“Critical Care for Pregnant Women” – with Dr. Stephanie Martin

In the final episode of the mini series, Dr. Stephanie Martin explains critical care for pregnant women or newly postpartum mothers. Critical care is necessary for situations or conditions that put the patient’s life at risk, and Dr. Martin is an expert and lecturer on this topic. She explains how hospitals and doctors should plan for critical care in labor and delivery and what common situations can arise.

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Dr. Stephanie Martin explains critical care, or situations and conditions when a pregnant or newly postpartum mother’s life is at risk. Dr. Martin is an expert and lecturer on this topic, and explains that “postpartum is one of the most dangerous times for women,” due to risks like high blood pressure, bleeding, and stroke.  

Critical Care in Labor and Delivery 

Dr. Martin explains that “pregnant women can have critical illness and still be in the labor and delivery unit,” which can cause confusion because while the mother’s life might be at risk, she may look fine. There are risks such as infection, sepsis, or blood clots for postpartum moms. In addition, Dr. Martin explains that some women come into pregnancy with known health conditions, but others may be undiagnosed.  

Dr. Martin says that hospitals and doctors must have programs in place to be aware when moms get too sick and plans when this occurs. It is relatively common to have plans in place for babies to move to the NICU (or a hospital with a NICU), but there is not always a plan if something happens to the mother.  

According to Dr. Martin, there aren’t necessarily standards regarding each hospital having critical care for pregnant women and obstetrics, but the situation is improving. She says “some states are ahead of the curve and others are lagging behind.” Regarding hospitals, she says “there’s this assumption that everybody is ready for everything, but that’s just not the case.” 

Training Hospitals on Critical Care for Moms 

Dr. Martin explains that “the maternal mortality rate…is frankly unacceptable. It’s higher than any other developed nation.” She adds “what’s also not arguable is that women of color, of lower socioeconomic status, and older moms are dying at absolutely unacceptable rates—eclipsing white women and women with more resources.” 

Part of the problem is that hospitals are not prepared to treat women or to prepare for and predict complications. Dr. Martin says “what we can do is make sure every pregnant woman is getting the right care at the right place at the right time.” She started a company to help evaluate medical centers and hospitals to determine what level of services they have, what their community needs, and how to meet that level of care. She explains that “most places think they’re at a higher level than they actually are.” However, through training and developing simulations, hospitals can become better prepared to reduce maternal mortality rates through critical care. In her work, Dr. Martin has found that most maternal deaths are preventable, which she sees as a positive because it means the mortality rate can be decreased with adequate resources and training.  

Getting Started in Critical Care 

Dr. Martin explains that she initially found it very rewarding when critical care patients recovered and was very interested in the subject scientifically. During her Maternal Fetal Medicine fellowship, she delivered a baby via Cesarean for a mother who had cardiac arrest and died. She says “that flipped a switch for me,” motivating her to learn more about why that occurred and whether it could be prevented for future patients. She says “I started seeing the same problems over and over again,” and explains “I want to go back and help hospital systems, teams of providers, deal with these issues.”