When it comes to maternity care, America is failing.
As global maternal mortality declines, the U.S. is the only developed country where it’s on the rise. The statistics are jaw-dropping: An American woman today is 50 percent more likely to die in childbirth than her own mother. Black women are three to four times more likely than white women to die from pregnancy-related causes. The Centers for Disease Control and Prevention (CDC) recently added yet another heartbreaking number to the list:84 percent of maternal deaths in our country are preventable.
For years, U.S. maternity care has been defined by abysmal health outcomes, awful patient experiences, and sky-high costs. We started Oula, a maternity care company, because we believe that by improving the experience of pregnancy and childbirth, we can improve outcomes. This can’t wait. By any measure, our country is doing a terrible job of caring for new mothers. It’s a reflection of how little investment has been made in this space, despite the extraordinary human cost and moral imperative to act.
According to the World Health Organization, one of the most powerful ways to reduce maternal mortality can be summed up in a word: midwives. Oula is one of a growing number of providers using collaborative care, which brings together obstetricians and midwives and can help bring down maternal death, preterm birth, and cesarean rates, and lower the cost of childbirth. In fact, one study published in The Lancet found that including more midwives in health care systems could prevent more than 80 percent of maternal and infant deaths. We have a lot of work to do on this front. Right now, there are only four midwives per 1,000 births in the U.S., while many European countries have five to 10 times as many.
Simply making it through pregnancy and childbirth alive is not good enough; we need a higher standard. At Oula, our focus on experience means that our team spends twice as much time with patients as regular obstetricians do. That additional time leads to deeper connections, which in turn leads to a more comprehensive understanding of a patient’s needs and makes it easier to identify potential problems. Our clinics are warm, welcoming, and comfortable, not just because we want to give people something pretty to look at, but because research shows that thoughtful design can put patients at ease and influence their health, while bad design can actually make people sicker.
The new CDC report underscored the fact that one of the biggest problems with our country’s current maternity care system is insufficient postpartum care. The standard six-week postnatal checkup isn’t enough; we need a greater focus on the “fourth trimester.” More than half of pregnancy-related deaths occur up to a year after birth, and with one in four women in the U.S. returning to work within two weeks, it’s not hard to see how postpartum care can fall by the wayside. At Oula, we’ve seen that little things—like following up with every patient within the first week of giving birth—can make a big difference. That’s a crucial opportunity to connect new parents to services from lactation consultants to nutritionists. It can also be a make-or-break moment when it comes to addressing mental health conditions—the single most common underlying cause of maternal deaths.
Pregnancy should be an exciting, hopeful time. But talk to parents in the U.S. and you’ll hear the same things over and over again: For too many people, pregnancy and birth are at best impersonal and isolating, and at worse, traumatizing.
There are steps we can take right now to bring about the sweeping changes we need. For example, we can make it easier to use insurance for midwifery care by fighting for parity in reimbursements, and guaranteed inclusion in Medicaid and private insurance plans. At Oula, we proudly take insurance, including Medicaid, and we hope this will one day be the norm, not the exception. We can move away from fee-for-service arrangements and toward value-based care models that reward providing high-quality, effective care to patients. We can invest in training and education programs to increase the number of midwives and build a more diverse workforce. We can advocate for paid family leave. And we can treat addressing systemic racism and bias in our health care system as a matter of life or death, because it is.
We are calling on our country’s leaders to act with the urgency this moment deserves, investors to devote more time and attention to this space, and anyone with a platform—whether you’re a business owner, a public figure, an insurer, or a health care provider—to use it. Maternity care in America is outdated and unacceptable, and we deserve better.
Adrianne Nickerson is the co-founder and CEO of Oula. Prior to starting Oula, Adrianne co-founded Robin Care, a virtual cancer care management company, and worked for Deloitte and Northwell Health. Adrianne holds a bachelor’s in biology from Columbia University and a master’s in global health from Harvard University, where her research focused on the barriers to accessing reproductive health services.
Elaine Purcell is the co-founder and COO of Oula. Elaine’s career encompasses nearly every facet of our country’s health care system. She worked in public policy during the passage of the Affordable Care Act, consulted with large health systems and insurers at Deloitte, and sat on the leadership teams at two major primary care companies, Privia Health and CareMore. She holds a bachelor’s of science in public health and business administration from George Washington University and a master’s of public administration in health care administration from New York University.
The views expressed in this article are the writers’ own.
This content was originally published here.