WASHINGTON, D.C. — In a landmark move to address the escalating crisis of maternal mortality in the United States, the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) announced on July 14, 2026, that it has been awarded a $500,000 grant from Merck for Mothers. This significant financial injection is earmarked for the development and nationwide implementation of the POST-BIRTH Triage Index (PBTI), a pioneering standardized tool designed to revolutionize how emergency departments, urgent care centers, and freestanding emergency facilities identify and treat postpartum complications.
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The initiative arrives at a time when the "fourth trimester"—the year following childbirth—is increasingly recognized as the most dangerous period for new mothers. By providing non-obstetric clinicians with the specialized tools necessary to recognize life-threatening symptoms, AWHONN aims to bridge a lethal gap in the American healthcare continuum.
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The Critical Context: The Crisis of Postpartum Mortality in America
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To understand the weight of this grant, one must look at the sobering statistics defining maternal health in the United States. While much of the public discourse surrounding maternal safety focuses on the act of childbirth itself, the data tells a different story. According to the Centers for Disease Control and Prevention (CDC), more than half of all pregnancy-related deaths occur between seven days and one year after delivery.
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Perhaps most tragic is the fact that the vast majority of these deaths—estimated at over 80%—are considered preventable. The period following hospital discharge is often characterized by a "drop-off" in clinical supervision. While newborns receive frequent check-ups, mothers often wait six weeks for a single postpartum visit. During this window, complications such as delayed postpartum hemorrhage, preeclampsia, infection, and cardiomyopathy can escalate rapidly.
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When a postpartum woman experiences a medical crisis, she rarely returns to the labor and delivery unit where she gave birth. Instead, she typically seeks help at the nearest emergency department (ED) or urgent care center. However, research conducted across 23 emergency departments in 17 states has revealed a systemic vulnerability: clinicians in these non-obstetric settings often lack the standardized protocols and specialized training required to recognize that a patient’s symptoms are related to a recent pregnancy.
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The PBTI initiative is designed to be the definitive solution to this "recognition gap," ensuring that no matter where a mother seeks care, her postpartum status is identified and her risks are accurately triaged.
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Chronology: The Evolution of the POST-BIRTH Initiative
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The development of the POST-BIRTH Triage Index (PBTI) is not an isolated event but the culmination of years of advocacy and clinical research by AWHONN.
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The Foundation: POST-BIRTH Warning Signs (PBWS)
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The journey began with the successful launch of AWHONN’s POST-BIRTH Warning Signs (PBWS) program. This initiative focused on patient education, providing mothers with clear, actionable information about "red flag" symptoms—such as chest pain, seizures, or heavy bleeding—that require immediate medical attention. To date, the PBWS program reaches more than 1.7 million postpartum patients annually through hospital discharge education and integration into statewide maternal mortality prevention efforts.
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Identifying the Gap (2022–2025)
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As the PBWS program empowered patients to seek care, a new problem emerged: patients were showing up at emergency rooms, but the systems were not prepared for them. AWHONN’s internal research and collaborative studies with emergency medicine associations identified that without a specific triage tool, postpartum patients were often assigned lower acuity levels, leading to long wait times that proved fatal in cases of fast-moving conditions like preeclampsia.
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The 2026 Expansion
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With the $500,000 grant from Merck for Mothers, AWHONN is now moving from patient education to clinical standardization. The timeline for 2026 involves a rigorous, evidence-based approach to formalize the PBTI. This includes the establishment of a multidisciplinary expert panel comprising obstetricians, emergency physicians, nurses, and patient advocates. This panel will oversee three consecutive research studies intended to validate the index’s efficacy across diverse clinical settings.
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Supporting Data: Why Specialized Triage is Necessary
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The necessity of the PBTI is underscored by clinical data regarding the "presenting symptoms" of postpartum complications. Many life-threatening postpartum issues mimic common, less-urgent conditions.
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- Hypertension and Preeclampsia: A headache in a general ED might be triaged as a migraine. For a woman three weeks postpartum, it could be the first sign of late-onset preeclampsia, leading to a stroke or seizure if not treated with magnesium sulfate—a medication rarely prioritized in general triage for headaches.
- Postpartum Cardiomyopathy: Shortness of breath might be mistaken for anxiety or a mild respiratory infection in a busy urgent care center. For a new mother, it is a hallmark of heart failure.
- Sepsis: Post-surgical infections following a C-section can present as general malaise or low-grade fever, which can quickly spiral into septic shock without targeted obstetric-informed intervention.
