Last week, the NPIC Blog introduced one of our team members and their Unexpected Journey into Advocacy. This week, we continue to discuss advocacy and recognize Sepsis Awareness Month.

“But the [infection] that cost Tara her life had not come entirely without warning. She began to feel unwell in the hospital after delivery, taking the time to speak to her health care providers about the concerns and suspicions that her body did not feel the way it was supposed to. But Tara was considered a healthy postpartum patient and therefore sent home. In my experience, the only person who knew something was wrong was Tara, and she was right. Complaints just kept falling on deaf ears, with everyone assuming that the pain she was describing was to be ‘expected’ because she just had a baby.”
--Ryan Hansen, Tara Hansen’s husband and founder of The Tara Hansen Foundation.

What is Sepsis?
According to the Centers for Disease Control (CDC), Sepsis is the body’s extreme response to an infection. Infections that lead to sepsis most likely start in/on the skin, in the lungs, or urinary or gastrointestinal (GI) tract. If left untreated, sepsis can lead to organ failure and death.

Sepsis in Pregnancy
CDC Pregnancy Mortality Surveillance System (PMSS) data showed that from 2016 – 2018, infection or sepsis was the second leading cause of pregnancy-related death. Pregnancy-related death is when a woman dies during pregnancy or within one year after the end of her pregnancy from health problems related to pregnancy.

In reviewing the NPIC Perinatal Database, there has been a steady decline in postpartum readmissions within 42 days for major puerperal infection but was stable at 10.6% for the years 2020 and 2021. Continued monitoring of outcomes within the NPIC database will be key, particularly through the lens of COVID-19 and its impact on healthcare readiness and response. As hospitals and healthcare systems incorporate electronic early warning systems into electronic health records and more sophisticated artificial intelligence (AI) to support expert clinician assessment, the data will continue to be important to continually assess and measure.



Providing the Tools to Recognize and Advocate for Care
Early recognition of sepsis is critical to provide the best chance of treatment, recovery, and survival. There are several important options for those caring for pregnant or postpartum patients to support early recognition and identification, as well as healing and the road to recovery:

• Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) POST-BIRTH Warning Signs and Save Your Life Program. This program provides critical education and information on warning signs that require immediate medical attention, or symptoms that should be reported to a provider quickly. Rhode Island is one of several states that provide this important education to all patients at every hospital upon postpartum discharge.


• CDC’s Hear Her Campaign. One of the most problematic issues within pregnancy and postpartum care is that women experience not being heard by their providers or those they come into contact for care. Women who reach out for concerns related to symptoms express frustrations of being told that their “symptoms are normal” for pregnancy. For Black women, this experience is magnified tremendously and overwhelming documentation of the experiences of Black women who have died after verbalizing their symptoms and concerns continue to permeate the maternal health conversation. Black women are 2-3 times more likely to die of a pregnancy-related complication than white women.


• Alliance for Innovation on Maternal Health (AIM) is a quality improvement initiative to support best practices that make birth safer, improve maternal health outcomes and save lives. AIM provides support and resources for hospitals and states across the US, including patient care bundles, which provide structure and guidance around specific clinical conditions. The Sepsis in Obstetrical Care bundle is in development and should be available soon to AIM states and hospitals across the nation.


• Patient advocacy organizations can be tremendous sources of support and strength for those who have experienced sepsis during or after pregnancy. Organizations such as the Sepsis Alliance Sepsis Alliance or MoMMA's Voices can be critical allies in supporting healthcare teams to better understand the impact of maternal morbidity and mortality through lived experience. If your perinatal QI team does not have the benefit of lived experience or a patient voice to guide sustainable change, you are missing a critical team member.

September provides many key perinatal awareness themes. In the coming weeks, we will discuss Substance Use Recovery, Suicide Prevention, and others that impact patients, healthcare teams, and communities. Sustainable quality improvement only comes from including the entire team, including patients. NPIC applauds member hospitals and others across the nation who continue to elevate their quality improvement activities through the intentional collaboration of patients and those with lived experience, including those patients who have survived sepsis, as well as those families who mourn their loss and can be an essential voice. May all our work to eradicate maternal deaths from sepsis be done in their honor.