leading the implementation of maternal mortality review processes. Leaders of the Perinatal Programs of four provinces (British Columbia, Alberta, Ontario and Nova Scotia) developed a Toolkit for Maternal Mortality Review Committees (MMRCs) with the ultimate goals of capturing and reviewing all maternal deaths to one year post-delivery, identifying contributory factors and opportunities for prevention. 

The ultimate goal is to eliminate all future preventable maternal deaths in Canada.

Canada’s MMRC Toolkit promotes best practices in maternal mortality review by providing guidance for all aspects of the review process, from how to establish a review committee to providing recommendations and follow-up for prevention.

 

The importance of Maternal Mortality Review Committees

Maternal Mortality Review Committee

MMRCs have the critical task of determining whether each case of maternal death was preventable and recommending specific and feasible actions to prevent future deaths. Objective and standardized reviews of all maternal deaths, and the implementation of recommendations for prevention, have had a positive impact on maternal health and outcomes around the world. It is important that each maternal death be reviewed in a thorough and timely manner; each province and territory should have, at the minimum, an annual review of all deaths. Some jurisdictions may have committees for specific institutions or regions as well.

To read more information about existing MMRCs in Canada, please click the links below:

Province Committee Information/ Annual Report
British Columbia Perinatal and Maternal Mortality & Morbidity Review Process, Perinatal Services BC
Alberta
 Quality & Innovation, Alberta Health Services
Manitoba Maternal and Perinatal Health Standards Committee, The College of Physicians and Surgeons of Manitoba
Ontario Maternal and Perinatal Death Review Committee: 2019 annual report: Introduction | Ontario.ca
Quebec Fiche 2 - Déclaration d'un décès périnatal en ligne (cmq.org) (Available only in French)
Quebec Fiche 1 - Déclaration d'un décès maternel en ligne (cmq.org) (Available only in French)

Important Documents

Important Documents

An Overview of Canada’s Toolkit for Confidential Enquiry into Maternal Deaths

This overview can be used to provide context for the importance of Maternal Mortality Review in Canada and the critical role of the MMRCs.

VIEW DOCUMENT

Important Documents

Maternal Mortality Review Committee Orientation Slides

These slides can be used to orient stakeholders, partners and MMRC members to the importance of the review process, and the goals and functions of the MMRCs. Specific information can be inserted related to statistics, processes or anything else that users feel is important

VIEW DOCUMENT

Important Documents

Maternal Mortality Review Committees Guide

This guide provides suggestions and best practices that will help MMRCs establish processes for standardized case review and reporting. The guide is structured in the general order of steps a committee might take in conducting a MMRC meeting.

VIEW DOCUMENT

Important Documents

Abstractor Document Checklist

This checklist was designed to provide an overview of the documents and information obtained by the Abstractor.

VIEW DOCUMENT

Minimum Dataset

This minimum dataset identifies indicators that should be captured to inform a comprehensive review of maternal mortality, including suggested data sources and definitions. It also suggests which indicators may be important to report on provincially or nationally. Existing data systems may or may not currently capture this information and will have to determine the process that works best for them.

VIEW DOCUMENT

Important Documents

Maternal Mortality Review Committee Forms for Reviewers

A comprehensive Maternal Mortality Review Process requires notes from a thorough abstraction that are compiled into a comprehensive Case Narrative for presentation to the committee. After all data and information is gathered, it can be used to populate the forms.

Forms for Reviewers:

HOME RECORD WOMAN’S DETAILS SIGNATORY DEFINITIONS OTHER INFORMATION INFANT MATERNAL MORTALITY REVIEW LOCAL OBSTETRICIAN REPORT SUMMARY FORMS FOR REVIEWERS ALL FORMS

 

Important Documents

Interview Guide for Confidential Enquiry into Maternal Deaths

Most MMRCs do not have access to information about perceptions, experiences, and accounts of families, health care professionals, and others who can provide an understanding regarding the circumstances of a maternal death. However, these accounts, when obtained through established confidential enquiry methods, can provide multi-faceted perspectives on the woman’s care and experiences before and surrounding her death. This guide provides detailed information about how to conduct interviews related to a maternal death.

