Anesthesia Patient Safety Podcast

#278 Transforming Maternal Care Through Equity, Science, And Tech

• Anesthesia Patient Safety Foundation

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Maternal care is at a breaking point: delivering hospitals are disappearing while deaths that could be prevented keep climbing. We pull back the curtain on how structural racism, policy headwinds, and technology blind spots compound risk for birthing people—especially Black, Hispanic, rural, and low‑income patients—and what it takes to change the trajectory now.

We start by naming the problem with data: stable birth rates alongside a steep decline in maternity units have created care deserts. From there, we dig into disparities in obstetric anesthesia, including lower neuraxial labor analgesia use and higher rates of general anesthesia for cesarean delivery among Black and Hispanic patients. Drawing on ASA recommendations, we outline practical actions that reduce harm: accurate documentation of race, ethnicity, and language; disparities dashboards; education on bias and structural racism; shared decision making; and proactive epidural management to improve conversion to surgical anesthesia without general anesthesia.

Then we turn to implementation science—the missing link between guidelines and reliable practice. We map a simple decision pathway from efficacy to effectiveness to context and strategy, and we share the real levers that move systems: targeted education, inter‑institutional collaboration, policy mechanisms like bundles, and the business case that earns C‑suite commitment. When leaders see the return on investment in safety, liability reduction, and community trust, sustained resources follow.

Finally, we explore technology as an equity engine. AI‑guided ultrasound can extend expertise in low‑resource settings. Predictive analytics may flag fetal heart rate decelerations before they turn critical. And we confront the accuracy gaps in pulse oximetry tied to skin pigmentation and low perfusion, especially during the neonatal transition. With vendor accountability, rigorous validation across diverse populations, smarter sensor selection and placement, and frontline education, monitoring can serve every patient equally.

If this conversation resonates, help us spread the word. Subscribe on Spotify or YouTube, share this episode with a colleague, and leave a review so more clinicians can join the effort to make labor and delivery the safest unit in the hospital. Your feedback and stories shape where we go next.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/278-transforming-maternal-care-through-equity-science-and-tech/

© 2025, The Anesthesia Patient Safety Foundation

SPEAKER_01:

Another issue in rural health is the closure of maternity hospitals. Between 1981 and 2023, you can see a pretty stable total births. Not much change there, but a decrease in delivering hospitals from over 4,000 to less than 2,000. And in fact, since 2020, we've lost over a thousand delivering hospitals in the U.S.

SPEAKER_00:

Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Allie Bechtel, and I'm your host. Thank you for joining us for another show. We are continuing an exciting series today. We are continuing to talk about the 2025 APSF Stolting Conference, Transforming Maternal Care, Innovations and Collaborations to Reduce Morbidity and Mortality. If you weren't able to attend the Stolting Conference this year, then we hope that you will enjoy this podcast series and you can also check out the recordings from the conference on our YouTube channel. Check out the show notes for more information. Before we dive further into the episode today, we'd like to recognize Nihon Coden, a major corporate supporter of APSF. Nihon Coden has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care. Thank you, Nihon Coden. We wouldn't be able to do all that we do without you. Now it's time to get back into the conference and focus on transforming maternal care. Thank you so much to our industry sponsors for supporting the 2025 APSF Stolting Conference, BD, Medtronic, Solventum, and IntelliGuard. The next session focuses on inequities in care delivery and outcomes. Our first speaker is Jill Meyer, a professor and chair of anesthesiology at the University of Arkansas for Medical Sciences to talk about disparities and outcomes. Let's start with the definition of health disparities, which are largely preventable health differences that adversely affect populations who experience greater challenges to optimal health and are closely tied to social determinants of health and influence policy and resource utilization in our health systems. These populations include racial and ethnic minority populations, underserved rural, socioeconomic, disabilities, and sexual minority groups. These populations are at increased risk for maternal morbidity and mortality. There is a threefold increased risk for black mothers compared to white mothers. There is also an increased risk depending on where you live, with higher risk in some states in the south and in rural areas. There has been an increase in maternity care deserts in the United States with a decreasing number of delivering hospitals. This leads to decreased prenatal care for patients who may not be able to or want to travel to a major center and have concerns about separation from their families. Let's review the 2024 article, Structural Racism and Use of Labor Noraxial Analgesia among non-Hispanic Black Birthing People. You can find the citation in the show notes. This cross-sectional study annualized 2017 U.S. natality data for non-Hispanic Black and White birthing people and determined that there was reduced use of neuraxial labor analgesia for non-Hispanic black patients due to structural racism, which involves a system where public policies, institutional practices, cultural representations, and other norms work together to maintain and perpetuate racial group inequities in housing, education, employment, earnings, benefits, credit, media, health care, or criminal justice. The author in this study advocates for interventions to address structural racism and anesthesia care for the benefit of black and white patients, especially in areas with the highest racism index. They highlight the 2021 ASA recommendations for reducing maternal peripartum, racial and ethnic disparities in anesthesia care, including the following. Accurate documentation of race and ethnicity and primary spoken language. Creation of disparities dashboards to track changes over time. Education of anesthesia professionals on racial and ethnic disparities in anesthesia care and the roles of bias, institutional, and structural racism. Development of best practices for shared decision making when discussing labor noraxial analgesia, and diversifying the anesthesia workforce in their department. We hope that you will check out the entire statement. See the show notes for more details. Another important consideration is the increased use of general anesthesia for C-section for black and Hispanic patients. This same increase is not seen when patients have a labor epidural already in place. There is an opportunity here to partner with patients and obstetricians to figure out who needs a C-section, participate in shared decision making, help patients understand the benefits of epidural analgesia, rounding on catheters to make sure patients are receiving high-quality labor analgesia, which is the most important predictor for successful conversion to C-section anesthesia. Once you are in the operating theater for a C-section, it is important to continue to evaluate patients for pain since vulnerable populations may have interoperative pain that is dismissed or not prevented. There are times when it may be necessary to convert to general anesthesia, and tools such as pulse oximetry and video laryngoscopy have improved safety in this setting. Here are the key takeaways from Jill's talk. Disparities in mortality and severe maternal morbidity are persistent. In OB anesthesia, we see the following lower use of neuraxial labor analgesia, higher use of general anesthesia for C-section delivery, lower quality of peripartum pain management, with local and statewide initiatives to implement standardized care show promise to reduce health disparities, contraction of federal support for research and health care delivery, accelerating rural hospital closures, and state restrictions on bodily autonomy threaten to exacerbate them. Inequities in care delivery are persistent and prevalent with complex interactions between social determinants of health upstream from our clinical encounters. Going forward, we need to partner with our patients.

SPEAKER_02:

We have so many examples of seeing that work done well, and yet we still struggle to implement to see these interventions actually deployed at the level of patient care to improve outcomes at the bedside.

SPEAKER_00:

