Maternal Healthcare: Where Did We Come From, And Where Will We Go?

Maternal healthcare has come a long way, but the statistics show it still isn't perfect. How are the professionals pushing things forward?

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In 2012, Heather Beckius developed gestational diabetes while pregnant. Like other forms of diabetes, gestational diabetes affects cells’ ability to utilize glucose properly. The condition can lead to elevated levels of blood sugar, which can impact the health of both the mother and the baby, according to the Mayo Clinic.

Since she had this condition, the doctor performed a nonstress test—a simple procedure completed during pregnancy to evaluate the baby’s health. During the test, the fetal heart rate kept dropping. The doctor followed up the nonstress test with an ultrasound, which showed a sizable spot on the unborn baby’s brain.

The spot would later be identified as a brain bleed or a stroke. Although Beckius was going through a very challenging situation, she says, “All of the doctors were very supportive. They tried to prepare me for the very worst—my baby not surviving—and, at the same time, they told me that the brains in babies have a great tendency to rewire themselves.”

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Thankfully, Beckius’s story has a happy ending—she gave birth to a “miracle” baby boy. But the circumstances surrounding her pregnancy underscore the importance of the accessibility of maternal healthcare for women from prenatal to postnatal so that all mothers can receive the quality of care they require and reduce the risk of pregnancy-related complications.

What is maternal health?

The World Health Organization defines maternal health as “the health of a woman during pregnancy, childbirth, and the postpartum period.”

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For many women, pregnancy and childbirth are a joyous and anticipatory experience. For others, however, this period can be marked with adversity, mental or physical health issues, and worst case scenarios—even in the United States. In fact, WHO reports:

  • From 1990 through 2013, the maternal mortality rate in the U.S. increased from approximately 12 to 28 per 100,000 births.
  • Currently, the United States has a maternal mortality rate higher than other high-income countries and countries like Iran, Libya, and Turkey.
  • According to WHO, nearly half of all maternal fatalities in the U.S. are avoidable.
  • Approximately 1,200 women in the U.S. experience fatal complications during pregnancy or childbirth each year.
  • Each year, almost 60,000 women endure complications that are near-fatal.
  • Data from 2012 showed the upward trajectory of maternal complications and the mortality rate continued—even though the U.S. spent more than $60 billion on maternity care.

With that said, modern developments in maternal healthcare give women a much brighter outlook than they had in years past. Figures collected by Our World in Data show that the U.S.’ maternal mortality rate didn’t fall below 400-in-100,000 until 1940.

How was maternal medicine practiced back when?

Mary Jane Minkin, MD, a clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale and a private practice physician in New Haven, Connecticut, began medical school at the Yale School of Medicine in 1971. She delivered her first baby during her obstetrics rotation in 1973. With more than four decades of experience with women throughout pregnancy and childbirth, Minkin has seen some changes in maternal healthcare.

Minkin says the first significant advancements for obstetrics, gynecology, and maternal health occurred in the early 1970s. One of the primary areas of progress Minkin mentions is in early pregnancy detection. “When I started medical school, we literally had to wait for the rabbit to die to see if someone was pregnant,” she recalls.

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The phrase “the rabbit died” was created between the 1920s and ’30s. To see if a woman was pregnant, physicians would inject urine from their patient into a rabbit. If the urine contained the pregnancy hormone hCG, it would cause the rabbit to ovulate and verify if a woman was pregnant.

Unfortunately, this method came at a tremendous cost to the rabbits—their lives! The rabbit’s ovaries couldn’t be seen without an autopsy or surgery to remove the ovaries; the latter was typically deemed a waste of effort. Eventually, this practice was replaced with home test kits like First Response, which allows a woman to tell if she’s pregnant six days before her missed period.

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Another area Minkin cites as one of concern during her early years at Yale was with fetal well-being and the lack of imaging to assess fetal health. These pressing matters helped form the “backdrop for maternal and child health changes,” she says.

Through the decades, the technological developments have led to the invention of fetal monitoring, which allows for the fetal heart rate to be monitored during labor and delivery to determine the condition of the baby.

