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Sixty-five percent of maternal deaths in the United States occur postpartum, and the majority occur a week or more after delivery. And yet, there is comparatively little attention or follow-up paid during the postpartum period of patients’ journeys. The most common practice is a one-time postpartum visit (which many patients do not attend), rather than the recommended practice of ongoing touchpoints from maternal health practitioners and increased, postpartum-conscious attention from other clinicians.
This issue is all the more urgent given hundreds of women die from complications of pregnancy and childbirth in the United States every year— more than in almost any other high-income country. Eighty percent of these deaths would have been preventable if patients had received the right care in time. Furthermore, outcomes in the United States vary drastically for different groups: Black women and American Indian and Alaska Native women have three times the rate of maternal mortality compared to White women. The maternal health landscape only worsened during the COVID-19 pandemic, during which maternity care deserts in rural areas became increasingly common.
To support peripartum patients and those who care for them, the PCORI funding announcement: Improving Postpartum Maternal Outcomes for Populations Experiencing Disparities is funding four studies aiming to answer key questions about what, how and for whom different models and policy changes may help, to ensure equitable access to quality and respectful care during and after pregnancy. Taking into account the vast disparities in maternal mortality, both between urban and rural populations and different racial and ethnic groups, PCORI is supporting researchers to develop models to be responsive to, and address the concerns of, the patients most affected. These studies will provide evidence on the best methods to address disparities in maternal health and help fill in critical knowledge gaps.
Working to Close Critical Peripartum Gaps
To address the lack of large, systematic studies examining changes in maternal morbidity and mortality due to telehealth’s recent transformation of care, three large trials are studying how and when to use telehealth during the peripartum period and who will benefit most. Two of these trials will look at measures to inform which interventions are best for which populations. A fourth study will examine the value of implementing doula care to advance racial equity in maternal health outcomes.
Key in the learnings from these studies will be increased knowledge on the role of remote monitoring, including home blood pressuring monitoring, as well as the use of doula care to improve postpartum health, advancing health and racial equity and empowering patients to become active participants in their care. This research will build on momentum gathering around an existing study focusing on maternal and cardiovascular health through a trauma-informed lens.
Now is the time to improve maternal outcomes—we simply can't afford to wait. By better understanding how, when and where to connect patients to care postpartum, PCORI will utilize its signature practice of “research done differently” to improve maternal health outcomes for the groups most affected, and for the country as a whole.
Learn more about each of these studies here:
- Improving Maternal Postpartum Access to Care Through Telemedicine
- Improving Postpartum Care for Black Pregnant and Postpartum People
- Comparative Evaluation of Telehealth Multi-Component Optimal Model (MOM) of Postpartum Care Among Rural, Low-Income, and Diverse Women
- Implementing Doula Care in Medicaid to Advance Racial Equity in Severe Maternal Morbidity
And follow @PCORI for more updates on maternal health equity research.
