Maternal and Child Health Quality Indicators

Maternal and child health quality is a priority area in healthcare quality measurement. Despite advances in obstetric and neonatal care, the United States continues to have higher maternal mortality rates than many other developed countries. Quality indicators in this domain help identify opportunities to improve outcomes for mothers and infants. CPHQ candidates should be familiar with key measures and improvement strategies.

Key Maternal Quality Indicators

Several quality indicators focus specifically on maternal care. The rate of early elective deliveries (before 39 weeks without medical indication) is a widely tracked measure because early delivery increases risks for newborns without providing benefits when no medical indication exists. Cesarean section rates, particularly the Nulliparous Term Singleton Vertex (NTSV) cesarean rate, help identify potentially avoidable surgical births. Severe maternal morbidity (SMM) rates track serious complications during delivery hospitalization. Maternal mortality ratios monitor deaths during or within 42 days of pregnancy. Postpartum hemorrhage rates and rates of obstetric complications are additional important measures.

Neonatal and Infant Quality Indicators

Neonatal quality indicators include rates of neonatal intensive care unit (NICU) admission, particularly for full-term infants where admission may reflect preventable complications. Birth injury rates capture trauma during delivery. Rates of exclusive breast milk feeding during the birth hospitalization reflect support for recommended infant nutrition practices. Newborn screening completion rates ensure that infants are tested for treatable conditions. Infant mortality rates, while influenced by many factors beyond healthcare quality, remain important population-level indicators.

Perinatal Quality Collaboratives

Perinatal quality collaboratives (PQCs) are state-based networks of perinatal care providers that work together to improve maternal and infant outcomes. They collect data, identify best practices, and implement standardized quality improvement initiatives across participating facilities. Examples include the California Maternal Quality Care Collaborative (CMQCC) and the Ohio Perinatal Quality Collaborative. PQCs have demonstrated significant improvements in outcomes, including reductions in elective early deliveries, NTSV cesarean rates, and neonatal morbidity. These collaboratives serve as models for collective quality improvement.

Safety Bundles and Standardized Protocols

The Alliance for Innovation on Maternal Health (AIM) has developed evidence-based safety bundles for common obstetric emergencies, including obstetric hemorrhage, severe hypertension in pregnancy, and venous thromboembolism prevention. Each bundle includes readiness, recognition and prevention, response, and reporting and systems learning components. Implementing standardized protocols for these high-risk situations helps ensure consistent, evidence-based responses regardless of which team members are present. Simulation drills reinforce bundle components and improve team performance during actual emergencies.

Addressing Disparities in Maternal Health

Maternal health disparities are among the most pressing equity issues in healthcare. Black women in the United States experience maternal mortality at rates approximately three times higher than white women, a gap that persists across education and income levels. Contributing factors include implicit bias in clinical care, chronic stress from discrimination, higher prevalence of underlying conditions, and differences in hospital quality where care is received. Quality programs should stratify maternal outcomes by race and ethnicity, investigate root causes of disparities, implement implicit bias training for perinatal staff, and ensure equitable access to high-quality obstetric care. Addressing these disparities is both a quality imperative and a moral obligation.