Maternal Sepsis Week Spotlight: Laura Riley, MD

This Maternal Sepsis Week (May 8-14, 2022), Sepsis Alliance is asking: what does the work of a clinician on the front lines of maternal sepsis care look like?

“In medical school, I fell into obstetrics and just loved delivering babies,” recalled Laura Riley, MD, looking back on what became her life path. In 2018, Dr. Riley was appointed Chair of the Department of Obstetrics and Gynecology at Weill Cornell Medicine, and Obstetrician and Gynecologist-in-Chief at New York-Presbyterian/Weill Cornell Medical Center. The system encompasses eight hospitals in the biggest city in the country, including the new Alexandra Cohen Hospital for Women and Newborns. Last year alone, 7,400 babies were delivered there under Dr. Riley’s oversight.  

Dr. Riley also has some niche specialties within the world of obstetrics, including high-risk pregnancy and infectious disease. Given her specialized knowledge of infection, Dr. Riley is extremely familiar with maternal sepsis, which can develop from any infection that occurs during pregnancy, delivery, or the postpartum period, or after miscarriage or abortion. It’s no small problem: infection or sepsis, the body’s overwhelming and life-threatening response to infection, is the second leading cause of maternal mortality in this country.  

It also isn’t always easy to diagnose. “Most pregnant patients are otherwise young and healthy, and that sometimes catches us, because people can look good for such a long time, and then they fall off a cliff,” Dr. Riley said. “Being able to see that that’s happening as early in the process as possible is what is tricky, but absolutely critical for us.” 

She came to this specialty in part due to timing. When Dr. Riley finished her obstetrics training, it was the very beginning of the HIV epidemic in Boston, where she then lived. In response to the quickly changing landscape in that city, she pursued additional medical training in infectious disease. During this time, she also developed what would become a lifelong research interest in fever and labor – “understanding how, why, and when to treat women who develop fever during labor. We still don’t have the answers there,” she explained.  

As HIV infections began to fade in both frequency and severity in Boston and around the country, Dr. Riley’s attention turned to other infections that impact pregnant people and can cause maternal sepsis, like Group B strep, Zika, Ebola, and, of course, COVID-19. This is where a lot of her work is focused today. 

In practice, maternal sepsis is most often caused by uterine infection, endometritis, wound infection after Caesarean delivery, and pyelonephritis (kidney infection). Any of these infections can develop during routine parts of the pregnancy and delivery process. “Once you contaminate sterile spaces – which we do, especially when we do a Caesarean delivery, a vaginal delivery, or multiple vaginal exams – it increases the risk that a patient gets infected, and then that the infection goes further if it’s not treated,” Dr. Riley said. 

She also emphasized that viruses like influenza or the coronavirus can be causes of maternal sepsis. “Viruses can adversely affect pregnant women more than non-pregnant individuals,” she said. “The physiology of pregnancy puts some people at greater risk.” 

Dr. Riley has another notable area of focus and passion, which is tackling health inequities in pregnant populations, particularly for Black people. This intersects and overlaps with her other specialties because Black pregnant people are twice as likely to develop severe maternal sepsis as compared to their white counterparts. Additionally, according to the Centers for Disease Control and Prevention, Black women are three times more likely to die from any pregnancy-related cause than white women. “We now recognize the structural racism that exists such that people don’t have appropriate access to good care or timely care,” Dr. Riley explained. Certain social determinants of health, such as poverty, level of education, access to transportation, and access to childcare have a huge impact on these disparate outcomes for pregnant people. “There is variation in the quality of obstetrical care within the same city – even within the same hospital, if you look at race and ethnicity and socioeconomic status,” Dr. Riley said.  

This trickles down from the level of a national crisis right into Dr. Riley’s office. “When my patients – many of whom are Black women, who came to me because they want a Black doctor – come into the office, many come with fear, because they’ve read about Black maternal mortality,” she said. “Even if they don’t say ‘I’m afraid I’m going to die,’ that’s there, right at the forefront.” To address this fear and to help face these large structural hurdles, Dr. Riley begins by setting a tone of open communication. “I feel it’s important to just bring it up,” she said. “It’s a hard conversation, but by not dealing with it and not verbalizing it, in some ways you’re perpetuating this sense that they’re not being heard, that you’re not worried about it. So I say, ‘you know what? I am sure you’ve read all the stories. You know who Serena Williams is.’ And I’m very honest with them that yes, you could get sick. Pregnancy is not always easy.”  

