Enhancing Perinatal Care Support to Improve Maternal Mortality Disparities

Northwestern University At Chicago, Evanston IL

Investigators

Linked publications, trials & patents

Abstract

ABSTRACT Increasing severe maternal morbidity and mortality health disparities in the US are urgent public health concerns requiring innovative, sustainable solutions. The perinatal period, the time before and after birth, has important implications for a woman’s health and that of her child. Standard perinatal care is lagging to meet the needs of Black and Hispanic women, especially with consideration to the non-medical drivers of health. Doula care is increasingly recommended to support high-risk, lower-resourced women during labor and the immediate postpartum period and is posited to mitigate the effects of poor quality of care and non-medical drivers of poor health outcomes. However, a key limitation to doula care is that doulas are largely relegated to working in parallel with the healthcare team and the potential consequences of this include disjointed care coordination and missed opportunities to improve healthcare quality for Black and Hispanic women. Building on our team’s prior and current work optimizing perinatal care for Black and Hispanic women, we will develop and evaluate a Well-Mama intervention in 3 participating medical centers in Chicago IL, Baton Rouge LA, and Newark NJ which have some of the highest US rates of maternal morbidity and mortality. The Well-Mama intervention is centered on uninsured and publicly insured Black and Hispanic pregnant and postpartum women supported by Community Doula Navigators (CDNs) who will conduct in-person and telehealth wellness check-ins using the Well-Mama safety checklist; make referrals to resources following the check-ins, with feedback provided to the perinatal care team; lead virtual pregnancy and postpartum support groups; attend select patient visits; and provide labor support. The Well-Mama checklist includes 5 priority topic areas representing leading factors in maternal morbidity and mortality in which to attune doulas and their patients: (a) mental health/depression; (b) cardiovascular symptoms; (c) safety (e.g., guns at home and intimate partner violence); (d) opioid/substance abuse; and (e) social support, self-agency, and well-being. Well-Mama advances a Shared Care Model approach to health care delivery focused on interprofessional collaboration in relation to centering care on the individual patient. Through a Hybrid Type 1 randomized effectiveness-implementation trial of N=576 women, we will compare the effectiveness of the Well-Mama intervention relative to standard perinatal care in improving women’s receipt of recommended care components (primary outcome), reducing patient potential medical distrust and experience of poor quality of care, increasing health engagement, self-efficacy, and perception of care team quality, and enhancing perinatal care team cohesion (secondary outcomes), while evaluating intervention implementation. This study seeks to optimize doula integrated perinatal care to address the top drivers of maternal morbidity and mortality with the goal of reducing maternal health disparities experienced by Black and Hispanic pregnant and postpartum women.