More than 3.6 million babies are born each year in the U.S.—about 10,000 births per day—yet many women are unable to access adequate maternity care and more than 80 percent of pregnancy-related deaths are considered preventable. Even though the U.S. spends twice as much as other high-income countries on maternal health, we are in a maternity care crisis. Compared to peer nations, the U.S. has high rates of maternal mortality and morbidity, with roughly 50,000 near deaths a year (as was my own experience in 2019), as well as high rates of C-sections, preterm births, NICU stays and poor maternal mental health. In the face of massive OB-GYN shortages and 217 Labor & Delivery unit closures since 2011, 36 percent of all U.S. counties are designated maternity care deserts with the highest prevalence in rural areas across Midwestern and Southern states.
Maternal health isn’t the only care crisis impacting Americans at the moment—substance use, mental health disorders and obesity are all on the rise.
Against this backdrop, we are seeing a massive wave of technology-driven solutions geared towards fixing American healthcare. Technology can certainly play a role in stemming the maternal health crisis, but cannot replace in-person care. Babies aren’t birthed through an app.
A 2021 study from the Obstetrics and Gynecology Clinics of North America shows that between 40 to 75 percent of OB-GYNs experience physician burnout. These are alarming statistics, given that in 2018 the American College of OB-GYNs (ACOG) already projected a net shortage of 8,800 OB-GYNs in 2020 and potentially 22,000 fewer OB-GYNs than needed by 2050. These trends are largely due to fewer OB-GYNs entering the profession and many leaving practice earlier due to unsustainable workloads, increasing malpractice risk following the Supreme Court’s Dobbs v. Jackson decision that overturned Roe v. Wade, and insufficient compensation with declining reimbursements. While technology cannot fix the problem, it can play a significant role in preserving and extending the limited OB-GYN capacity we have, alongside the expansion of the workforce and expanding the role of midwives on the frontlines of American maternity care.
For example, voice-enabled ambient charting solutions can minimize the burden of patient note-taking, free up hours of clinical time, reduce physician burnout, and open up care to more patients. Smart scheduling can similarly automate appointment allocation to patients with the greatest need while minimizing clinical time lost to no-shows and late cancellations. These solutions already exist, and we need to scale their adoption quickly.
On top of national OB-GYN shortages, big hospitals around the country—especially in rural America—are announcing maternity ward closures left and right, fueled by staffing issues, inadequate Medicaid reimbursement and financial distress. March of Dimes reports that up to 6.9 million women find themselves deprived of alternatives to maternity care and are forced to travel greater distances for care or risk delivering in an emergency room. Data shows that the rate of women receiving early and adequate prenatal care is declining from 76.7 percent in 2019 to 74.9 percent in 2022.
Telehealth and connected devices like BP cuffs and fetal dopplers can extend care beyond the clinic into the home and community. Fifty percent of standard prenatal visits can be done at home via telehealth visits aided by connected devices and sophisticated monitoring tools now available even for higher-risk pregnancies. Not only does this help reach care into communities where access is declining, but it can also help improve patients’ ability to attend their scheduled appointments—many are challenged by transportation issues, lack of childcare or inability to take time off from work.
The maternity care experience is approximately 46 weeks long from conception through the last postpartum visit. Standard prenatal care in the U.S. comprises 12-14 visits at defined points along the pregnancy journey (with the last two being postpartum checkups) per a model that has changed relatively little since WWII. This means most of the pregnancy happens at home between visits.
A study by the Commonwealth Fund showed that more than 50 percent of maternal and pregnancy-related deaths happen after the baby is born, concentrated in the first six weeks postpartum while 31 percent happen during pregnancy. The CDC notes that 80 percent of pregnancy-related deaths are preventable with timely care—a deeply troubling statistic.
Remote monitoring tools can help replace the current paradigm of episodic care with one that is more complete, continuous and right-sized to the specific risks that patients may be vulnerable to. Patients can conveniently track and report early symptoms, enabling providers to facilitate their management with quick clinician consultations anywhere and at any time. Timely care saved my life—and my own firsthand experience of a near miss with postpartum preeclampsia and HELLP syndrome–inspired me to start Millie. At our core, Millie believes that the ability to disseminate information and personalized alerts via our mobile app empowers patients to remain aware of various risks throughout pregnancy and the postpartum journey. Early detection, reporting and management reduce potential complications.
Moms-to-be are especially vulnerable to anxiety from the unknowns, so being able to access responsive care 24/7 can be very reassuring. Technology allows care providers to deliver curriculum and support in a lower-cost, higher-impact form, which cuts down physician workload and allows them to engage with patients at a higher level and focus on providing quality care. Streamlining operational processes such as eligibility checks, billing queries, data reporting and prior authorization to remove friction in patient interactions are also no-brainer applications.
Of course, there is a fine line between empowering patients and protecting the well-being of clinicians. Providers and clinical staff don’t always have capacity to answer a question in seconds; trying to do so can exacerbate burnout, which is already at crisis levels.
Emerging technologies like A.I.-enabled inbox management hold some promise, but very careful evaluation is needed to determine what types of questions they should be used for, the oversight structures they may use, and potential biases in the training data they are built on.
When an organization or health system integrates new technology, its success is contingent on its ability to be seamlessly added into the daily operations of the clinicians on the frontlines—they are already stretched thin and are often dealing with acute patients who demand their full attention. When done correctly, the combination of technology-powered in-person maternity care can address the many challenges we face around mitigating OB-GYN shortages, improving access and outcomes, and creating better patient experiences–without burning out our clinicians who are doing critical work in the face of challenging odds. This is how we must move forward–to build a better maternity care system that can serve American mothers when they need us most.
