Ask Me 5: Not Another Checklist

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About 80% of all pregnancy-related deaths in Missouri are preventable, according to the 2025 Pregnancy-Associated Mortality Review Annual Report.

The Missouri Perinatal Quality Collaborative, in partnership with the Missouri Hospital Association, is working to change that with a statewide initiative called Ask Me 5.

The idea for Ask Me 5 began when the Missouri PAMR board, which reviews all cases of maternal death from conception through one year postpartum, began seeing the same five concerns recur in these preventable deaths, according to Alison Williams, DNP, MBA-HCM, CPHQ, LSSGB, vice president of clinical quality improvement at MHA and the team lead for the MO PQC.

“We weren't having good conversations with our patients, so we decided we really needed to do something about that,” she said.

With a goal of improving maternal health outcomes during pregnancy and the postpartum period, Ask Me 5 encourages health care providers to ask their patients five essential health questions that build trust, open dialogue and address critical health concerns.

The five questions are outlined in an easy-to-recall acronym: H.E.A.R.T.

• High blood pressure/preeclampsia: Have you ever been told you have high blood pressure or preeclampsia?
• Emotional and mental health: How have you been feeling lately?
• Access to health care: Are there obstacles that make it difficult to attend appointments?
• Recognizing substance use: Can we discuss your experience with alcohol or drug use?
• Trauma, abuse and safety: Do you feel safe in your home, both emotionally and physically?

These questions were developed to help providers and patients have more open, authentic and nonjudgmental conversations that are based on five highly preventable causes of death in mothers in Missouri, Williams said.

“We developed the Ask Me 5 framework and the H.E.A.R.T. acronym to better support providers and patients when it comes to saving lives and improving the health of moms and babies,” Williams said. “Being more intentional and talking about these areas of concern better enables providers to help expectant moms find solutions, which leads to better birth outcomes.”

The MO PQC crafted this initiative but didn’t do it alone.

“The MO PQC has a wider network called our Maternal-Child Learning and Action Network, which consists of clinical professionals, state- and community-based organizations, birth workers, patients, and various maternal and infant stakeholders throughout the state,” Williams said.

In addition, MO PQC staff asked a patient focus group for feedback about Ask Me 5.

According to Williams, Ask Me 5 encourages maternal and infant health care providers to raise these concerns with patients through a conversation built into existing workflows. She added that not all five questions must be asked at one patient visit, but providers should keep in mind that they need to cover these topics with their patients early and often from pregnancy through postpartum.

“Some of these issues can make people feel very isolated. We just want these patients to know that they're not alone, and we're here to help,” said Mary Conley, perinatal quality collaborative engagement specialist at MHA.

By asking questions designed around H.E.A.R.T., providers can address sensitive topics with patients, provide them with resources, and empower them to understand and prioritize their health during pregnancy and the postpartum period.

“These questions can be asked by any provider of maternal or infant care services,” Williams said.

While pediatricians have a duty to evaluate infants and children, they also have the opportunity to connect with the mother and check on her while they’re in the same room. Doulas and public health and community-based workers  who come in contact with pregnant or postpartum patients can ask these questions, too.

“Providers should know that having these conversations is better for everyone. The information they elicit from their patients helps them better care for their patients and helps the patients have a better care experience,” Williams said.

Dr. Niraj Chavan is a Missouri health care provider who uses the Ask Me 5 conversation tool. Chavan has a master’s degree in public health and is an associate professor of the Department of Obstetrics, Gynecology and Women’s Health at Saint Louis University; PAMR board member; maternal chair of MC LAN; and medical director of the Women and Infant Substance Help Center at SSM Health. 

“The Ask Me 5 campaign really equips us, as providers, in being able to understand and identify, ‘Are there things that are not going right? Are there issues that need to be addressed?’” Chavan said.

Williams said data show that Missouri has one of the highest maternal mortality rates in the country. She noted that Ask Me 5 equips providers and patients to have meaningful conversations that can save lives.

Williams and Chavan urge providers to utilize Ask Me 5 to help reverse Missouri’s maternal mortality rates.

“What I would say to every provider out there is that if you want to be part of this process, part of this change to impact the lives of moms and babies across Missouri, use Ask Me 5,” Chavan said.

The MO PQC offers training materials that can help providers feel more comfortable having conversations about these sensitive topics.

A free workshop scheduled for Tuesday afternoon, Oct. 28, at the 2025 MO PQC Maternal & Infant Symposium will discuss the Ask Me 5 initiative. Attendees at the workshop also will have an opportunity to learn about Ask Me 5 Ambassadors, a program for passionate supporters dedicated to educating others about Ask Me 5 and spreading awareness on ways to address maternal morbidity and mortality. 

To learn more about Ask Me 5, visit MO PQC’s website to access free resources, including provider and patient booklets, posters, reference cards and video trainings.

Listen to Williams and Conley discuss the Ask Me 5 initiative on MHA’s PolicyHuddle podcast.