Pregnant women in the United States face a daunting task: staying alive. U.S. women have the highest mortality rate among developed nations—23.8 per 100,000 as of 2020—and what’s worse: the rate is rising. Even though deaths related to pregnancy are largely seen as preventable, it’s more dangerous than ever to be pregnant in America. The statistics worsen if you are a Black woman. Research shows that the maternal mortality rate among non-Hispanic Black women is 3.5 times that of non-Hispanic white women, a dramatic increase from previous research that still showed Black women were 2.5 times more likely to die from childbirth.
In response to this expanding catastrophe, Northwell Health has launched the Center for Maternal Health, a first-of-its-kind center that utilizes a 360-degree model with a high-touch, high-tech approach to address the very real, yet solvable, problems today’s pregnant women face, focusing on Black maternal health specifically.
“Women in the United States face an unacceptable level of risk during pregnancy and childbirth, and the danger facing Black women is a national crisis,” says Michael Dowling, Northwell Health’s president and CEO, of the new Center for Maternal Health. “We must do better, and we can do better. Today, we are pledging to mobilize our entire health system to rectify this shameful health disparity so that Black women and their babies can flourish.”
According to Zenobia Brown, MD, senior vice president of population health and associate chief medical officer at Northwell, the root of the maternal mortality crisis is that many women don’t get proper pre- or postnatal care. It’s an access issue, an education issue, a social determinants of health issue. But it’s also a health care issue, as for too long, Black women have had poorer health outcomes due to institutional bias.
MATERNAL HEALTH
Population Health Approach is Pivotal in Lowering Maternal Mortality Rate in the U.S.
“Women in the United States face an unacceptable level of risk during pregnancy and childbirth, and the danger facing Black women is a national crisis”
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At the new Center for Maternal Health, part of Northwell’s Katz Institute for Women’s Health, health care leaders like Brown are taking a proactive approach.
“We don’t wait for a referral because we know that referrals to needed services are also susceptible to biased attitudes and behaviors,” explains Brown. “We use a population-health approach to identify moms who can benefit most and then remove any barriers to their care. Our mission is to provide support, advocacy and connection to needed services, empowering women to be in charge of their own health care.”
To accomplish this, the Center for Maternal Health is using a multifaceted approach. Much of the maternal mortality rate comes down to the presence of risk factors and barriers to care. As such, the first step is identifying who is at highest risk for maternal death and complications from pregnancy and then putting programs and interventions in place to address these barriers. To do so, Brown and her team utilize patient navigators for those with high-risk
pregnancies who then follow the patients throughout their course and the post-partum period.
A high-risk pregnancy can be caused by anything from a mother’s age to any chronic health problems the mother has, like diabetes or hypertension. If a pregnancy is high-risk, Northwell assigns the mother-to-be a maternal-fetal medicine specialist. The high-risk specialists have special training in prenatal diagnosis and perform level 2 ultrasound exams, amniocentesis, chorionic villus screening (CVS) and other procedures. The maternal-fetal medicine specialist will also partner closely with the patient’s primary OB and any other specialists, sharing information and jointly making a plan for the delivery and any treatment mother and baby require.
This approach requires that the pregnancy in question has been identified within Northwell’s integrated system. But how do you identify those who are pregnant but don’t know they have a high-risk pregnancy? That’s where advanced predictive modeling comes in, a type of AI that analyzes data and creates an algorithm to help identify those who might have a high-risk pregnancy.
Northwell has partnered with tech startup Aegis to create Ascertain, a joint venture that pairs high-tech innovation with Northwell’s vast data system in order to improve care. At the intersection of high-tech and medical data, Ascertain will produce modeling tools with the aim of identifying high-risk pregnancies earlier, so crucial intervention can occur to ensure both moms and babies have the best health outcome. For example, Ascertain’s data science team has been working hand-in-hand with Northwell’s Maternal and Fetal Medicine team to examine tens of thousands of cases of preeclampsia, a hypertensive pregnancy complication that disproportionately affects Black mothers in the United States. When identified early, interventions can be put in place to avoid the worst outcomes.
Not all of Northwell’s innovations for maternal health are high-tech. Some are “high-touch,” meaning these interventions are designed to increase the level of interaction between caregivers and those who are pregnant. At the Center for Maternal Health, caregivers are using the Maternal Outcomes (MOMs) Navigation program to increase interactions, providing additional support to high-risk women outside the health care setting, with a mandate to address underserved populations like Black women.
