Obstetric Readiness in the Emergency Department: A Mixed-Methods Approach to Assessing Obstetric Readiness in Emergency Care

As US hospitals continue to close their labor and delivery units, more than 2.3 million women of childbearing age live in maternity care deserts without local access to specialized care. When pregnant or postpartum women require unplanned, emergent care, they may seek care from low-obstetric-resourced settings, such as the local, general emergency department (ED). General EDs without specialized inpatient obstetric services available may not be optimally equipped to recognize, diagnose, and treat obstetric and postpartum-related conditions, leading to worse patient outcomes. One recent approach to addressing maternal morbidity and mortality in low-obstetric- resourced EDs has been to improve obstetric readiness, or the capability (i.e., equipment and training) to provide high-quality care for a patient before, during, and after birth. However, there are currently no standardized means of implementing and assessing obstetric readiness in EDs nor evaluation of obstetric readiness and its association with quality of care. The overarching objective of this 4-year R01 project is to identify the settings that would benefit most from obstetric readiness efforts, improve our understanding of the resources needed for EDs to be ready to provide emergency obstetric care, and if readiness plays a role in improving outcomes. We will leverage our existing National ED Inventory database—containing information on all non-federal, non- specialty, US hospital-affiliated EDs—linked to patient-level data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project’s State Emergency Department Discharge and State Inpatient Discharge datasets in eight diverse states to investigate ED obstetric readiness. In Aim 1, we will determine if urbanicity and stage of pregnancy is associated with seeking emergency care in low-obstetric-resourced EDs to identify optimal settings for future interventions. In Aim 2, we will survey EDs to measure obstetric readiness using the Alliance for Innovation on Maternal Health’s framework for obstetric readiness to establish if higher readiness is associated with higher quality of emergency obstetric care. In Aim 3, we will use in-depth qualitative interviews with high- and low-performing EDs to identify key components of obstetric readiness that cannot be ascertained in surveys, such as functional readiness to provide care rather than structural readiness (e.g., presence of equipment), as well as facilitators and barriers to provision of high-quality emergency care for pregnant and postpartum patients. Based on preliminary data, we estimate identifying approximately 1 million admissions for birth, with over 80% power for the statistical analyses in Aims 1 and 2. The present R01 project will provide a unique opportunity for the first large-scale evaluation of ED obstetric readiness. This study directly responds to the NICHD priority to improve treatment of women at risk for pregnancy-related morbidities and mortality; the Healthy People 2030 objectives to reduce maternal deaths (MICH-04) and severe complications (MICH-05); and particularly focuses on the NICHD’s Goal 3 on pregnancy outcomes. Project Number: 1R01HD120490-01 | Fiscal Year: 2026 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Rebecca Cash | Institution: MASSACHUSETTS GENERAL HOSPITAL, BOSTON, MA | Award Amount: $443,954 | Activity Code: R01 | Study Section: Special Emphasis Panel[ZRG1 HSS-G (90)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11273130