Maternal Health Crisis: All Hands on Deck

Nicolas Encina
Founder, Modelo Health

My wife and I spent a lot of time trying to imagine our future children before we had them. It was a fun game that we played in anticipation of a major life event that would bring unimaginable joy, hope, and promise. We were not unique in this respect, because most soon-to-be parents naturally wonder in anticipation what their hereditary lottery will turn up. We even went full geek-mode, trying to estimate the odds of eye color, hair and facial features, along with who’s personality would they resemble most. We scoured the web for anything that made us feel more informed, more predictive, and a little more empowered. Creating life and welcoming a new family member should be a time to look forward to – a time for pleasant surprises.

Unfortunately, not all surprises in pregnancy are pleasant. There are the obvious, nerve-wracking unknowns about supplies, support, and agency over a rapidly changing future, but beyond that layer there’s something far more inconceivable. For those that start reading the literature, the first surprise is the terrible maternal health crisis in the U.S. that has seen maternal care drastically worsen over the past 30 years, as reported by the CDC and many other trustworthy sources. We have some of the highest maternal mortality and morbidity rates in the developed world. It’s further surprising to learn about the scale of these problems, and how many of them could be prevented from happening. It’s also worth noting that COVID made things worse by increasing U.S. maternal mortality rates by 33% (1), with Hispanic moms jumping by 44.4% (2).  If only that’s where the negative surprises ended but, heartbreakingly, for many pregnant women those negative surprises become terribly personal. Those are the women that we need to protect and save.

The state of maternal health and female reproductive rights in the U.S. is being attacked on many fronts. Statistically, we know that pregnant women today are twice as likely to die during pregnancy than their mothers 30 years ago (3). If we take a step back from mortality (i.e. death), it’s no less concerning to look at pregnancy-related complications. In fact, the rate of severe maternal morbidity (SMM) (i.e., complications) went up by 200% between 1993 and 2014 (4). Further adding fuel to the fire, it has also been reported that for every maternal death there are 50 “near misses” of cases that could have ended badly. Finally, 60% of these cases (and 75% of deaths related to obstetric hemorrhage) are preventable by following commonly accepted standards of care combined with better risk management. If this weren’t all bad enough, the recent overturning of Roe v. Wade by The Supreme Court (5) has the potential of layering on a host of additional maternal health risks. There are retrospective studies showing that states with higher abortion restrictions are associated with higher rates of maternal mortality (6). Things were bad. They could get worse.

Regrettably, Roe v. Wade ruling is going to make things worse for many women, teens, and even adolescent girls. How women manage their reproductive plans is a highly personal decision, and in many cases it isn’t much of a decision to begin with, particularly when you realize that there are women with valid medical reasons that prevent them from having safe pregnancies in the first place. Taking away options for these women immediately puts them in a high-risk medical category that has been shown to increase maternal mortality. For those women we also offer refuge in that our system is built for the purpose of identifying risk through advanced risk stratification algorithms, and alerting both mother and clinician with recommendations for mitigating and preventing them.

This is all terrible, to be sure, but the stats on possible prevention give us hope. There is something to focus on. Something to fix. The Biden administration last week released a Fact Sheet on Maternal Health Blueprint to deliver better care for women, mothers, and families (7). In it they outline five priorities and 15 actions that The White House intends on taking to solve the crisis. Of course, how these priorities are implemented are the details that will make all of the difference on whether they help or not, but at a high level Modelo Health was built in much the same vision. For example, below I share the five Biden priorities, along with how Modelo Health offers complementary support:

