By Tom Peterson, Michigan Advance
Modern maternal health care in the U.S. may be excellent, but connecting with it can be fraught with challenges — especially to pregnant women in vulnerable populations.
Black women nationwide are at a greater risk of dying while pregnant or immediately after, compared to other groups, reports the Centers for Disease Control and Prevention.
That makes prenatal care — and providers who connect with the patients — even more important, experts say. Standard care includes screening for depression, testing for anemia and other blood counts, and screening for hepatitis B and gestational diabetes.
But, if coming into a clinic regularly is difficult, medical providers need to offer alternatives to make screening and care easier for vulnerable women, said Dr. Hyagriv Simhan, maternal fetal medicine physician at UPMC Magee-Womens Hospital.
“Our approach is to make sure all of these things happen for all of our patients,” said Simhan, professor and executive vice chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of Pittsburgh. “Most people actually do get prenatal care … and it’s really important. If one does not seek regular prenatal care at all, one is at risk of a variety of things. There are a variety of barriers for ongoing care.”
Utilizing technology is a key aspect of connecting at-risk patients to consistent care, Simhan said.
That happens in varying degrees across Pennsylvania, where at least six counties lack standard options for maternity care, according to a March of Dimes report, and scant access to an obstetric provider.
At UPMC, asking patients who already have been seen at a clinic for prenatal care to use the MyUPMC platform has been a convenient option for many, Simhan said. Since most people have a cellphone, they can take some screening tests — particularly ones for depression — digitally from home.
“That works well for most patients,” Simhan said. “Ideally, everyone gets screened in advance — and the sooner, the better. We’ve created a sort of belt-and-suspenders approach to doing in-clinic screening as well.”
Pregnant women who come in for in-person depression screenings also can access the MyUPMC app in the clinic. If the patient indicates signs of depression, the program’s algorithms rank the severity of symptoms.
“I think everyone has realized depression during pregnancy is an important thing to screen for. But the screening itself doesn’t do anything if you don’t connect people to care.” — Dr. Hyagriv Simhan, maternal fetal medicine physician at UPMC Magee-Womens Hospital
Dr. Hyagriv Simhan, professor and executive vice chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of Pittsburgh // Photograph by Martha Rial
When the screening indicates a patient is depressed, the staff directs her to treatment resources such as counseling.
“I think everyone has realized depression during pregnancy is an important thing to screen for,” Simhan said. “But the screening itself doesn’t do anything if you don’t connect people to care.”
UPMC tries to do as much face-to-face prenatal care in the community as possible, but also tries to maximize opportunities for virtual care, to potentially reach more people, he said.
Despite efforts of many medical providers, patients in vulnerable populations are sometimes reluctant to trust the health care industry, or may not feel heard by their providers.
What can doctors and other health care professionals do to meet these patients where they are and help them be open to receiving more prenatal care?
Simhan said the doula program is an excellent choice. Doulas are trained to provide emotional, physical, and educational support to a mother who is expecting, is in labor, or has recently given birth.
Doulas aim to help women have a safe, empowering, and memorable birthing experience, according to the American Pregnancy Association.
The increasingly popular use of doulas is a key piece in lowering maternal mortality rates, some experts say.
Doulas can help to create a birth plan, teach women about perineal massage and other techniques that can reduce stress during labor, and provide emotional support.
The doulas are near mom during delivery, and can provide comforting techniques like massage. Their relationship with mothers-to-be usually starts a few months before labor.
As wonderful as the care of a doula can be for a pregnant woman, Simhan cautions that doulas are not health care providers. They are trained professionals and a member of the care team, but they act as a support to the mother and a liaison. They just don’t provide direct treatment or advice about health care.
Pregnant and need support? Allegheny County residents have a number of options for support during and after pregnancy.
Pennsylvania Partnerships for Children also offers resources for those living in the Commonwealth.
To learn more about doula services at Magee-Womens Hospital, visit the website or e-mail to email@example.com.
Kellie B. Gormly is a journalist whose work has appeared in The Washington Post, among others. She holds a master’s degree in public affairs reporting from the University of Illinois, Springfield, and had stints at Copley News Service and The Associated Press. She is from Texas.
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