Emergency Obstetric Care Made Easier: Emergencies in obstetrics can develop suddenly and escalate within minutes. Whether in a tertiary hospital or a rural clinic, clinicians must act fast, and with confidence.
That’s where Maternal 911 comes in: a simplified, systematic approach to recognizing and managing life-threatening obstetric emergencies with clarity and efficiency.
This post explores the Maternal 911 care system and how to respond to the five most common obstetric emergencies using the CARE at EASE framework, a powerful mnemonic that helps healthcare providers take swift, structured action.
What is Maternal 911?
Maternal 911 is more than a phrase—it’s a framework for structured emergency response in obstetric care.
It emphasizes:
- Rapid recognition of danger signs
- Immediate life-saving interventions
- Team-based protocols for coordinated care
- Clear escalation plans for transfer or surgical intervention
The ultimate goal? Zero preventable maternal deaths.
The CARE at EASE Framework for Emergency Obstetric Care
When every second counts, the CARE at EASE mnemonic provides a step-by-step guide for assessment and stabilization:
| Letter | Action | Purpose |
|---|---|---|
| C | Call for help | Activate the emergency response team immediately |
| A | Assess airway, breathing, circulation (ABCs) | Quickly evaluate vital signs and stabilize |
| R | Resuscitate as needed | Start IVs, give oxygen, fluids, and reposition the patient |
| E | Evaluate obstetric cause | Identify the underlying issue: hemorrhage, seizure, dystocia, etc. |
| E | Emergency interventions | Deliver the baby if needed; perform key procedures |
| A | Act with protocols | Follow evidence-based, condition-specific pathways |
| S | Support patient & family | Communicate, reassure, and involve loved ones |
| E | Escalate or evacuate | Prepare for surgery or transfer to a higher-level facility |
This framework ensures no step is missed—even in the chaos of a high-stakes emergency.
Top 5 Maternal Emergencies and How to Respond
Postpartum Hemorrhage (PPH)
Recognition: Bleeding exceeding 500 mL after vaginal birth or 1000 mL after cesarean delivery.
Common causes: Tone (uterine atony), Trauma, Tissue (retained placenta), Thrombin (coagulopathy).
Key Actions:
- Perform fundal massage.
- Administer uterotonics (oxytocin, misoprostol, tranexamic acid).
- Manually remove retained products if necessary.
- Use Bakri balloon , Jada suction or surgical interventions for uncontrolled bleeding.
Eclampsia/Severe Pre-eclampsia
Recognition: Hypertension with seizures, severe headache, visual disturbances, or right upper quadrant pain.
Key Actions:
- Magnesium sulfate for seizure prevention and control.
- Antihypertensives (labetalol or hydralazine).
- Expedite delivery after stabilization.
Shoulder Dystocia
Recognition: Fetal head retracts (“turtle sign”) and difficulty delivering the shoulders.
Key Actions (ALARMER protocol):
- McRoberts maneuver plus suprapubic pressure.
- Internal maneuvers such as Rubin or Wood’s screw.
- Delivery of the posterior arm to reduce shoulder width.
- Gaskin position (all-fours) if other methods fail.
Amniotic Fluid Embolism (AFE)
Recognition: Sudden collapse with hypotension, hypoxia, and disseminated intravascular coagulation (DIC).
Key Actions:
- High-flow oxygen and CPR if necessary.
- Activate code blue protocols.
- Treat DIC with blood products.
- Consider emergent delivery for fetal and maternal survival.
Uterine Rupture
Recognition: Sudden, severe abdominal pain, loss of fetal station, and abnormal fetal heart rate—often in VBAC (Vaginal Birth After Cesarean) cases.
Key Actions:
- Emergency laparotomy and expedited cesarean delivery.
- Aggressive maternal resuscitation with fluids and blood products.
Why CARE at EASE Works
In the chaos of maternal emergencies, decision-making can falter without a clear system.
The CARE at EASE approach:
- Streamlines actions in a logical order.
- Ensures teamwork in high-pressure situations.
- Works in low-resource settings and emergency departments without OB teams.
- Improves simulation-based training outcomes for obstetric staff.
This makes it a life-saving tool for any healthcare provider involved in maternal care.
Quick Maternal 911 Checklist
- Call for help immediately
- Assess ABCs and stabilize
- Establish IV access and provide oxygen
- Identify the obstetric emergency quickly
- Follow appropriate protocols for intervention
- Communicate clearly with the patient and family
- Escalate to surgery or transfer if required
Final Thoughts on Emergency Obstetric Care Made Easier
Every maternal emergency is time-sensitive, but with the right tools and training, healthcare teams can save lives.
Maternal 911 and the CARE at EASE framework provide a simple, scalable, and life-saving approach for managing critical obstetric situations.
Incorporate these steps into your emergency drills, simulation sessions, and clinical protocols, because preparation makes all the difference.