  1. Increasing access to and coverage of comprehensive high-quality maternal health services, including behavioral health services.
    • Modelo Health offers a care-at-home platform with automated risk stratification across all health determinants. The advanced screening algorithms empower patients to control factors at-home, while alerting health systems about clinical risks in order to deliver patient-centric and culturally-concordant, quality care. Our system covers behavioral, social and emotional wellbeing, along with clinical and hereditary factors.
  2. Ensuring women giving birth are heard and are decision makers in accountable systems of care.
    • At the heart of our mission is to empower women to become informed and active decision makers in their own care. We even have an entire metric that we created just for this, called the M•Power score.
  3. Advancing data collection, standardization, harmonization, transparency, and research
    • Modelo Health exists because we realized early on that there was an abundance of relevant and trusted scientific data out there. But it required immense efforts to digest, structure, harmonize, and personalized to every pregnancy. Modelo Health’s work with leading healthcare systems is centered on the concept of utilizing this data to push the boundaries of research in maternal care and decrease maternal risk.
  4. Expanding and diversifying the perinatal workforce.
    • We cannot increase the workforce directly, but our objective in eliminating health disparities convinced us early on that we needed to support multiple languages and to offer clinicians ways of diversifying their care in culturally-concordant ways.
  5. Strengthening economic and social supports for people before, during, and after pregnancy.
    • Modelo Health looks for signs of risk during pregnancy and postpartum, or 4th Trimester. Our purview stretches beyond delivery, and we are currently working on more tools to better support mothers after delivery, which carries significant risk for certain moms.

For the sake of brevity, we won’t go into detail on the 15 actions but they are subsets of the 5 priorities, and Modelo Health is relevant in 10 of the 15.

In our experience working at the front-lines of genomics, precision medicine, healthcare technology, and public health, some key areas that we feel are either subtly alluded to or not at all in the priorities, which could make a profound impact would be:

  • Standardized Guidelines: Standardize the guidelines and quality of care that women receive from clinic to clinic, and state to state, so that every mother is guaranteed a safe and specific baseline of care no matter where she gets it.
  • Expanded Research: Invest in the research necessary to identify the key factors that lead to increased rates of morbidity and mortality, particularly those that are “silent killers” that doctors don’t talk about, such as environmental conditions, socioeconomics, institutional racism, domestic violence, and emotional distress.
  • Education: Provide better educational resources to teens and parents, so that they are aware of the key factors to consider during pregnancy, and to be familiar with decisions that they should consider if and when they are pregnant.

From our 3 recommendations above, the third one is particularly relevant in a time when it’s hard to know who to trust, and especially when we question if our highly polarized political environment has the best intentions when it comes to women’s health. For these reasons, there is no substitute for education, increased health literacy, and empowerment of women to make informed decisions on their own behalf. As I tell friends: trust your doctor, and believe that the health care system is trying to do what’s best for patients, but ultimately it’s YOUR life, and that of your unborn child. NOBODY will care as much as YOU will. We strongly feel that some of the responsibility, and power, needs to be shared with the mother by giving her a sense of confidence, agency, and dignity in a process that, although carries inherent risks, should be primarily a time for celebration. Studies have shown that increased self-reported levels of health literacy are associated with lower rates of readmissions after surgeries (8). In general, a better informed patient is a better patient, and the greater the odds that there will be patient-clinician alignment, and therefore a better chance of positive outcomes. But in order to have that we need to empower mothers to have a voice and a seat at the table in their own care – not just as objects to be managed and handled.

There will always be risks when it comes to pregnancy because, by definition, it is a high-risk medical event. There’s no way around that. But the statistics speak for themselves. We’re in a crisis, and one that could be fixed by addressing health inequities and disparities, by using the tools that are available to deliver better care, and by holding health systems accountable for following the proper guidelines that are updated and defined by trusted medical bodies. There’s a lot of low-hanging fruit to cover before we get to the difficult stuff, so why wait? There aren’t many patient-populations that universally draw empathy more than mothers and babies. They are the agents of our future, and the very citizens that will steward our society once we are gone. What will we do to protect them when they are at their most vulnerable, which is at the beginning of life? What would we have wanted for our mothers? What do we want for our wives and daughters? Do we want our pregnant daughters to be thrilled with the joy of creating new life, or do we want them to be consumed by the fear of losing their own? This isn’t somebody else’s problem. It’s a human problem. We own it.

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  1. US maternal mortality increased 33% during pandemic, hitting Black and Hispanic women especially hard
  2. All-Cause Maternal Mortality in the US Before vs During the COVID-19 Pandemic
  3. Pregnancy Mortality Surveillance System
  4. Severe Maternal Morbidity in the United States
  5. Supreme Court overturns Roe v. Wade
  6. The association between state-level abortion restrictions and maternal mortality in the United States, 1995-2017
  7. FACT SHEET: President Biden’s Maternal Health Blueprint Delivers for Women, Mothers, and Families
  8. Patient-reported health literacy scores are associated with readmissions following surgery