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Additionally, breakthroughs in ultrasound technology have given clinicians the ability to view the placenta in all locations and positions, diagnose fetal abnormalities more quickly, and provide expectant parents a real-time, color image of the fetus in 3D/4D. Furthermore, advances in amniocentesis created a minimally-invasive procedure for doctors to test for chromosomal abnormalities, fetal lung health, and infections.

These are a few of the ways in which maternal healthcare was practiced in the last four decades and how it has made strides.

What are some ways healthcare providers are working to improve a woman’s experience with pregnancy and beyond?

There’s a growing trend to provide expectant mothers with a comprehensive birthing experience. Vice Chief Medical Officer Michael Moxley, MD, and Department Chair of OB-GYN Miguel Fernandez, MD, are professors at Georgetown University School of Medicine and physicians at Virginia Hospital Center. One way medicine is working to improve maternal health is through a multidisciplinary approach to care.

“We have sought to become more collaborative with our colleagues. Traditionally, medicine has been siloed, with each group acting independently,” Moxley and Fernandez say. “Now, at VHC, we work in teams that include not only doctors and nurses, but administration and, most importantly, patients.”

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Besides a more collaborative approach to maternal health, Moxley and Fernandez say medicine is taking cues from the field of aviation to reduce errors. Medical flight simulations, so to speak.

“In the last 10 years, we have started regularly practicing to react for emergencies that rarely happen so that we are better prepared and have better outcomes when the time comes,” they stated.

Furthermore, Moxley and Fernandez aim to cut down on unnecessary C-sections, which increase the maternal risk of having complications during childbirth.

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“The statistics indicate after the first C-section, repeat births will be done via C-section 90 percent of the time. Since the risk of complications increases with C-sections, we want to make sure that the C-section is medically needed,” they say. “We follow the guidelines that were created in 2014 by the American Congress of Obstetricians and Gynecologists—the guideline that made the biggest change was allowing more time for the labor to progress.”

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Regarding how healthcare providers are working to enhance a woman’s maternal experience, Minkin furthers the conversation by stating, “The most important advances in maternal and child health actually pertain to getting ready for pregnancy. We know that smoking [and substance use] … are very toxic to the fetus. So we encourage all of our patients to stop taking drugs, stop drinking … , and stop smoking before pregnancy, or limit these as best as possible.”

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Additionally, Minkin acknowledges that women with chronic medical conditions—either mental or physical—have better outcomes when they have the opportunity to carefully plan their pregnancies. To illustrate an example, she says, “If a woman has high blood pressure, she should meet with her primary care provider to make sure she has her blood pressure well-controlled and is not taking certain drugs that are bad for babies.”

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“Also, we know that if a woman is diabetic, her baby will do much better if mom’s blood sugars are in excellent control before she gets pregnant. A pre-pregnancy meeting with an obstetrician is ideal before a woman conceives to maximize her healthy outcomes.”

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Finally, Minkin emphasizes the importance of addressing a woman’s mental health needs throughout her pregnancy. “These days, all women are screened during pregnancy for depression and hooked up with a mental healthcare provider before delivery to minimize the chances of postpartum depression,” she says. “We do know that certain antidepressants are safe to use during pregnancy, and some of these may be prescribed if the woman is suffering from depression.”

Advice and Tips

Although maternal healthcare in the U.S. still has obstacles to overcome, particularly in its accessibility to all women, these are a few tips women can follow to prepare for a safe childbirth and develop a strong patient-doctor relationship:

  • Look for a physician who will seek to meet your needs. If you’re unhappy with your current doctor, don’t be afraid to try another one—either within the same practice or a different one. Wherever you go, it’s important you feel heard and valued as a patient.
  • If you have pre-existing health conditions, work with your doctor to get those under control before, during, and after pregnancy.
  • Your doctor may offer you lifestyle, supplement (like prenatal vitamins), or exercise recommendations. Try to be as compliant as possible with these recommendations.
  • If you’re considering a midwife or doula, our experts suggest using a hospital that has midwives or doulas as a part of their birthing team. Or find a doctor who is willing to work with them to give you and your baby the best care possible.
  • Lastly, Minkin says, “One thing that I strongly recommend is that women don’t take advice from a celebrity about medical health just because she is a celebrity. You hear all sorts of crazy things put out by folks who really don’t know any medicine!” Instead, focus on creating a reliable social network, so when you have the baby, you have the support you need.
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