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June 2018 Vol. 5 No. 2

In This Issue 

Welcome Our New Legislative Coordinator

Oregon AWHONN has a new Legislative Coordinator. She's not new to AWHONN, but this is a fairly new role within our section, so we wanted to take the opportunity to introduce her to you.

A Letter From Our New Legislative Coordinator

I appreciate the opportunity to introduce myself. My name is Nancy Alt and I am the Oregon AWHONN Legislative Coordinator. I am an Oregon native and have worked in Women’s Health since graduating from Good Samaritan School of Nursing in 1982. I started as a new grad in L&D in a small hospital in Tacoma Washington. I did not have AWHONN as a resource at that time (or even another nurse to consult with!) I am so thankful new nursing graduates today have the resources and support they need to be skilled, successful nurses. I have truly enjoyed my involvement in AWHONN and appreciate the education, collaboration, and various opportunities it has offered me.

The Legislative Coordinator role is new to me. My interest in the role is derived from a desire to learn about legislative advocacy and how to positively impact women’s and children’s health. My first goal is to connect with other AWHONN Legislative Coordinators through a telephone forum to learn what they are currently doing and understand the Legislative Coordinator role. My second goal is to familiarize myself with accessing legislative developments that are occurring at the federal and state level and how to get involved. Luckily I live in Salem so the state capitol is close.

All of my nursing jobs have been inside a hospital, either in the inpatient side or the education arena. This is an exciting opportunity for me to learn how to advocate for Women’s and Children’s health issues and hopefully be a vehicle for change.

Nancy Alt, BSN, RNC-OB

[email protected]

Thank you Nancy!

Moving forward, we hope to keep you updated with changes in legislation that affect our practice or our patients. If you know of any legislation in the works that you think others should know about, please feel free to reach out to Nancy. Her email is listed above. And on that note, we've dedicated this issue to Legislative issues recently enacted in our state.

Women's Health Update

House Bill 4133: Oregon Maternal Mortality and Morbidity Review Committee

by Kara Johnson, DNP, RNC-OB, CNS

As of 2013, the U.S. has one of the highest rates of maternal mortality of all developed countries and is the only industrialized country with an increasing rate at 17.3 per 100,000 live births (CDC, 2016). In Oregon, from 2011-2016 maternal deaths ranged from 4 to 12 per year (Oregon Health Authority, 2016) with a maternal mortality rate of 13.2 per 100,000 live births (United Health Foundation, 2016). The increasing rates of maternal mortality is gaining more national attention and many states, including Oregon, are establishing Maternal Mortality and Morbidity Review Committees (MMRCs).

Multiple studies have demonstrated that almost half of pregnancy-related deaths are preventable (Ozimek & Kilpatrick, 2018). One study reported the highest rates of preventability among hemorrhage (70%) and preeclampsia (60%) maternal deaths (Main, McCain, Morton, Holtby, & Lawton, 2015). Many influences have been identified related to pregnancy-related deaths including healthcare provider factors, facility factors, and patient factors. The highest percentage of preventable maternal deaths were attributed to delay in response to clinical warning signs (Main, McCain, Morton, Holtby, & Lawton, 2015).

Major health disparities among racial and ethnic groups persist, with Black women experiencing a three to four-fold increase in maternal mortality compared to White women (CDC, 2016). Access to care, health insurance, poverty, and education impact outcomes. These racial and ethnic disparities suggest that system-wide improvements are needed so that all women receive high quality care. For every maternal death a much larger number, about 50,000 women a year (D’Alton, Main, Menard, & Levy, 2014), experience severe morbidity in the U.S. ACOG, the CDC, the Association of Maternal and Child Health Programs, NIH, and HRSA recommend that every maternal death should be investigated to identify ways to improve quality of care and educate health professionals, patients, and families about preventing deaths and complications.

According Zaharatos, St. Pierre, Cornell, Pasalic, & Goodman (2018) key components of maternal death case reviews include:

  • Was the death pregnancy-related?
  • What was the underlying cause of death?
  • Was the death preventable?
  • What were the contributing factors to the death?
  • What are the recommendations and actions that address those contributing factors?
  • What is the anticipated impact of those actions if implemented?

House Bill 4133, effective April 3, 2018, establishes a MMRC in the Oregon Health Authority to conduct studies and reviews on incidence of maternal mortality and severe maternal morbidity, and to make policy and budget recommendations to reduce the incidence of maternal mortality and severe maternal morbidity in Oregon. The interdisciplinary committee is comprised of at least 11, but not more than 15 members appointed by the Governor.

