Maternal Early Warning System

The Maternal Early Warning System (MEWS) initiative seeks to implement a protocol into practice to facilitate timely recognition, diagnosis, and treatment for pregnant women developing critical illness, thus avoiding major morbidity and mortality. Essential components of an early warning system include: 1) maternal early warning criteria that prompt reporting to a clinician; and 2) an effective notification and escalation process that prompts bedside evaluation by a clinician. The MEWS initiative is an integral component of TexasAIM, which is coordinated by the Texas Department of State Health Services (DSHS). TCHMB provides MEWS technical assistance to all TexasAIM hospitals.  







Learning Collaborative


Maternal death in the United States is “just the tip of the iceberg.”For every maternal death, 100 women experience severe maternal morbidity (SMM). SMM refers to unexpected outcomes of the process of labor and delivery that result in significant short- and long-term consequences to a woman’s health. According to a recent report, SMM prevalence in Texas in 2016 was 17.0 per 1,000 deliveries. A substantial proportion of SMM is potentially preventable and, thus, can be targeted as a means of preventing maternal mortality.

The MEWS learning collaborative is working on implementing a MEWS protocol to increase the early recognition of changes in a mother’s vital signs and clinical conditions leading to effective escalation and prompt evaluation with the goal of reducing the number of women experiencing obstetrical hemorrhage, hypertension, or other severe maternal morbidities.

The Department of State Health Services (DSHS) has teamed up with the Alliance for Innovation on Maternal Health (AIM) and the Texas Hospital Association (THA) to create the TexasAIM initiative. TexasAIM will help hospitals and clinics in Texas carry out maternal safety projects. The goal of TexasAIM is to end preventable maternal death and severe maternal morbidity.

An AIM Maternal Safety Bundle is a collection of best-practices for improving maternal care. Experts in the field have vetted these practices to ensure their effectiveness. Each bundle focuses on a specific maternal health and safety topic. TexasAIM will first work on the Obstetric Hemorrhage Bundle. The initiative will then focus on the Obstetric Care for Women with Opioid Use Disorder Bundle and Severe Hypertension in Pregnancy Bundle.

If you are interested in implementing AIM Maternal Safety Bundles in your hospital or would like more information, please complete the TexasAIM Enrollment Form or email


Obstetrics Subcommittee Co-Chairs

Christina Davidson, MD, Baylor College of Medicine

Catherine Eppes, MD, MPH, Baylor College of Medicine

Project Leads

Divya Patel, PhD, UT Health Science Center at Tyler, Affiliate of The University of Texas System

Amanda Wagner, MSN, WHNP-BC, UT Health Science Center at Tyler, Affiliate of The University of Texas System