After an exhausting pregnancy punctuated by hospital visits for severe nausea and vomiting, Talicia Williams, 25, was at the finish line. Late on a muggy July night in 2021, Williams vaginally delivered her second child, her first baby girl, at the Hospital of the University of Pennsylvania. It was finally time to rest.
Then Williams’ mother noticed the blood clots.
New and expectant mothers in the United States are more likely to die than those in any other developed country in the world. In 2021, the year Williams’ daughter, Zahiri, was born, the U.S. maternal mortality rate was nearly 33 deaths per 100,000 live births, according to the Centers for Disease Control and Prevention. For Black women in Philadelphia like Williams, the risk of death is four times that of their white counterparts. Perhaps the most heartbreaking: more than 80 percent of these deaths are preventable.
As blood soaked her hospital bed, Williams was perilously close to becoming a statistic.
But within moments, about a dozen Penn Medicine doctors and nurses flooded her hospital room, bringing a cart loaded with supplies to treat the hemorrhage. A doctor massaged Williams’ uterus while reaching inside her to remove remaining blood clots. Another team member used an ultrasound to check for placenta fragments. A third started an intravenous line for fluids. A nurse told Williams: “We’re not going to let you die.”
Williams, who survived the hemorrhage, fully recovered and is back home as a mother of two in West Philadelphia, later learned that her life-saving care on the night of Zahiri’s birth wasn’t an anomaly. The standardized postpartum hemorrhage treatment she received, which included the availability of hemorrhage carts, enhanced safety protocols and training for labor floor nurses to rapidly transfuse blood, was part of a comprehensive, system-wide, multi-year initiative by Penn Medicine to improve maternal health outcomes and reduce racial and ethnic disparities.
The approach to maternal health equity at Penn Medicine encompasses a unified effort from across the University of Pennsylvania Health System, endorsed and supported as a system goal by its executive leaders, with participation from any and all departments that could potentially make an impact.
This comprehensive undertaking involves not only a broad array of quality improvements and innovations in patient care, but also faculty research and community engagement. Some of the core principles underlying the efforts include standardizing patient care during key moments in pregnancy and childbirth to reduce opportunities for racial bias, and centering equity as a goal by targeting specific maternal health programs to historically underserved populations. More than just focusing on pregnancy and childbirth, the initiative aims to connect with pregnant people during this unique time of intensive medical care as a bridge across the continuum—aiming to keep them and their entire families connected to a lifetime of quality health care. And making a broader influence with these innovations is a primary goal, so not only Penn patients benefit, but also new parents and families across the city of Philadelphia, the region, and the U.S. as a whole.
“We’re doing everything we can to intervene so we can have a healthy mom and a healthy baby, and then have that translated to a healthy family and healthy community,” said Elizabeth Howell, MD, MPP, chair of the Department of Obstetrics and Gynecology in the Perelman School of Medicine and the Harrison McCrea Dickson, MD President’s Distinguished Professor, who is spearheading the initiative along with Sindhu Srinivas, MD, MSCE, a professor and vice chair for quality and safety in the department.
The new system-wide standard procedure for postpartum hemorrhage care is just one aspect of the maternal health equity initiative. Starting in 2020, Howell and Srinivas led an outreach process that went wide and deep to connect with faculty and front-line staff at all five birthing hospitals in Penn Medicine’s system, building consensus and connections. The system-wide team goal gave a framework for each person involved in the care of a birthing parent or infant to see their role in patients’ experiences—and to contribute to both discrete and collaborative efforts to reduce the harmful inequities for Black birthing parents.
The results speak for themselves. Maternal morbidity—that is, health problems resulting from pregnancy and childbirth—dropped nearly 30 percent at Penn Medicine hospitals after the first year of implementing the system-wide effort to address disparities.
Today, Philadelphia’s postpartum hemorrhage death rate is lower than the national average. That is partly due to Penn Medicine’s influence in the city—Penn hospitals account for roughly half of all baby deliveries in Philadelphia. But it also stems from the hospital system’s commitment to sharing its successes with maternity care providers throughout the city and beyond, helping to improve care for even more new and expectant mothers.
“Penn is not proprietary with [its innovation],” said Aasta Mehta, MD, MPP, medical officer of women’s health at the Philadelphia Department of Public Health and an obstetrician-gynecologist at Pennsylvania Hospital. “There’s a sense of collaboration and community and improving the health of all.”
At Penn Medicine, the motivation behind this massive effort runs deep. The death of a mother—from postpartum hemorrhage, a cardiovascular complication, an infection, suicide, substance use disorder or any other cause—has intergenerational effects, said Howell, who knows from personal experience.
“My dad lost his mother from a preventable cause when he was 10 years old,” she said. “He was always so worried that he or my mom might pass away and that [his children] would have to live with the pain he lived with. I grew up with this story.
“He’s 80-something now and he’ll still come to tears when he thinks about his mother,” Howell added. “It’s that profound impact that women and birthing people play in families. They are the cornerstone, not only of families, but of communities.”
Addressing the health needs of birthing parents and their families is something that Penn Medicine is addressing to eliminate inequities at every stage in the continuum of care:
Back home in her West Philadelphia community, today Talicia Williams is a healthy mother of two who delights in seeing her young children play alongside a gaggle of nieces and nephews. Her son, Tayale, is nearly 5 and attends a half-day preschool program. Daughter Zahiri, now 2, loves to chase her older brother when he’s home—and to playact some ideas she has picked up about mothering from Williams, the mother she so easily could have lost in those frightening moments after her birth. “My niece was crying and Zahiri ran out and shushed her,” Williams said, laughing at her toddler pretending to be her cousin’s mom. “I’m like, ‘Girl, you’re the same age!’”
Additional in-depth coverage of this topic will be published in December on this website and as the cover story of the Fall/Winter 2023 issue of Penn Medicine magazine.