Oregon MMRC consideration for membership includes:

  • Physicians (family medicine, OB/GYN, and maternal fetal medicine)
  • Labor and delivery registered nurse
  • Certified nurse midwife
  • Direct entry midwife
  • Doula
  • Traditional health worker
  • Representation from a community-based organization
  • Expert in the field of maternal and child health
  • Expert in public health
  • Medical examiner

All meetings and activities are confidential and exempt from disclosure. The committee will submit a biennial report after January 2021 to include:

  • Summary of conclusions and findings related to maternal mortality
  • Aggregated data related to cases (non-identifiable)
  • Description of actions necessary to implement recommendations of the committee
  • Recommendations for allocating state resources to decrease the rate of maternal mortality in Oregon

Recognition of the critical role that MMRCs serve in identifying opportunities to prevent maternal deaths has resulted in a rapid growth in the number of MMRCs in the U.S. MMRCs grew from about 19 review committees in 2010 to about 34 MMRCs in 2017. Ten additional states and cities, or jurisdictions,

are in the process of establishing MMRCs (Zaharatos, St. Pierre, Cornell, Pasalic, & Goodman, 2018). State and local maternal mortality review committees are best positioned to comprehensively assess maternal deaths and identify opportunities for prevention. Maternal mortality review committees develop local solutions to local problems which then inform national solutions to save lives. Thank you to all that supported passing Oregon House Bill 4133 to improve maternal care and outcomes.

For more information House Bill 4133:


Centers for Disease Control (CDC). (2016). Pregnancy mortality surveillance system. Retrieved from

D’Alton, M.E., Main, E.K., Menard, M.K., & Levy, B.S. (2014). The National Partnership for Patient Safety.

Obstetrics & Gynecology, 123, 973-977. doi: 10.1097/AOG.0000000000000219

Main, E.K., McCain, C.L., Morton, C.H., Holtby, S. & Lawton, E.S. (2015). Pregnancy-related mortality in California: Causes, characteristics, and improvement opportunities. Obstetrics & Gynecology, 125, 938-947. doi: 10.1097/AOG.0000000000000746

Oregon Health Authority. (2018). Deaths, maternal deaths, infant deaths, neonatal deaths and fetal deaths, Oregon residents, selected years, 1910-2016. Retrieved from

Ozimek, J.A., & Kilpatrick, S.J. (2018). Maternal mortality in the twenty-first century. Obstetrics Gynecology Clinics North America, 45, doi: 10.1016/j.ogc.2018.01.0040889-8545

Zaharatos, J., St. Pierre, A., Cornell, A., Pasalic, E., & Goodman, D. (2018). Building U.S. capacity to review and prevent maternal deaths. Journal of Women’s Health, 27, 1-5. doi: 10.1089/jwh.2017.6800

Neonatal Update

Cytomegalovirus Legislative Update

by Pat Scheans, DNP, NNP-BC

As promised in the spring newsletter, here is an update to the June 2017 Oregon Legislature rules about congenital Cytomegalovirus (CMV) infection related hearing loss. The rules allow for/improve early detection and intervention (early intervention improves outcome). The final bill doesn't require that we test or treat babies, but it does say that the Oregon Health Authority (OHA) must create and disseminate information about CMV that will be provided to families of babies who fail newborn hearing screening.

A regional, multi-site, multidisciplinary group is being developed to discuss this mandate and determine a good systematic approach for hospitals to follow. Stay tuned for more as this blossom unfolds.

Oregon Legislature bill:


Centers for Disease Control and Prevention. (2017). Cytomegalovirus (CMV) and congenital CMV infection. Retrieved from


Oregon AWHONN Fall Conference Call for Posters

The 2018 Oregon AWHONN Fall Conference Program Committee is seeking poster presentations for the annual fall conference to be held September 30 - October 2, 2018 at Salishan Spa and Golf Resort in Gleneden Beach, Oregon.

Oregon AWHONN invites all staff nurses, students, and researchers who have implemented a best practice idea, found an innovative solution to a clinical problem, or conducted a research study, to create a poster about a research or quality improvement project that is either in process or finished within the last year. We welcome anyone, including students that you my be mentoring, to make their first attempt at a poster presentation in our supportive conference environment.

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Upcoming Events

Registration is Open!

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Oregon AWHONN Abstract Writing Webinar

Wednesday, Jun 9 at 5:00 PM - 6:00 PM

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Each one of us can make a difference. Together we make change.

Barbara Mikulski