Limited access to maternity care has become increasingly dire over the past few years, according to a recent report from March of Dimes, a nonprofit dedicated to the health of mothers and babies.
The report found that 36% of U.S. counties are maternity care deserts — defined as counties in which there are no hospitals providing obstetric care, birth centers, obstetricians, gynecologists, or certified nurse midwives. This finding marks a slight increase from the 34% of counties being classified as maternity care deserts in the 2020 report, and it means that more than 2.2 million women of childbearing age lack access to maternity care.
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This dearth of maternity care providers is exacerbating the country’s less-than-stellar reputation for birth outcomes, according to Leah Sparks, CEO and founder of maternity care provider Wildflower Health. In order to ensure better health for mothers and their newborns, OB-GYNs need to move toward value-based care and do it quickly, she said in an interview.
To ensure better birth outcomes, providers must identify risk factors that negatively impact pregnancy early on. These include behavioral health issues, diabetes and hypertension, which are all undertreated conditions in the U.S., Sparks pointed out.
“There’s this perfect storm of staffing shortages and providers who are on this treadmill of trying to see patients, so it becomes very difficult for them to conduct whole health assessments,” she said. “Providers need to understand the clinical factors in your bloodwork and whatnot, but they also need to understand if you have access to healthy food, if you’re safe at home, what your race and ethnicity is, your LGBTQ status and everything else that can impact your access and navigation to care.”
Sparks called for more OB-GYNs to issue mental health assessments to their pregnant patients, noting that this can be done through care coordinators, community health workers and virtual screening tools.
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Behavioral health screenings can easily be done virtually, which would be more accessible to the millions of women living in maternity care deserts. But Sparks noted that while there has been a much greater adoption of telehealth among behavioral health providers, data from these appointments doesn’t often integrate back to a patient’s other providers.
“What OB providers need is not to just hand off their patient to a telehealth behavioral health provider, but to know the outcome of that visit and what happened with that patient,” she said. “It shouldn’t just be telehealth; it should be telehealth integrated with the primary provider.”
On the diabetes and hypertension side of things, Sparks advocated for more remote monitoring for high risk women. She said that compliance for remote glucometer monitoring has been good for high risk pregnant women in the past.
The interventions Sparks recommends are necessary to improve birth outcomes in this country, but she pointed out a huge problem in rolling out these preventive maternal health measures: they’re simply not paid for in today’s fee-for-service payment model. Without value-based care, OB-GYNs aren’t incentivized to understand the whole picture of their patient’s health and how it could affect their pregnancy.
In order to tackle this issue, Sparks pointed to the lobbying being done by the U.S. Women’s Health Alliance. The group is made up of independent OB providers who advocate for the adoption of value-based models in maternity care. The organization advocates for policy changes in Washington and develops partnerships with health systems, payers and government entities to strengthen the reach of OB-GYNs throughout the country.
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