VIEW DOCUMENT

 

Maternal Mortality Review Cycle

Click on graphic to learn more.

Maternal Mortality Review Cycle

 

 

Reports

Maternal Death Surveillance and Response Technical Guidance
(World Health Organization)

The World Health Organization published information for action to prevent maternal death in their Maternal Death Surveillance and Response Technical Guidance.

LEARN MORE

 

 

Reports

Perinatal Health Indicators

The Perinatal Health Indicators Report, produced by the Public Health Agency of Canada's Canadian Perinatal Surveillance System, presents information on maternal, fetal and infant health in Canada based on data from the Canadian Institute for Health Information’s Discharge Abstract Database (CIHI-DAD), the Canadian Community Health Survey (CCHS), and Vital Statistics (birth, stillbirth and death databases).

LEARN MORE

 

 

Reports

Healthcare Insurance Reciprocal of Canada (HIROC)

The Healthcare Insurance Reciprocal of Canada (HIROC) is a non-profit insurance reciprocal owned and governed by over 700 health care organizations across Canada. The reciprocal/cooperative model allows for pooling of data across multiple similar organizations, sharing of lessons learned, and collective pressure exerted by members to implement effective risk management programs that reduce injury.

HIROC publishes a number of evidence-based reports that provide important information related to obstetrics.

OBSTETRICS SERVICES DELIVERY IN FOCUS (2018) 2020 TOP HEALTHCARE RISKS REPORT

References

  1. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014 Sep 13;384(9947):980-1004. Erratum in: Lancet. 2014 Sep 13;384(9947):956.
  2. Public Health Agency of Canada, Perinatal Health Indicators for 2017: A report from the Canadian Perinatal Surveillance System. http://publications.gc.ca/collections/collection_2018/aspc-phac/HP7-1-2017-eng.pdf Accessed November 26, 2021.
  3. Maternal Mortality Review Information App. Building U.S. Capacity to Review and Prevent Maternal Deaths. Report from nine maternal mortality review committees: a view into their critical role. 2018 Retrieved 11/25/21 from https://www.cdcfoundation.org/sites/default/files/upload/pdf/MMRIAReport.pdf
  4. Maternal, Newborn and Infant Clinical Outcome Review Programme. MBRRACE-UK Saving Lives, Improving Mothers' Care – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2017-19. Marian Knight, Kathryn Bunch, Derek Tuffnell, Roshni Patel, Judy Shakespeare, Rohit Kotnis, Sara Kenyon, Jennifer J Kurinczuk (Eds.) 2021. https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2021/MBRRACE-UK_Maternal_Report_2021_-_FINAL_-_WEB_VERSION.pdf
  5. Nair M, Kurinczuk JJ, Brocklehurst P, Sellers S, Lewis G, Knight M. Factors associated with maternal death from direct pregnancy complications: a UK national case-control study. BJOG. 2015 Apr;122(5):653-62.
  6. Nair M, Knight M, Kurinczuk JJ. Risk factors and newborn outcomes associated with maternal deaths in the UK from 2009 to 2013: a national case-control study. BJOG. 2016 Sep;123(10):1654-62.
  7. Hwang SS, Diop H, Liu CL, Yu Q, Babakhanlou-Chase H, Cui X, Kotelchuck M. Maternal Substance Use Disorders and Infant Outcomes in the First Year of Life among Massachusetts Singletons, 2003-2010. J Pediatr. 2017 Dec;191:69-75.
  8. Metz TD, Rovner P, Hoffman MC, Allshouse AA, Beckwith KM, Binswanger IA. Maternal deaths from suicide and overdose in Colorado, 2004-2012. Obstet Gynecol. 2016 Dec;128(6):1233-1240.
  9. Schiff DM, Nielsen T, Terplan M, Hood M, Bernson D, Diop H, Bharel M, Wilens TE, LaRochelle M, Walley AY, Land T. Fatal and Nonfatal Overdose Among Pregnant and Postpartum Women in Massachusetts. Obstet Gynecol. 2018 Aug;132(2):466-474.