On the patient side, Dr. Riley said the most important way to self-advocate is to ask questions and to insist on answers. “You have to speak up, and you have to ask questions. And when the answers don’t make sense, or you’re not getting answers, you need to ask again,” she said. She sees this as good advice for all her pregnant patients, but especially as a way to tackle inequitable interactions with the healthcare system. “I tell patients that it is really important for them to communicate to me when they’re not feeling well. I say, ‘if you’re saying something and I’m just not hearing you, tell me again.’”  

There is much more to the problem of inequitable outcomes than just what occurs in the doctor’s office, including all the factors that impact a pregnant person’s health before coming to the hospital and everything that happens post-hospital discharge. “We need to get outside of healthcare in order to get to the root of some of those problems,” Dr. Riley emphasized. “That said, as a physician, what I am in control of is standardizing obstetrical care and making sure that we are using the same evidence-based bundle of information and treatments so that, at the very least, once women get to us, they are getting the high-quality care that they need.” For sepsis specifically, that includes timely recognition, timely intervention with therapeutics, and a standardized, step-by-step approach.  

Weill Cornell is undertaking some key quality improvement initiatives to tackle maternal sepsis recognition, which include provider education and work to maximize utilization of electronic medical record alerts. According to Dr. Riley, it is already standard practice in her hospital system to review every sepsis case after the fact. “It’s always incredibly fruitful,” she said. “We have conversations about what we could have done better, whether we could have done this sooner, etc.” One area that she specifically wants to improve is patient sepsis education after discharge. Weill Cornell has made some strides, including instituting two-week postpartum check-in calls by video, which are aimed at encouraging earlier interventions in patients’ own homes and environments. But there’s always more to be done. And in the face of overwhelming maternal mortality numbers, especially for people of color, it can sometimes feel like a lot more needs to be done, as soon as possible.

“It’s daunting and many times frustrating, because I want to do more, and I want to do it faster,” Dr. Riley said. “I can do what I can do in my own office, seeing patients. I can do what I can do when I supervise residents. I can do my part in encouraging a more diverse workforce and using my voice and expertise at a national level as well, to continue to push and strive to make healthcare better.”

It can be slow work. But since the early 1990s, Laura Riley has been working to make a difference, one delivery at a time.
 

For more information and resources about maternal sepsis signs and symptoms, and to read the experiences of those whose lives have been impacted by maternal sepsis, please visit MaternalSepsisWeek.org.  

Find out how to use your voice to make a difference for patients with sepsis – including maternal sepsis – and their loved ones at SepsisVoices.org.  

To stay in touch with Sepsis Alliance, sign up for our newsletter here.  

 

About Dr. Riley

Laura E. Riley, MD, is Obstetrician and Gynecologist-in-Chief at NewYork-Presbyterian/ Weill Cornell Medical Center and Given Foundation Professor and Chair of the Department of Obstetrics and Gynecology at Weill Cornell Medicine. In this role, Dr. Riley leads the Alexandra Cohen Hospital for Women and Newborns, which opened in August 2020. She also leads the obstetrics and gynecology enterprise at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine as well as at NewYork- Presbyterian Lower Manhattan Hospital, NewYork-Presbyterian Brooklyn Methodist Hospital, and NewYork-Presbyterian Queens. A particular clinical focus of the department is transforming women’s health care beginning with attention to maternal mortality and morbidity.

A maternal-fetal medicine specialist and internationally recognized expert on obstetric infectious diseases, Dr. Riley specializes in the treatment of expecting mothers whose pregnancies are high-risk because of chronic illness or infectious disease. She also works with the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, and the American College of Obstetricians and Gynecologists to develop practice guidelines for the care of pregnant women with Group B Strep, Ebola, zika, influenza and COVID-19, as well as, maternal immunization.

Dr. Riley received her Bachelor of Arts degree in biology from Harvard University and her medical degree from the University of Pittsburgh School of Medicine. Dr. Riley remained at the University of Pittsburgh for her residency in obstetrics and gynecology before completing a fellowship in maternal fetal medicine at Brigham and Women’s Hospital in Boston and a fellowship in infectious disease at Boston University Medical Center.