Our next speaker is Megan Lanefall, professor and chair of anesthesiology at Columbia University Vagalos College of Physicians and Surgeons. Her talk is Implementation Science. What is it and why does it matter for maternal health? Implementation science is the bridge between evidence and practice for when we know what we ought to do and we know that we don't do that. Megan takes us through a stepwise algorithm. The first stop is, has the practice of interest shown efficacy? Does it work? If the answer is no, then efficacy research is needed. If the answer here is yes, then we move on to the next question. Has the practice of interest shown effectiveness? If no, then effectiveness research is needed. If partial, then it's time to move on to hybrid effectiveness implementation trials. If the answer is yes, then you can move on to mixed methods studies to understand context, design implementation strategies, and test the implementation strategies. This is the important step where we know that it works, but people aren't doing it yet. Implementation strategies can be thought of as the stuff we do to get people to do the practice of interest. These strategies may include patient education, advocacy phrases, peer-reviewed publications to improve knowledge, team building, building relationships between institutions, and policy-level interventions like Joint Commission and Bundles, as some examples. Check out the article Scoping Implementation Science for the Beginner, locating yourself on the subway line of translational research for more information. And I will include a link in the show notes. Another important consideration when it comes to implementation science is how do we acquire the resources to do the thing that we want to do. It is vital to identify the return on investment, and it may involve partnering with industry teammates and identifying C-suite partners. When it comes to maternal patient safety, the argument starts with the understanding that labor and delivery is the riskiest place in the hospital, but it could be the safest place. This is where we need implementation science to help bridge the gap between evidence and practice to improve maternal patient safety going forward. Our next speaker is Mahesh Vedyanatha, an assistant professor of anesthesiology at Northwestern University Feinberg School of Medicine, to talk about opportunities for technology to improve monitoring and care and address disparities. An important consideration is that the level of care can change drastically depending on country and location. This means that there is an opportunity to use technology to be a force multiplier to support equitable care anywhere in the world. We are moving into a future where we have the ability to consume data and rapidly reproduce it in real time and de-identified data, which allows for sharing knowledge and care around the country and around the world. Mahesh offers several examples of using technology to improve care. One example of a technology that can be used in low and middle-income countries is ultrasound scanning with AI to give diagnoses. It works by following a scanning protocol and letting the AI and software give findings related to gestational age, location of placenta, and number of births. This is being developed now and takes the burden off of having an expert in the room and even on relying on having an expert available. Another example is building an algorithm to try to predict when a fetal heart rate deceleration is going to happen so that clinicians can take action before it is too late. The future of how we harness healthcare data and share it around the world may lead to important advances in patient safety around the world. Our final speaker for this session is Michael Mestec, Vice President of Clinical Research and Medical Science at Medtronic, to talk about equitable monitoring with pulse oximetry. The risk for maternal mortality is real. Despite having one of the most technologically advanced healthcare systems in the world, the U.S. continues to have unacceptably high rates of maternal mortality and more than 80% of pregnancy-related deaths are preventable. Michael provides an overview for a pregnant patient and how they might interact with monitors and technology throughout the peripartum period. Technology needs to be accurate and work for all patients. We have learned that pulse oximetry readings are influenced by skin pigmentation, perfusion index, and hypoxemia, with implications for accuracy in darker skin and low perfusion cases. Medtronic has made a commitment to improve the performance of their technology. An area where this is crucial is with oxygen saturation and heart rate monitoring during the neonatal transition period. Inequity occurs when subtle differences add up, starting from the base technology performance and then onto sensor selection and position, plus patient perfusion and patient skin pigmentation. An important consideration is that education can be helpful to address sensor selection and positioning. The next step for Medtronic is a vision for equitable delivery of care with research in the Medtronic Physiology Lab, as well as enhanced guidelines and standards, collaboration with regulators, researchers, and clinicians, and investment in innovation and education. Six words drive the Medtronic Company. Alleviate pain, restore health, and extend health. These six words are also vital when it comes to maternal care and keeping patients safe throughout the peripartum period. Thank you so much for tuning in to the third episode in our series on the 2025 APSF Stolting Conference. If you have any questions or comments from today's show, please email us at podcast at apf.org. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit apf.org for detailed information. And check out the show notes for links to all the topics we discussed today. Thank you for tuning in. And if you found this episode valuable, please share it with your colleagues, friends, or anyone interested in improving anesthesia patient care and safety. Your support helps us reach more listeners and spread awareness about the importance of safety in anesthesia. We're excited to share that the podcast is available on Spotify and YouTube, or wherever you get your podcasts, so it's easier than ever to listen and share. If you are on Spotify, make sure you click the bell icon to subscribe so that you don't miss an episode. Until next time, stay vigilant so that no one shall be harmed by anesthesia care.