Comprehensive maternity and postpartum care are essential to the well-being of mothers, birthing people and infants. Hospital leaders do not want to shut down maternity and postpartum units. However, capacity and resource limitations have forced an uptick in these units closing.
Financial and operational pressures have exacerbated five critical gaps in care.
Maternity and Postpartum Care Gaps:
1. Staffing shortages are the catch-all for gaps in all businesses today. In the wake of the COVID pandemic, it is understandable that burnout resulted in frontline staff exiting care settings. But hospitals have often grappled with inadequate staffing levels for maternity and postpartum care. The shortage of skilled nurses, lactation consultants, and specialists can compromise the quality of care provided to expectant and new mothers. Doulas offer continuous labor support, whether in-person or virtually, relieving the workload on nursing staff.
2. Postpartum care is frequently overlooked. Hospitals and OB/GYN groups may lack the resources to provide comprehensive support during this crucial period. The focus is often placed on immediate post-birth care, leaving new mothers with limited assistance and guidance during the weeks and months following childbirth. Typically, patients have to wait six-weeks before the first follow up appointment. In some cases, two-weeks following a Cesarean section.
Dr. Amanda Williams, MD, MPH, FACOG, Medical Director of Mahmee, said recently, “We know that over half of the maternal deaths happen after the time of delivery and a third are entirely out of the medical space. We need to think about what we are doing in between when patients are in contact with the medical system.”
3. High-risk pregnancy care can be taxing for hospitals and health systems in differing ways. Some hospitals may encounter difficulties in providing specialized care for high-risk pregnancies due to the need for specialized equipment, expertise, and coordination with other healthcare providers. Other hospitals may have the equipment and rooms, but lack the staff. And still others do not have the bandwidth to focus on high-risk patients due to all the basic needs low-risk patients need.
4. Mental health services increased during the COVID pandemic. However, these services were not commensurate with the increase in mental health issues, and did not include pregnancy and postpartum expertise. Many hospitals are able to check the box of postpartum and depression screening. However, there is no bandwidth to administer treatment for weeks if not months. As a result, maternal mental health issues, such as postpartum depression and anxiety, may go undetected and untreated.
Melissa Hanna, Mahmee’s Co-Founder and CEO, recounted a relevant patient story recently:
“A patient who was experiencing suicidal ideations and hadn't reached out to anyone for help yet... She wasn't sure if this was a normal part of being a new mom. She had a 2-week-old baby. After taking the postpartum depression survey that was available to her on her [Mahmee] patient dashboard, [she] scored really high and [was] immediately flagged for additional assistance.”
A lactation consultant at Mahmee was able to step in and engage the patient, verify these symptoms, and immediately escalate this to the OB-GYN's attention – who had no idea the patient had been struggling.
5. Perinatal education encompasses a veritable library of resources. Not all are appropriate for all parents, and the staff that would tailor or deliver these resources are strapped. Even if hospitals license or acquire educational resources, ‘prescribing’ support groups, videos, articles, etc. at the right time is not a part-time job staff can sustain. That leaves expectant parents with gaps in information and preparation for prenatal and postpartum care.
The repercussions of these challenges, and the gaps they create, are life and death. Especially for BIPOC, in both high-income and low-income communities.
“We've worked with families and with mothers that are experiencing prenatal anxiety and supported them in preparing for their childbirth experience in the hospital,” said Melissa Hanna, describing serious albeit routine examples. “There have been patients who have experienced postpartum depression; in some cases, some very severe postpartum psychosis symptoms. We've had patients who've experienced severe blood loss and postpartum hemorrhaging.”
Following Tori Bowie’s death, a slew of media outlets questioned ‘Why’ and ‘How’ this could happen to an Olympian and financially secure Black woman. “Our fitness doesn’t save us. Our education doesn’t save us. Our income doesn’t save us,” Dr. Williams said in The Washington Post.
Wraparound Services Fill in the Gaps
Hospitals need to assess additional offerings beyond doctors to address the existing gaps. Implementing services such as lactation, nutrition, mental health, and remote nurse support, often referred to as "wraparound services," is an effective approach to enhance patient outcomes, ease capacity issues, and lower overall healthcare expenditures.
- Implementing telehealth services and remote monitoring can bridge the gap in access to specialized care for high-risk pregnancies and postpartum care. Conditions like hypertension, preeclampsia, and gestational diabetes, can be caught when RN-led live monitoring options are available. The emergent events caused by these conditions contribute to the disproportionately high maternal morbidity and mortality rate in the US. And prevented readmissions which are taxing on our healthcare system.
- Dedicating lactation support services alleviates many of the calls and questions that low-risk patients need answered. In-patient staff are often spread between neonatal and pediatric floors, making it difficult to schedule an appointment. Virtual, out-patient and at-home services are not nice-to-haves. Lactation support boosts the probability of sustained breastfeeding, which correlates with a decrease in childhood illness and an enhancement in parent bonding.
- Integrating mental health services within maternity care enables timely detection and treatment, reducing the risk of complications.
- Introducing doula services provides invaluable support to pregnant individuals during labor, childbirth, and the postpartum period. Doulas offer emotional, physical, and informational assistance, leading to improved birth outcomes and maternal satisfaction.
- Offering access to support groups, childbirth classes, and parenting education provides anticipatory guidance regarding birth and new parenthood, and fosters a sense of community among new parents, promoting overall well-being.
Maternity care is a ‘front door’ for health systems. Administrators know a good experience may lead to a lifetime of utilization by families (pediatrician visits, speciality care, etc), and improve the health of the communities they service. However, maternity care and childbirth facilities are closing, sometimes abruptly, due to financial and resource constraints.
Solving the severe capacity limitations that US hospitals face is a key challenge. Wraparound maternity and postpartum care services reduce the burden on providers.
Mahmee’s mission is to make the US the best place in the world to have a child. The Mahmee membership for wraparound pregnancy and postpartum services launched in April 2023. The uptake across the US has been astonishing.
We offer the wraparound maternity and postpartum care services that address specific gaps hospitals have. Together, we can significantly enhance patient experiences, outcomes, and overall satisfaction. As hospitals strive for excellence in maternal and infant care, embracing wraparound services like Mahmee’s can solve the financial and operational pressures. Contact us to learn more.