Bio

Bio


Christine Morton is a medical sociologist with expertise in women's reproductive experiences and maternal quality improvement. Since 2008, she has managed CMQCC's state funded project on California Pregnancy-Associated Maternal Review (CA-PAMR), overseeing data collection, committee matters and conducting qualitative analysis on improvement opportunities identified from case reviews. She serves as co-chair of the CMQCC Cardiovascular Disease in Pregnancy and Postpartum Taskforce, coordinating the development of a Maternal Quality Toolkit on this leading cause of maternal death in California. She also collaborates on research projects that support CMQCC’s goals and mission, including an interview study of women's experiences with severe maternal morbidity and an analysis of women's online peripartum cardiomyopathy narratives. Dr. Morton is a member of the National Partnership Maternal Safety workgroup on Patient, Family and Staff Support after a Severe Maternal Event and serves on the Board of Directors of Lamaze International.

Current Role at Stanford


Research Sociologist and Program Manager at California Maternal Quality Care Collaborative (CMQCC)

Education & Certifications


  • PhD, UCLA, Sociology (2002)

Professional

Professional Interests


Maternal Mortality and Morbidity, Preeclampsia, Cardiovascular Disease, Quality Measurement, Quality Improvement, Childbirth and Pregnancy, Qualitative Methods

Publications

Journal Articles


  • Pregnancy-Related Mortality in California Causes, Characteristics, and Improvement Opportunities OBSTETRICS AND GYNECOLOGY Main, E. K., McCain, C. L., Morton, C. H., Holtby, S., Lawton, E. S. 2015; 125 (4): 938-947

    Abstract

    To compare specific maternal and clinical characteristics and contributing factors among the five leading causes of pregnancy-related mortality to develop focused clinical and public health prevention programs.California pregnancy-related deaths from 2002-2005 were identified with enhanced surveillance using linked birth and death certificates. A multidisciplinary committee reviewed medical records, autopsy reports, and coroner reports to determine cause of death, clinical and demographic characteristics, chance to alter outcome, contributing factors (at health care provider, facility, and patient levels), and quality improvement opportunities. The five leading causes of death were compared with each other and with the overall California birth population.Among the 207 pregnancy-related deaths, the five leading causes were cardiovascular disease, preeclampsia or eclampsia, hemorrhage, venous thromboembolism, and amniotic fluid embolism. Among the leading causes of death, we identified differing patterns for race, maternal age, body mass index, timing of death, and method of delivery. Overall, there was a good-to-strong chance to alter the outcome in 41% of deaths, with the highest rates of preventability among hemorrhage (70%) and preeclampsia (60%) deaths. Health care provider, facility, and patient contributing factors also varied by cause of death.Pregnancy-related mortality should not be considered a single clinical entity. Reducing mortality requires in-depth examination of individual causes of death. The five leading causes exhibit different characteristics, degrees of preventability, and contributing factors, with the greatest improvement opportunities identified for hemorrhage and preeclampsia. These findings provide additional support for hospital, state, and national maternal safety programs.

    View details for DOI 10.1097/AOG.0000000000000746

    View details for Web of Science ID 000351595200026

    View details for PubMedID 25751214

  • Pregnancy-related cardiovascular deaths in California: beyond peripartum cardiomyopathy. American journal of obstetrics and gynecology Hameed, A. B., Lawton, E. S., McCain, C. L., Morton, C. H., Mitchell, C., Main, E. K., Foster, E. 2015

