The Public Safety Group Blog

In 2023, there were 676 pregnancy‑related deaths in the United States. According to the CDC, more than 80% of these tragedies were preventable with timely, appropriate care before, during, and after pregnancy. Emergency Medical Services (EMS) are a critical part of that safety net, often serving as the first clinical touchpoint when complications emerge. Yet national survey findings show that few EMS professionals have received recent training on issues like peripartum cardiomyopathy, one of the leading causes of postpartum death. These gaps show a clear need for better, more accessible EMS education.  

The Public Safety Group sat down with Perinatal Quality Nurse Danielle Wittig, BSN, RNC-ONQS, and OB Service Line Perinatal Educator Keri Schubert, BSN, RNC-MNN, C-EFM, at FHN Memorial Hospital in Freeport, Illinois to discuss these postpartum risks, as well as how a new program is improving how EMS provide care for new mothers. 

Common Challenges During Pregnancy  

Pregnancy brings with it a number of risks, even for women who were healthy before getting pregnant. These can include gestational diabetes, high blood pressure, infections, anemia, and depression, all of which can impact fetal development and put the mother at risk of preterm labor or preeclampsia. While getting early and regular prenatal care can help decrease the chance of these dangers, it is not a guarantee.  

Health Risks after Pregnancy  

The risks do not disappear once pregnancy ends, whether through birth or miscarriage. Schubert says that many EMS providers are unaware of this fact, and it is impacting how they deliver care.  

“The thing we recognized the most when we started going out to see EMS providers was that they didn’t realize that there were complications that occurred after pregnancy. They assumed that delivery was where complications ended,” she said. 

According to the CDC, nearly 80% of pregnancy-related deaths occurred between 1 and 365 days after birth. 28% of all deaths occur after 43 days postpartum. And there is a clear disparity in who is affected; the maternal mortality rate for Black women is more than double that of White, Hispanic, and Asian women. The maternal mortality rate for American Indian and Alaska Native women is even higher.  

Common postpartum risks include: 

• Blurred Vision Spots

• Upper Gastric Pain

• Excessive Bleeding

• Hypertensive Disorder

• Venous Thromboembolism (Blood Clots)

• Sepsis

• Cardiomyopathy (Thickening of the Heart’s Walls)

• Perinatal Depression

• Substance Use Disorder 

Postpartum risks also change over time, with hemorrhaging and high blood pressure occurring more frequently within the first six weeks after birth. Substance use disorder and postpartum depression are more common in the six-to-nine-month time frame.  

How EMS Should Respond to Postpartum Patients 

Because of the increased risk of health-related issues in postpartum patients, it is essential for EMS to be prepared to respond to these calls. Schubert says understanding the patient’s status is the first place to start. 

“The first key is just recognizing the postpartum status,” she said. “If you are transporting a 25-year-old female that’s never had a baby, those symptoms mean a lot different than a 25-year-old woman that has delivered in the past year. Start out with ‘Have you delivered a baby in the past year?’ or ‘Have you been pregnant and delivered in the past year?’ And then even focusing, if they say yes, ‘Have you delivered in the past six weeks?’ because the risks change throughout that whole year. 

Schubert says that once the postpartum status is recognized, EMS can communicate with their receiving hospital to ensure the right teams are in place. 

"Now that you know she's in the postpartum period, you're looking at what is happening right now. So, you can do that focused assessment. Then if you're an EMS personnel and you're out in the field somewhere, you're going to call your receiving hospital,” she said. “And you're going to say, ‘this patient, she's had a baby recently.’ You can tell them the symptoms; you can start specific treatment right away. And while that's going on and you're transporting the patient, the hospital can be preparing for this patient's arrival. They can reach out to the OB team there and have the OB team sitting in the waiting area, and that way you will have a very multidisciplinary team ready to treat whatever that patient has going on upon arrival.” 

Schubert notes one of the biggest signs of an emergency for EMS to watch out for is a relatively common one: high blood pressure.  

“High blood pressure in a woman of any age is concerning, but the threshold is much lower in a postpartum woman. And you might not start treatment appropriately if you weren’t aware that this patient was postpartum,” she said. 

