Across the board, no developed nation has the rate of maternal deaths that we in the United States suffer. American women are three times more likely to die during pregnancy, delivery, or within one year of giving birth than women in Canada.
When it comes to accessing health care in the United States, deep-seated disparities among marginalized populations continue to exist. And while there are nearly 1,400 free clinics throughout the country to help offset these inequities, the uninsured and underinsured continue to struggle with obtaining the care they so often need. Many free clinics serve as a critical safety net for vulnerable populations, as they provide more than six million patient visits on a yearly basis. However, of these clinics, only 7% offer prenatal and obstetrical services to their communities.
Many women of color report experiencing racial disparities and marginalization in their daily lives, but also while receiving health care, which often leads to a significant distrust of the healthcare system, overall. Immigrants are sometimes fearful of deportation or being denied a green card and may choose to avoid care entirely, while mortality rates for black and Hispanic infants are significantly higher than those of their white counterparts.
In the wake of the rapidly evolving COVID-19 pandemic, new approaches to prenatal care are emerging daily. Research indicates that these may be right for low risk pregnancies even after the pandemic ends but might be dangerous to high risk pregnancies, women with low care access and marginalized population. Specifically, because of COVID-19, in-person prenatal care has now been reduced to an initial prenatal visit, an anatomy ultrasound, and the 28-, 36-, and 39-week visits. Some practices have cut certain nonessential prenatal appointments entirely. With limited clinic visits to those that require in-person services (like ultrasounds and lab tests); pregnant and postpartum mothers are left to self-monitor with little or no support, education or advice. If the patient has home doppler devices, blood pressure cuffs and scales, the practitioners are asking them to use their equipment to monitor their pregnancy in conjunction with their virtual visits.
Another service that had “gone out the door” is the in hospital prenatal education, preparation for birth group classes, diabetic mom support group, parenting and breastfeeding classes and more. Moms and parents are now left to find their own education and information with no validation of content credibility.
Four months into the “official” pandemic, things remain in flux, and so do variations in practice depending on where you live. As information about COVID-19 continues to evolve, hospitals and practices across the country are still revising and updating their protocols. But the sad reality is labor, and delivery today is entirely different from what anyone would have expected, and it probably will be for a quite a while, on account of COVID-19. The maternal-Infant mortality rate has been increasing steadily between 2014-2018 and unfortunately now with the decrease pre and postnatal care access, loss of insurance coverage and economic stressor there is strong reason to believe we might see further increase in maternal morbidity or mortality in 2021.
About the Author: Sigi Marmorstein, MSN, PHN, FNP is the CEO and founder of BabyLiveAdvice a telehealth company dedicated to maternal child health, as a complete journey addressing every pain point and gap in care. Utilizing remote patient monitoring and telehealth technologies combined with certified, experienced live providers, BLA can educate, support, empower and monitor mothers and parents, thus reducing adverse health outcomes. BLA partners with healthcare providers and health systems to offer panel support, reducing physician burden, improving care adherence and patient satisfaction.