Evaluating the statewide expansion of an educational intervention to address urgent maternal warning signs

Recognizing the signs of life-threatening maternal complications and receiving timely, quality care can help prevent pregnancy-related deaths and adverse health consequences.

This study evaluated the scale-up of the EMPOWER Moms initiative, one of the first statewide efforts to strengthen and standardize maternal warning signs education provided in home and community settings.

The EMPOWER Moms initiative supported home visitors, community nurses, and other family support staff with training and tools to educate families in Maryland and Washington D.C. on urgent maternal warning signs. Support included online training for these educators, monthly collaborative calls, an implementation manual, and a client education toolkit with a 3-min video, illustrated handout, magnet, and discussion guide.

This mixed-methods, observational study evaluated implementation and behavioral outcomes among educators and their clients using surveys, monitoring forms, and semi-structured interviews.

Two hundred and thirty-seven educators completed the training, and more than 3,300 pregnant and 3,600 postpartum clients received education between July 2022 and December 2023. The use of standardized printed materials on warning signs increased from 50.0% before training to 92.5% after (p < 0.001), and use of informational videos increased from 9.7% to 53.8% (p < 0.001). Educators showed significant improvement in their self-rated ability to educate clients about warning signs, help clients find answers to their questions, and build clients' self-confidence to discuss concerns with healthcare providers (all p < 0.001). Qualitative feedback endorsed the intervention's benefits in encouraging care-seeking. Educators shared stories of clients obtaining necessary care for urgent complications and suggested education had encouraged quick action when they might have otherwise hesitated. Feedback also highlighted how women were more proactively sharing their concerns and asking questions during healthcare visits.

We found EMPOWER training and tools were effective in improving educators' confidence and skills to engage families in conversations about pregnancy-related complications and to support them in recognizing and obtaining prompt care.