While Mother’s Day, which just passed,  is typically a joyous occasion, I can’t help but reflect on the high maternal mortality rate (MMR) we face in this country. While our MMR has nearly doubled over the past 30 years, globally maternal mortality decreased 43 percent. The U.S. now has the highest maternal mortality rate among all developed countries.

Our nation’s MMR also is affected by race/ethnicity. To further explore this topic, and what we as nurses can do to improve maternal mortality rates, particularly among women of color, I have invited Desiree Diaz, PhD, FNP-BC, CNE, CHSE-A, ANEF, FAAN, to take over this week’s blog. As Undergraduate Simulation Coordinator and Associate Professor at the University of Central Florida College of Nursing, Dr. Diaz has spent more than a decade studying and working to improve healthcare disparities in ethnically diverse and underserved patient populations through simulation education.

Maternal mortality is a major health crisis in this country, but it does not have to be. Sixty percent of all pregnancy-related deaths are preventable. We can help change our country’s statistics by better preparing nurses to identify maternal morbidity concerns, educating them on the challenges presented by cultural and racial differences and offer professional development through simulation.

Maternal Morbidity as a Predeterminant of Mortality

Access to prenatal care and patient education are key components to reducing maternal deaths. As caregivers, we must increase efforts to reach all women, especially women of color. Statistically speaking, Black and Hispanic women have far higher incidences of maternal morbidity than non-Hispanic White women.

Through proper prenatal care, we can educate expectant mothers on the risks associated with maternal morbidity. Maternal morbidity, not to be confused with maternal mortality, is a term used to identify health conditions aggravated by pregnancy. For instance, someone with hypertension could face severe pregnancy complications such as preeclampsia or gestational diabetes. Ignored and left untreated, these issues could result in death during childbirth or post-partem.

Women need to understand that during pregnancy they must look out for their own health in addition to the health of their unborn baby. By helping expectant mothers recognize their underlying medical issues can affect their pregnancies, we can help prevent maternal mortality. This education needs to be part of basic prenatal care.

Racial and Cultural Challenges

While there is a clear disparity between ethnicities and races when it comes to healthcare in America, nurses have the power to change these systemic issues. When we treat our patients, we need to see their race, as this can be a precursor to unforeseen disparities.

If we choose to treat all patients the same, regardless of their race, we may miss important risk factors. For example, Black women have a higher rate of preeclampsia, so we must use our skills to teach them how to monitor their blood pressure and what to do if it becomes elevated. Hispanic women often face gestational diabetes, and we can help them manage sugar levels with proper nutritional information. Asian and Pacific Islander mothers are at a higher risk of developing cardiovascular complications, which could be avoided with proper post-partem education.

One must be careful with using tonality of skin tone and think beyond skin color, understanding cultural distinctions can reduce maternal mortality rates. Nurses must provide culturally congruent care while expressing cultural humility. There are many differences in how cultures approach motherhood, especially breastfeeding and co-bedding. We must respect the patient’s beliefs while ensuring her health and safety, and that of her newborn.

Even after a healthy pregnancy and birth, there are complications that can arise related to maternal morbidity risk factors. Patients need to know what symptoms and signs they should be looking for after giving birth. We need to take the time to explain what is normal and what is not in a culturally sensitive manner. Once mothers are home, exhausted and caring for a newborn, they need to know when something is serious enough to warrant a call to their doctor or to go to the emergency department.

Simulation Supports Nurses

In order to educate expectant mothers, we need to educate new nurses on these cultural and racial risk factors. The best way to do this is through simulation. I’m a firm believer that knowledge is power only if you use that knowledge. Simulation allows students, new graduates and seasoned nurses to put knowledge into action.

Educators can tap into a vast simulation program base when creating their assignments and assessments. Population and community health simulations introduce nurses to a wide demographic, with patients of varying ages and ethnicities. The family assessments incorporated into these exercises expose nurses to determining factors and genetic predispositions that could impact prenatal care, delivery and post-partum recovery.

Maternal Health and OB simulations provide practical scenarios which we can expand upon during the debriefing sessions. While the simulation exercise may have involved a Hispanic patient, we can use the scenario as a wonderful catalyst for a discussion on how ethnicity and race impact maternal mortality rates.

Simulation has the potential to play a significant role in reducing maternal mortality rates. It prepares nurses to identify silent signs, such as high blood pressure, but it shows us how to educate our patients in a soft and compassionate way. We need to get back to the aesthetic side of nursing. Nurses are more than science. It is our job to provide humanity and compassion in healthcare.


Thank you, Dr. Diaz, for enlightening us on this critical issue. Sentinel U’s menu of maternal health and OB virtual clinical simulations provide unique opportunities for nurse learners to practice caring for a diverse set of patients and presenting symptoms. These true-to-life scenarios are designed to build confidence and develop nursing skills, which ultimately will benefit mothers and babies by reducing maternal mortality rates.