When EMS responds to a postpartum patient, Schubert says that these five red‑flag emergencies should be top of mind: 

• Hemorrhage

• High Blood Pressure

• Postpartum Depression

• Sepsis

• Substance Use Disorder  

The Post-Birth Alert Orange Bracelet Program 

In an emergency, every second matters. The FHN Post-Birth Alert Orange Bracelet Program (PBAOB), one of the first of its kind in the United States, gives new mothers an orange bracelet with the words “Post-Birth Alert.” These alert bands are worn for six to twelve weeks, until the mother’s postpartum appointment with their provider. Wittig says that the bracelets take the guesswork out of a patient’s status, allowing EMS to provide faster and better care. 

“One of the big risks is going up to a scene and the patient’s unresponsive,” she said. “So, by identifying these patients with the Post-Birth Alert Orange Bracelet, it takes that little factor out of it so you can immediately start to think toward those highest risk diagnoses.” 

The FHN team developed and expanded the bracelet idea beyond OB by creating a multidisciplinary group, led by Wittig, that included emergency nurses and emergency preparedness staff. They built focused training for ED teams and then created a quick 10-minute education to be given directly to rural EMS crews, whose long transport times of 20-45 minutes make early recognition critical. The goal was simple: ensure anyone who might encounter a postpartum patient could identify the bracelet, act quickly, and alert the hospital. 

“It’s very universal communication,” Wittig says. “We’re in a rural community, and we have had patients who have delivered at another facility come to our emergency room and are identified by this Post-Birth Alert band. And we’ve also had patients deliver here and present to an emergency room in another community, but they can get that patient help right away because she has this bracelet on that is identifying her as a postpartum patient.” 

To date, the program has expanded to more than 30 states nationwide. FHN has begun partnering with the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), and in 2026 the bracelets will include a QR code that directs to information on the AWHONN website. For EMS providers who have not received thorough training on postpartum care, they will have access to these post-birth warning signs and know what to look for in their patients. 

Delivering Education to New Mothers 

In addition to an alert bracelet, patients receive resources on what they can expect and should look out for after giving birth. Wittig says this education is essential for reminding new mothers that while they have a new life to care for, they still matter and need to closely monitor their own health. 

“Once a patient delivers, that person is so much more worried about their child that they are automatically put on the back burner,” she said. “Now that we give this education and we give them the Post-Birth Alert bracelet, they see that every day and that’s a reminder that they are still important, their health is important. They’re still a patient. It has really shifted the way that these patients think about themselves postpartum.” 

Wittig says the effects have been noticeable, with more women taking control of their health both in and out of hospital settings. 

“We’re seeing that patients are intervening in their own care before it becomes these emergent crisis situations. They’re paying attention to their body more. They want to get checked out. They’re not disregarding these problems,” she said. 

How EMS Can Train in Women’s Health 

2022 data from the NAEMT notes that up to 75% of EMS providers do not ask if a patient has been pregnant in the past year. And less than 30% said they received education or training in the last three years on peripartum cardiomyopathy, which is one of the leading causes of postpartum death. Better training for EMS is needed, but how can it be delivered?  

Schubert says that EMS stations can start by reaching out to their receiving hospital to see if there is an available OB educator or another expert who can provide training, and to not be afraid to reach out to more than one hospital if needed. Locally, FHN hosts an annual education night, where local EMS providers are invited to learn more about pregnancy and postpartum complications. Simulations are conducted, and protocols are reviewed. If these methods are not an option, AWHONN offers a number of resources for individual learning.  

For many, it can be difficult and awkward to learn about these intimate topics. Wittig says that departments should remain sensitive to these feelings, while still navigating training conversations in a way that ensures students still receive the education they need.  

“We have to be very sensitive to what people bring to the table and what kind of traumas have they been through themselves...Allow that time to really get a space where you can talk about that and what makes you uncomfortable because those are inevitably those scenes that you’re going to go on,” she said. 

Better education and training are key. Wittig credits the PBAOB with giving new moms the best chance to stay safe before, during, and after delivery. 

“This community, the mortality rate is so high, and their needs are so unique that having this information out there has just really changed the way that people are assessing patients,” she said. 

For more information on the Post-Birth Alert Orange Bracelet Program Toolkit, reach out to FHN Memorial Hospital.