The California Maternal Quality Care Collaborative (CMQCC) just released the second update of the Hemorrhage Toolkit incorporating the Latest Evidence and Best Practices

Statewide Maternal Mortality Reviews have taught us that obstetric hemorrhage remains a leading preventable cause of maternal mortality and severe maternal morbidity, a life-threatening complication during pregnancy. -Improving Health Care Response to Obstetric Hemorrhage, a California Maternal Quality Care Collaborative Toolkit, 2022, p 35.

Updated Management of Iron Deficiency Anemia:

• Anemia in pregnancy was recently identified as an important and potentially modifiable contributor to severe maternal morbidity.
• Postpartum anemia is associated with increased rates of postpartum depression, fatigue, breastfeeding difficulties, and poor wound healing. -CMQCC Toolkit, p. 41-50.



Key changes in the newly revised toolkit include:

Resources to address inequities in quality of care and shared voices of women including their lived experiences with hemorrhage

"Studies of women and their partners show that lack of timely information and long periods of separation from their babies and families are central themes in their experience. The lack of communication affects women’s understanding of their health needs postpartum, particularly around breastfeeding and mental wellness". -CMQCC Hemorrhage Toolkit, p.31

"Women with known risk factors should be counseled and informed about the likelihood of obstetric hemorrhage, and how to prepare in advance for recovery support after they are discharged postpartum". -CMQCC Toolkit, p. 31

Several studies have highlighted higher rates of morbidity and mortality related to hemorrhage among Black, Indigenous, and Persons of Color. "This difference is not explained by biological factors but is most likely due to inequitable quality of care (e.g., not listening to patient’s concerns or not responding in as timely a manner)." "This is such an important issue that implicit bias training for all providers and staff, and its relationship to and impact on maternal and infant morbidity and mortality, is now required by California Senate Bill 464, California Dignity in Pregnancy and Childbirth Act." -CMQCC Toolkit p. 14.