    Abstract

    Maternal mortality rates rose markedly from 2002 to 2006 in California, prompting an in-depth maternal mortality review in a state that comprises one twelfth of the US birth cohort. Cardiovascular disease has emerged as the leading cause of pregnancy-related death in the United States. The primary aim of this analysis was to describe the incidence and type of cardiovascular disease as a cause of pregnancy-related mortality in California. The secondary aims were to describe racial/ethnic and socioeconomic disparities, risk factors, birth outcomes, timing of death and diagnosis, and signs and symptoms of cardiovascular disease and identify contributing factors.The California Pregnancy-Associated Mortality Review retrospectively examined a case series of 64 cardiovascular pregnancy-related deaths from 2002 through 2006. Two cardiologists independently reviewed complete inpatient and outpatient medical records including laboratory, radiology, electrocardiogram, chest X-ray, echocardiograms, and autopsy findings for each cardiovascular death and classified cause of death by type of cardiovascular disease. Demographic data, racial disparities, risk factors, signs and symptoms, timing of diagnosis and death, birth outcomes, and contributing factors were analyzed using bivariate comparisons with noncardiovascular pregnancy-related deaths and population-based data.Among 2,741,220 California women who gave birth, 864 died while pregnant or within 1 year of pregnancy; 257 of the deaths were deemed pregnancy related, and of these, 64 (25%) were attributed to cardiovascular disease. There were 42 deaths caused by cardiomyopathy, and the pregnancy-related mortality rate from cardiomyopathy was 1.54 per 100,000 births. Dilated cardiomyopathy existed in 29 cases, of which 15 met the definition of peripartum cardiomyopathy. Women with cardiovascular disease were more likely than women who died from noncardiovascular causes to be African-American (39.1% vs 16.1%; P < .01) and more likely to use illicit substances (23.7% vs 9.4%; P < .01). Thirty-seven percent were obese and 20% had a concomitant diagnosis of hypertension or preeclampsia during pregnancy. Health care decisions in the diagnosis or treatment of cardiovascular disease during and after pregnancy contributed to the fatal outcomes.African-American race, substance use, and obesity were risk factors for pregnancy-related cardiovascular disease mortality. Chronic disease prevention and better recognition and response to cardiovascular disease during pregnancy are needed to reduce maternal mortality.

    View details for DOI 10.1016/j.ajog.2015.05.008

    View details for PubMedID 25979616

  • The Problem of Increasing Maternal Morbidity: Integrating Normality and Risk in Maternity Care in the United States BIRTH-ISSUES IN PERINATAL CARE Morton, C. H. 2014; 41 (2): 119-121

    View details for DOI 10.1111/birt.12117

    View details for Web of Science ID 000337298500001

    View details for PubMedID 24851998

  • California Pregnancy-Associated Mortality Review: Mixed methods approach for improved case identification, cause of death analyses and translation of findings Maternal Child Health Journal Mitchell, C., Elizabeth Lawton MHS, Christine Morton PhD, Christy McCain MPH, Sue Holtby MPH, Elliott Main MD 2013
  • Creating a Public Agenda for Maternity Safety and Quality in Cesarean Delivery OBSTETRICS AND GYNECOLOGY Main, E. K., Morton, C. H., Melsop, K., Hopkins, D., Giuliani, G., Gould, J. B. 2012; 120 (5): 1194-1198

    Abstract

    Cesarean delivery rates in California and the United States rose by 50% between 1998 and 2008 and vary widely among states, regions, hospitals, and health care providers. The leading driver of both the rise and the variation is first-birth cesarean deliveries performed during labor. With the large increase in primary cesarean deliveries, repeat cesarean delivery now has emerged as the largest single indication. The economic costs, health risks, and negligible benefits for most mothers and newborns of these higher rates point to the urgent need for a new approach to working with women in labor. This commentary analyzes the high rates and wide variations and presents evidence of costs and risks associated with cesarean deliveries (complete discussion provided in the California Maternal Quality Care Collaborative White Paper at www.cmqcc.org/white_paper). All stakeholders need to ask whether society can afford the costs and complications of this high cesarean delivery rate and whether they can work together toward solutions. The factors involved in the rise in cesarean deliveries point to the need for a multistrategy approach, because no single strategy is likely to be effective or lead to sustained change. We outline complementary strategies for reducing the rates and offer recommendations including clinical improvement strategies with careful examination of labor management practices; payment reform to eliminate negative or perverse incentives; education to recognize the value of vaginal birth; and full transparency through public reporting and continued public engagement.

    View details for DOI 10.1097/AOG.0b013e31826fc13d

    View details for Web of Science ID 000310512500027

    View details for PubMedID 23090538

  • Standardising or individualising?: A critical analysis of the 'discursive imaginaries' shaping maternity care reform International Journal of Childbirth Reiger, K., Christine Morton 2012; 2 (3): 173-186
  • Safety in childbirth and the three ‘C’s: community, context, and culture Midwifery Sandall, J., Christine Morton, Debra Bick 2010; 26: 481-482

Presentations


  • Creating a Public Agenda for Maternity Safety and Quality in Cesarean Delivery

    Time Period

    2/26/2013

    Presented To

    Perinatal Patient Safety and Education Quarterly Meeting/Regional Perinatal Programs of California, San Diego/Imperial Counties, and Hospital Association of San Diego and Imperial Counties, and Patient Safety First

    Location

    San Diego, CA

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