Methodology of BAMM

BAMM is an enhanced system for the surveillance of maternal deaths in Belgium.

It is both

  • a national multicentre epidemiological survey: to assess numbers of maternal deaths, Maternal Mortality Ratio (MMR), and
  • an in-depth analysis of each case of maternal death: to identify opportunities for improvement in the (obstetric) care.

Confidentiality and a NO-BLAME approach is paramount for the BAMM system to succeed.

The timeline below demonstrates the 'flow' of the BAMM system in case of a maternal death.

Timeline BAMM

  • A case of maternal death is reported via the B.OSS/BAMM platform in response to the monthly mailing of B.OSS, directly on the BAMM website or by sending a mail to the BAMM-team.

  • Firstly, a local retrospective incident analysis of the maternal death takes place at the hospital.

The quality coordinator(s) of the hospital organises and takes the lead in this local analysis. If the hospital quality coordinator is not available or does not feel confident to perform a retrospective analysis of such a serious event, the hospital can use the services of an external quality coordinator. BAMM has a partnership and good experience with Ms. Evelien Raman. This information is without obligation.
All caregivers involved in the care of the deceased mother are invited to take part in the local analysis. This takes place in group with all caregivers together. Or with every caregiver individually, which we would recommend.
The local analysis provides an opportunity for caregivers to debrief and to be informed of possible assistance in the process of the tragic event.
Detailed information is gathered from every step in the chain of events. Therefore forms will be completed and relevant anonymised case notes will be collected.

  • Then, an online confidential national analysis is undertaken

A multidisciplinary national expert team is invited to assess the case.
Experts are given access to the information collected during the local analysis.
Experts are asked for their opinion on the following questions:

  1. What was the cause (causes, chain of events)?

  2. Which patient related, technical, organisational and human factors played a role in this maternal death?

  3. Which recommendations can we formulate based on the analysis of this case?

  • The national expert team is invited around the table in a life meeting,

to discuss cases without consensus
      this will be organised two times per year

  • For every case of maternal death, conclusions of the BAMM analysis will be drawn up as a national BAMM report.

A resume of the findings concerning the contributing factors, the cause of death and the recommendations formulated by the team of experts.
This BAMM report is anonymous, nothing in this report will refer to the woman, the caregivers or the hospital.

  • A national BAMM publication will be brought out after 3 to 5 years

An aggregated resume of all cases of maternal death in these years:
the numbers and the lessons learned based on the in-depth analyses