B.I.R.T.H. Equity Overview
This initiative was a joint effort between the Mid-Atlantic Patient Safety Center (MPSC) and the Maryland Hospital Association, guided by an expert advisory group across maternal health, emergency medicine, family practice, and health equity. Participation in B.I.R.T.H. Equity Maryland was offered to any ED in the State of Maryland. Primary Care offices and community organizations were also provided participation. Participation was free of charge. The program was funded by grants from the France Merrick Foundation, the Maryland Hospital Association, and the Mid-Atlantic Patient Safety Center.
The primary aim of B.I.R.T.H. Equity Maryland is to educate non-obstetric providers to recognize early warning signs of obstetric complications, leverage teamwork and communication strategies, and identify and mitigate personal biases through implicit bias training and personal reflection. The program will also provide patient and family education resources to promote awareness of obstetric complications and self-advocacy.
Seventeen sites enrolled in the program: 2 Primary Care Offices and 15 Emergency Departments. Sites were organized into three cohorts: April 2023, July 2023, and August 2023. Approximately 1,000 healthcare professionals working in Emergency Departments across the State of Maryland completed the program.
The program reinforced that the work in this space must continue and that hospitals need to commit resources to supporting emergency department personnel in identifying and treating pregnant and postpartum people and eliminating disparities in maternal health outcomes.
B.I.R.T.H. Equity
Based on the program implementation, we recommend the following solutions implemented by hospital emergency departments across the state:
1. Update Emergency Department Policy
Revise the Emergency Department policy to explicitly cover care for both pregnant individuals and those who have given birth within the past 365 days.
​
2. Embed Hard‑Stop Triage Questions into the EHR
Design triage workflows in the electronic health record that embed mandatory questions about pregnancy and postpartum status in the triage navigator, functioning as a hard-stop before proceeding.
​
3. Automate Assessment for Urgent Maternal Warning Signs
Implement EHR workflows that require evaluation of urgent maternal warning signs for pregnant and postpartum patients. Embed these warning signs directly—so providers can reference them without relying on memory.
​
4. Align Vital Sign Triggers with ACOG Severe Hypertension Guidelines
Integrate vital sign alerts in the EHR for people identified as pregnant or postpartum, aligned with ACOG criteria for severe hypertension (e.g., systolic ≥160 mm Hg or diastolic ≥110 mm Hg), to ensure prompt recognition and intervention.
​
5. Provide Guideline‑Aligned Antihypertensive Order Sets
Ensure ED providers have access to order sets that align with ACOG-recommended antihypertensive treatments, such as intravenous labetalol or hydralazine and oral nifedipine, for pregnant and postpartum populations.
​
6. Include Urgent Maternal Warning Discharge Instructions
Embed discharge instructions describing urgent maternal warning signs into the after‑visit summary for all pregnant and postpartum patients seen in the ED.
​
7. Generate EHR Reports for Quality Review and Monitoring
Support and develop electronic reports to enable ED teams to quantify pregnant and postpartum patient visits and associated diagnoses. This data will facilitate case review and benchmarking against policy and evidence-based practices.
​
8. Facilitate Interdepartmental Case Review and Safety Evaluation
Establish regular collaboration between labor and delivery and ED leadership to review cases, shared safety reports, and continual improvement opportunities.
​
9. Ensure Timely Notification and Transfer to Obstetric Care
Create systems that ensure obstetric care providers are notified promptly when urgent maternal warning signs are identified—and that transfer to labor and delivery occurs immediately when safe and appropriate.
​
10. Develop Joint Training and Simulation Programs
Have labor and delivery leadership and educators collaborate with ED teams to deliver targeted education, including simulation exercises and drills for both ED nurses and providers.
​
11. Foster Collaborations with Birthing Centers
For non-birthing hospitals, urgent care centers etc. encourage and maintain collaborative relationships with birthing hospitals—especially those routinely involved in transfers of birthing patients—to ensure coordinated, seamless care.
Access our B.I.R.T.H. Equity Maryland Patient Education video series
Topics include fetal movement counting, patient self-advocacy, urgent maternal warning signs, postpartum depression, safe sleep, and the roles of each member of the maternal care team. We encourage healthcare professionals to save and share these videos with pregnant and postpartum patients and their families.
Perinatal Debriefing
THE GAP WE AIM TO CLOSE
Healthcare providers are often the “second victims” of traumatic childbirth events. Exposure to severe maternal or neonatal outcomes can cause emotional distress, burnout, and long-term occupational stress. While leaders can’t prevent every traumatic event, they can build supportive environments that prioritize psychological safety, access to emotional support, and standardized, effective debriefing practices.
​
-
Lack formal training in leading debriefs
-
Have no standardized workflows to connect teams with mental health support
-
Miss opportunities to learn from adverse events and improve future care
​
The Maryland Perinatal Debriefing Initiative, funded through MDMOM, was created to fill this gap by equipping perinatal leaders with tools, education, and structured support for their teams.
Our Goals
To provide perinatal nurses and provider leaders across Maryland with the skills, resources, and standardized workflows they need to:
Lead meaningful debriefings after severe maternal or neonatal events
Build psychological safety and resilience on their units
Identify opportunities for quality and safety improvements
Normalize emotional support as a core part of patient safety culture
Funding & Support
This initiative is part of the Maryland Maternal Health Innovation Program (MDMOM), funded by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS).
We’re proud to share the MDMOM Provider Support Bundle—created to help providers implement debriefs, access emotional support resources, and drive improvements in quality and safety.
Count the Kicks
OUR SHARED GOALS
Through the MPSC, this program provides free educational resources on fetal movement monitoring to hospitals, health departments, OB/GYN offices, and doula groups across the state and region. Since launching in 2023, more than 70,000 pieces of educational material have been ordered, including resources translated into Spanish and Haitian Creole, and eight organizations are currently enrolled in the Count the Kicks Implementation Partner Program to standardize the delivery of fetal movement education.
If your organization has fully implemented Count the Kicks or is in the process of doing so, MPSC would love to celebrate YOUR TEAM and highlight this important accomplishment. Join us as a Count the Kicks Implementation Partner.
Learn More from Experts
Learn how to engage in the Kick Counting conversation with your patients and guide them is downloading and using the FREE Count the Kicks app today!
Webinar Recording: Introduction to Count the Kicks for Healthcare Providers
Both resources are designed to make kick counting accessible, easy, and reliable for every expecting family.
