New Report Looks at the Present and Future of Maternal Care

By Matt Phillion

With maternal death rates at the highest among the world’s wealthiest nations, the U.S. is facing a maternal and infant health crisis. The maternal mortality rate doubled between 1999 and 2019, and according to the Centers for Disease Control and Prevention, as many as 80% of pregnancy-related deaths are preventable.

A new report, “A Troubling Reality, a Hopeful Future,” from maternity and NICU care management organization ProgenyHealth, LLC, identifies key trends and insights into this crisis.

The report looks at critical areas within maternal and infant health that hospitals, healthcare providers, and health plans should pay attention to in the year ahead. It also looks at 2024 trends in maternal and infant health, including:

• Stronger health plan interventions
• A shift in healthcare research
• Better maternal and infant care using AI and machine learning
• Advancements in virtual prenatal and postpartum care
• New definitions of risk

“We’ve been sounding the alarm for a long time,” says Linda Genen, MD, MPH Chief Medical Officer of ProgenyHealth. “I think the difference now is that it’s hitting the mainstream press; all the issues that we epidemiologists and clinicians have been talking about from the CDC or medical journals.”

Genen notes this improved focus beyond the industry is like how the public increased awareness about the opioid crisis and how that shift changed the conversation as well.

While the conversation is changing for the better, the numbers are not, she says.

“What’s surprising is the numbers aren’t really moving. The numbers are horrific, and the reality is we know that for every maternal death there are 70 times that number in maternal morbidity. We’re a fully developed nation and spend the most money in the world on healthcare and yet we have alarming outcomes.”

There are many factors at play here, Genen says, and at the forefront among those factors is access.

“It’s definitely an issue: there are parts of this country—OB deserts—where there is literally no maternal care. Fifty-one percent of counties in the US don’t have practicing obstetricians,” she says. “That right there should set off big alarm bells. We know the correlation between health challenges for newborns when the moms don’t receive prenatal care. How do we solve for that?”

One way: the emergence of telehealth.

“One of the beautiful things that came out of the pandemic was the fast-forwarding of telehealth. Prior to the pandemic, few practices had embraced telehealth, but we went into an emergency situation and telehealth became part of our lives,” she says. “If not for the pandemic the acceptance of virtual care would not have skyrocketed forward the way it did.”

Telehealth helps address a core challenge for prenatal care: the number of visits. With an average of 14-15 visits for expectant mothers, it’s not an easy lift, as issues like childcare, transportation, and scheduling can make those appointments nearly impossible.

“If you’re in a healthcare desert, it’s even more challenging,” says Genen. “It’s hard to take time off from work to take care of yourself. The mom is always focused on other people, and we know women put themselves second or third or last.”

Telehealth opens the door for lower-risk patients to do half or more of their visits remotely and enables mothers to have the tools they need to monitor their care from home.

“This isn’t just prenatal but also postpartum,” says Genen. “That’s game changing. You can scale it down to seven or eight visits and escalate as needed.”

Reimbursement remains a barrier to the continued use of telehealth, Genen notes, and stresses that it can continue to be game-changing lifesaver both before and after the birth of a child.

“The postpartum period is crucial: maternal mortality occurs prenatally, during birth, and postpartum, and more research is shedding light on those mortalities. We’re seeing data about the postpartum period that is of grave concern,” says Genen. “That’s the period we cannot forget. Initially, we were focused on the fourth trimester and now we’re looking at the whole year after birth.”

It’s a matter of providing access to knowledge and education for mothers, she says.

“We’re engaging with the moms, letting them know things such as: if you don’t feel right or have a headache, that might not just be a headache,” she says. “And having the availability of telehealth solve for a maternity desert, enabling engagement with a case manager who is aware of issues that may need intervention, that’s key.”

It also enables the chance to connect patients with the right kinds of contacts. Study after study shows correlation between specific negative outcomes and different segments of the population, so making sure the provider or case manager is a part of and intimately familiar with the unique challenges of the patient population they work in can be pivotal.

“We also need a knowledge and awareness that one visit is not all that a woman needs during the postpartum period. Some patients will say, ‘It’s my third baby. I’ve been there, done that,’ but there are signs and symptoms to look for during those weeks and months after birth,” says Genen.

Health plans stepping up

Genen points out that health plans are realizing the problem and beginning to engage and develop programs to put interventions in place where they haven’t been before.

“We know that prenatal and postpartum care is covered, but telehealth coverage is still an issue,” she says. “I could be an optimist, but I believe as CMS looks forward it’s going to keep playing out.”

But while plans and organizations build programs to address these challenges, engagement remains a battle. The hope is that creating a digital front door will help increase engagement by meeting the patients where they are.

“Nowadays most people have some kind of phone to connect them to these resources, to their personal care manager,” says Genen. “Knowledge is power, and we’re making sure they have access to this education all along the way. When we work with a health plan, we want to make sure they’re marketing to their members and sharing this benefit.”

There’s also a trust issue to overcome, Genen points out.

“There’s an inherent lack of trust for women in healthcare. We’ve been let down by the system,” she says. “It’s important to build up that trust and let women know these free resources are available.”

The other significant challenge is the ubiquitous issue of staffing—or lack thereof.

“We’re seeing fewer and fewer people sign up to be OBs,” says Genen. “We also have a huge gap in behavioral health, and we need people who have experience with engaging with moms, understanding their concerns. It’s not just access to care from the clinical standpoint but also for behavioral health and we need to solve those gaps. They require access to people who can ask the right questions to identify not just postpartum depression, but anxiety and depression in general who are able to identify the signs and provide treatment.”

OB visits are limited and spaced out, so asking the right questions all along the way is pivotal.

“OBs spend time with their patients, but many of the challenges occur beyond the clinical walls: Do they have a safe environment, are they facing domestic abuse, is there a situation they need to get out of?” says Genen.

To supplement existing staff, it’s important to look to other places: peer support, for example.

“Someone who’s been there—for example, pairing someone dealing with a substance abuse disorder with someone who has gone through that, someone they can talk to and get support from,” she says.

One key to addressing OB deserts, Genen says, is to better support doula and midwife care.

“We’re not going to have enough OBs, and we’re not going to have enough OBs who are matched culturally. You want to match someone with a care provider who is of the same cultural background, who speaks the same language, who understands the unique questions mothers have,” says Genen. “Doula and midwife care can be very substantial in this area.”

But these providers are limited in number as well, and they are minimally reimbursed for their work. Changing how they are considered by payors and making them part of the continuum of care in a stronger way can open avenues for better care in OB deserts.

“They can only engage with a few patients a month, and when they engage, they are deeply involved, but they need to more than just survive – I’ve met doulas literally carrying other jobs because they can’t afford to live on their income as a doula,” says Genen. “This is one area where we need to move faster on, so we have a way of certifying and reimbursing these professionals.”

All of these components—improved access, continued evolution in telehealth, changes to reimbursement, and expanding how and through who providers connect with mothers before and after childbirth—all add up to the potential for real change, Genen says.

“There’s not one fix,” says Genen. “Especially when it comes to racial inequality and social determinants of health. We need a nationwide EHR where we can all communicate together. I’d like to see lactation consultants and doulas and midwives covered by Medicaid and commercial plans alike equally. I’d like to see improvement in education about reproductive health at a younger age.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.