Accelerating Momentum: How COVID-19 Presents an Opportunity to Improve How We Care for Birthing…
By: Ariadne Labs
Tags: Covid 19, Equity, Pregnancy, Birth, Healthcare

By Avery Plough, MPH; Amber Weiseth, DNP, MSN, RNC-OB; Elizabeth Curtis; Joyce Edmonds, PhD, MPH, RN; Monica Christina Esqueda, PhD; Heather M. Young, PhD, RN, FAAN; Neel Shah, MD, MPP

The rapid and unyielding spread of the COVID-19 pandemic has radically changed how health care is administered, delivered, and experienced. While this is true across the entire spectrum of care, maternal health is particularly sensitive to these disruptions, with potentially far-reaching generational impacts.

The pandemic has exposed weaknesses and inequities in our maternal care systems, including fragmented care, anti-Blackness, and unconscionable racial inequities; however, it has also revealed unique opportunities to re-envision how our existing systems can be built to better serve the needs of people giving birth.

At the behest of Congress, in January 2020 the National Academies of Science, Engineering and Medicine (NASEM) produced a consensus committee report on Birth Settings in America that articulated the ways the current design of our maternity system “is fraught with inequities in access and quality and high costs, and there is growing recognition of the mismatch between the collective expectations of the care and support people giving birth deserve and what they actually receive.” It also provides the set of evidence-based solutions necessary for progress.

In June of 2020, we began convening virtual sessions to hear from people from across the country, including birthing people and those at the frontlines of care, in order to understand what lessons we can take from the shared challenges and promising responses. Over four sessions, we brought together 244 obstetricians, midwives, registered nurses, doulas, health administrators, investors, community leaders, and people who had recently given birth. Drawing on their combined insights and lived experiences, we were able to assess the shared challenges in providing high quality care, and began to form recommendations to address those challenges with high-impact innovations.

In a recently released white paper, we discuss how those findings can help leaders understand what investments and innovations have the potential to make the biggest and most sustained impact. In many cases, these innovations are not new. Rather, they are familiar, cross-cutting solutions that align with existing evidence-based recommendations, and we believe that makes them all the more powerful.

Our recommendations address the potential backslides in care resulting from the COVID-19 pandemic, while looking ahead for opportunities to make needed progress. Consistent with the NASEM report, we held a particular focus on approaches with the potential to eliminate or reduce racial and geographic inequities in maternity care. Our recommendations fall into three key categories:

1. Focus on investments that address challenges related to the continuum of care, family and support for birthing people, and patient-provider relationships.

In conversations with our participant community, these key themes were identified as priority areas likely to have the greatest potential for long-term impact on maternal health, particularly for people who experience racial and geographic inequities.

2. Identify the innovations that address these challenges and align best with both the needs of your community and the assets of your organization.

Participants identified six categories of innovations health system leaders should consider to specifically address high priority challenges. These include:

Build trust & enhance communication between birthing people and clinicians

Leverage virtual access to deliver clinical care, education, or support

Customize care planning & support to meet birthing people’s unique needs

Coordinate existing services & needs by integrating clinical and social services to minimize disjointed care

Adapt roles & responsibilities to promote non-clinical and clinical capacity to address emotional, informational, and physical needs

Utilize alternate care settings to facilitate the availability and accessibility of alternative settings

3. Accelerate existing momentum for your innovations by reinforcing the “demand” among birthing people or health system stakeholders and the “supply” of enabling factors.

Within each of our six priority areas, opportunities exist to capitalize on the momentum initiated by COVID-19 adaptations to further improve care and leverage this unique moment for change.