Transforming Maternal Care

I am feeling called to start a collective of people willing to imagine better maternal care. I want to gather experiences, ideas and imaginings together in one place and come together to discuss ways we think maternal care can be improved in this country (and everywhere). I imagine input from patients, doctors, doulas and other birth workers. I want to figure out not only how care can be improved for birthing people but also the people who care for them.

Right now, maternal care is siloed into little bits and pieces. There is no collective coming together to care for someone going through this journey into motherhood. Fertility specialists take care of the fertility, hand it off to prenatal care providers who sometimes consult high risk OB (me) and then hand off the patient to someone else for delivery. Postpartum follow is hit or miss. Often patients do not have a primary care provider to pick up where their OB left off. And the social support for new mothers is less than ideal in many places.

I am struck by how many people I talk to feel so unsafe in their birthing journey. They do not know who their doctor is, they do not know who will be there for delivery. They have no idea what to expect, or worse they have had a traumatic experience in the past and do not know how to avoid this happening again. Or they are told all their other healthcare needs must be on hold through pregnancy and breastfeeding. Last week I talked to a pregnant woman that had a tooth pulled under local anesthesia only because the dentist never bothered to ask anyone if it would be ok to give her gas during pregnancy (it would be). I have had patients who dentists won’t even touch because they are pregnant. I have patients who are taken off their mental health medications due to a misunderstanding of their mental health providers on medications in pregnancy. I have had patients where potentially lifesaving care is withheld due to the patient being pregnant and no one wanting to “hurt the baby.” And then there is lack of resources for abortion care and the Dobbs decision infringing on my patients’ rights to adequate healthcare.

How do we make things safer? We have good data that racial and gender concordance in maternal care improves outcomes. Black women taking care of Black women is much safer than white men caring for Black women. Thank goodness more and more women of color are going into medicine. We need to make the medical education and healthcare system safer for healthcare workers that are women of color as well, so they are supported. We need to make the system safer and more supportive of everyone. A system that cares for the healthcare workers will also be safer for patients. I imagine a system that supports shared decision-making by honoring the humanity of the patient and the healthcare worker at the same time. This means allowing time for discussion. Letting go of the need to control everything all the time- this is also an obstacle. Obviously, we want to have good outcomes for our patients- but we need to be ready for our idea of a good outcome and their idea of a good outcome to differ- and then figure out how to meet on common ground.

Some of the things that get in the way are fear of lawsuits (need for tort reform), lack of time with patients, a medical culture that still hasn’t let go of wanting to control women rather than care for them as equal to men. This is a start to where transformation is needed.

If you are interested in joining this discussion, please email me at emmie@powerpassengerpassage.com.

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