Policymakers Must Take Action to Ensure Maternal Health Extends Beyond the Labor and Delivery Room

If we look for the silver linings among lessons learned in 2020, the brightest positive outcome may be a better coordinated and more robust investment in public health. Yet as we continue to fight COVID-19 in the U.S., it’s important not to lose sight of another incredibly important battle we face on the public health front: maternal health.

Before COVID-19 was even on the radar, the U.S. fell far short of other similarly positioned countries when it came to caring for its mothers. A report released by The Commonwealth Fund in November 2020 found that among the 11 developed countries ranked, the U.S. had the highest maternal mortality rate, was undersupplied when it came to maternal care providers, and was the only country that did not provide postpartum care benefits such as access to provider home visits or paid paternity leave. Women of color continue to be disproportionately impacted, faring worse in categories including severe maternal morbidity, maternal death, and neonatal morbidities.

Policymakers must recognize maternal health outcomes are not just about outcomes in the labor and delivery room. It extends from social determinants of health such as education, financial stability, and access to care. In a delivery setting it extends from the point of delivery into the postpartum phase of motherhood. As policymakers work to improve the nation’s public health infrastructure, we must ensure investments are made into the following areas to make a sustainable and lasting impact for families and their children.

Invest in community-based care. The availability of community-based options to support women throughout their pregnancy can make significant impacts on their birth outcomes by the time they reach the labor and delivery room. Community-based organizations provide important wrap-around services, such as mental health support and smoking cessation, can have a significant long-term impact on women and infant health outcomes.

Improve data collection processes. Data collection across the continuum of care identifies trends in maternal health and establishes benchmarks for quality improvements. OB hospitalists, for example, collect data on fetal heart rate monitoring, C-sections, depression screening, and hypertension, but this is a snapshot in time for a specific point of care. Establishing methods to collaborate and share aggregated data from prenatal through postpartum care is essential to seeing the impact that interventions have throughout the patient care journey.

Develop high quality care teams. Strengthening the care team includes ensuring highly skilled physicians are available to intervene at critical points for women during the labor and delivery process. For example, OB hospitalists are used in hospitals to complement the role of full-time staff and private practice physicians. Hospitalists can provide immediate care on behalf of the woman’s community physician until the provider arrives at the hospital, handle emergencies, and care for unassigned patients. Hospitals can also strengthen the use of certified nurse midwives as part of this team. These resources increase access to better care across the pregnancy spectrum as well as augment the care team during delivery. 

Expand postpartum benefits. The most recent numbers from the Centers for Disease Control and Prevention (CDC) show that about one-third of maternal mortality occurs between one week and one year after delivery. While improvements to technology such as wearables can help tracking and reporting outcomes after women leave or need to return to the hospital, more significant strides can be made by increasing support for women to continue to access care. The passage of the American Rescue Plan Act of 2021 is a great step forward in providing states with the option to expand Medicaid coverage for postpartum women from 60 days to 12-months. However, it will be up to state leaders to ensure that the benefit is implemented.

Legislation introduced in the early stages of 2021 is promising -- for example, the Black Maternal Momnibus Bill of 2021 would make significant improvements and investments into twelve key areas. The legislation also strives to mitigate racial and ethnic disparities in maternal health outcomes. Sound public health practices are needed now more than ever. When it comes to improving the lives of women in the U.S. we must set politics aside and bring research and best practices to the table.

Dr. Mark Simon is chief medical officer at the Ob Hospitalist Group (OBHG) and a board-certified OB/GYN.