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AWHONN’s research indicates that when a standardized triage index is used—one that mandates asking "Are you currently pregnant or have you been pregnant in the last year?"—the speed of diagnosis and treatment increases significantly. The PBTI will formalize this question and provide a weighted scoring system to ensure these patients are moved to the front of the line.
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Official Responses: A Unified Vision for Maternal Safety
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The partnership between AWHONN and Merck for Mothers represents a powerful alliance between the nation’s leading nursing organization and a global leader in maternal health philanthropy.
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Jonathan Webb, MBA, MPH, CEO of AWHONN, emphasized the transformative nature of this investment. "This represents a significant step forward in improving maternal safety during one of the most vulnerable periods in a woman’s healthcare journey," Webb stated. "By developing the first validated postpartum-specific triage index for emergency and urgent care settings, we can help clinicians identify life-threatening complications more quickly, improve care coordination and ultimately save lives. We are grateful to Merck for Mothers for partnering with us to advance innovative, evidence-based solutions."
Jacquelyn Caglia, Head of Merck for Mothers, echoed these sentiments, highlighting the importance of strengthening the systems that support families. "Merck for Mothers believes that every mother deserves access to high-quality, timely care throughout the postpartum period," Caglia said. "We are honored to support AWHONN’s efforts to expand this important work, building on the success of the Post-Birth Warning Signs program and helping to strengthen systems providing care for families across the United States during this critical time."
The grant is part of Merck for Mothers’ global initiative, known as MSD for Mothers outside the U.S. and Canada, which seeks to eliminate maternal mortality through strategic investments in healthcare infrastructure and innovation.
Implications: Redefining the Future of Emergency Medicine
The rollout of the POST-BIRTH Triage Index carries profound implications for the American healthcare system, extending far beyond the walls of the labor and delivery ward.
1. Inter-Specialty Collaboration
The PBTI will necessitate a new level of collaboration between the American College of Emergency Physicians (ACEP) and the American College of Obstetricians and Gynecologists (ACOG). By integrating obstetric knowledge into the "front door" of the hospital (the ED), the PBTI breaks down the silos that have historically contributed to medical errors.
2. Standardization and Health Equity
Maternal mortality disproportionately affects Black and Indigenous women, who are three to four times more likely to die from pregnancy-related causes than white women. Standardized tools like the PBTI help mitigate implicit bias by ensuring that every patient is evaluated against the same objective clinical criteria. When a protocol mandates specific actions based on symptoms and postpartum status, the room for subjective (and potentially biased) judgment is reduced.
3. Economic Impact
Preventing catastrophic postpartum events also has significant economic benefits. The cost of treating a stroke or long-term heart failure far exceeds the cost of early intervention for hypertension or infection. By streamlining the triage process, hospitals can reduce the length of stay and the intensity of care required for complications that are caught early.
4. A New Standard for "The Fourth Trimester"
The implementation of the PBTI signals a cultural shift in medicine. It reinforces the reality that a woman remains an "obstetric patient" for a full year after birth. This tool will serve as a constant reminder to the entire medical community that the postpartum period requires specialized vigilance.
Looking Ahead: Implementation and Outreach
Starting in 2026, AWHONN will begin the intensive work of protocol development and the expansion of maternal and newborn education resources. The organization plans to pilot the PBTI in a variety of settings—from high-volume urban trauma centers to rural freestanding emergency rooms—to ensure the tool is versatile and effective in all environments.
As the PBTI becomes integrated into electronic health record (EHR) systems and triage software, it is expected to become the gold standard for postpartum care nationwide. For the 1.7 million families currently reached by AWHONN’s education programs, this grant promises a future where the healthcare system is finally ready to meet them with the urgency and expertise they deserve.
About AWHONN
The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) is a 501(c)3 nonprofit membership organization. Its mission is to empower and support nurses caring for women, newborns, and their families through research, education, and advocacy. AWHONN is the leading professional organization for nurses working in maternal-child health.
About Merck for Mothers
Merck for Mothers is a global initiative to help create a world where no woman has to die while giving life. Supported by Merck (known as MSD outside the U.S. and Canada), the initiative applies Merck’s scientific and business expertise to reduce maternal mortality in over 50 countries.
Media Contact
For more information regarding the PBTI initiative or to schedule an interview, please contact:
Shannon Doolin
Phone: 202-261-2410
Email: [email protected]