To get the message out that everyone deserves proper pre- and postnatal care, the MOMs program is part educational, part transformational and part community outreach. By partnering with community leaders and faith-based organizations to disseminate valuable information on pregnancy risks through trusted resources, Northwell is increasing community awareness, thereby removing the educational barrier to pre- and postnatal care. To help increase access to care during and after pregnancy, Northwell is providing care monitors who identify problems and offer real-world solutions. For example, if a pregnant woman needs a specific medicine but has transportation issues that prevent her from accessing it, Northwell’s care monitors will make sure the medicine is delivered.
The transformational aspect seeks to solve chronic shortcomings on the health care side, specifically implicit bias that lies at the root of why many Black women have worse health outcomes during pregnancy. Through the MOMs program, if a pregnant woman develops worrisome symptoms, the care monitor will help make sure the patient’s voice is heard in a medical setting. By tackling this implicit bias head-on, educating its health care workers to be hyper-aware of potential complications in historically underserved populations, and providing these populations with better educational tools and care support, the MOMs program is already proving effective. Results from a 20-month pilot program at three of Northwell’s largest facilities show the MOMs Navigation program reduced hospitalizations caused by pregnancy-related life-threatening problems by 47% among participating women — and by 69% among participating Black women.
Results from a pilot program reduced hospitalizations caused by pregnancy-related life-threatening problems by 47% among participating women — and by 69% among participating Black women.
It's not just the MOMs program helping to increase interactions between those with high-risk pregnancies and health care. At facilities across its integrated system, Northwell is expanding its midwifery program. As experts in women’s health, Northwell’s board-certified midwives are a dynamic high-touch and cost-effective solution, providing an increased level of care and expertise throughout the birthing process. Midwives embrace many holistic and non-medical tools to support labor but are well-equipped to facilitate an intervention should one be needed, always in collaboration with the patient. Multiple studies have shown that for low-risk pregnancies, midwives have the same or better outcomes than obstetricians while utilizing fewer interventions.
Northwell recognizes poor maternal outcomes have been a problem in this country for too long. Solving such a multifaceted challenge requires a multifaceted approach.
“The high rate of severe maternal health problems among Black women is a complex, multivariant problem, and we know it will take a complex, multilayered approach to address this health inequity,” says Michael Nimaroff, MD, who leads the MOMs Collaborative. “This is a learning process, and Northwell will continue to adapt as needed. We are in this effort for the long haul.”
Innovations in tech and increasing patient-caregiver interaction are just the beginning. As the Center for Maternal Health expands its programs and initiatives, expect Northwell to lead the way nationally in reducing the maternal mortality rate across all demographics.
To learn more, visit Katz Institute for Women’s Health.
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At the new Center for Maternal Health, part of Northwell’s Katz Institute for Women’s Health, health care leaders like Brown are taking a proactive approach.
“We don’t wait for a referral because we know that referrals to needed services are also susceptible to biased attitudes and behaviors,” explains Brown. “We use a population-health approach to identify moms who can benefit most and then remove any barriers to their care. Our mission is to provide support, advocacy and connection to needed services, empowering women to be in charge of their own health care.”
To accomplish this, the Center for Maternal Health is using a multifaceted approach. Much of the maternal mortality rate comes down to the presence of risk factors and barriers to care. As such, the first step is identifying who is at highest risk for maternal death and complications from pregnancy and then putting programs and interventions in place to address these barriers. To do so, Brown and her team utilize patient navigators for those with high-risk
pregnancies who then follow the patients throughout their course and the post-partum period.
A high-risk pregnancy can be caused by anything from a mother’s age to any chronic health problems the mother has, like diabetes or hypertension. If a pregnancy is high-risk, Northwell assigns the mother-to-be a maternal-fetal medicine specialist. The high-risk specialists have special training in prenatal diagnosis and perform level 2 ultrasound exams, amniocentesis, chorionic villus screening (CVS) and other procedures. The maternal-fetal medicine specialist will also partner closely with the patient’s primary OB and any other specialists, sharing information and jointly making a plan for the delivery and any treatment mother and baby require.
This approach requires that the pregnancy in question has been identified within Northwell’s integrated system. But how do you identify those who are pregnant but don’t know they have a high-risk pregnancy? That’s where advanced predictive modeling comes in, a type of AI that analyzes data and creates an algorithm to help identify those who might have a high-risk pregnancy.
Northwell has partnered with tech startup Aegis to create Ascertain, a joint venture that pairs high-tech innovation with Northwell’s vast data system in order to improve care. At the intersection of high-tech and medical data, Ascertain will produce modeling tools with the aim of identifying high-risk pregnancies earlier, so crucial intervention can occur to ensure both moms and babies have the best health outcome. For example, Ascertain’s data science team has been working hand-in-hand with Northwell’s Maternal and Fetal Medicine team to examine tens of thousands of cases of preeclampsia, a hypertensive pregnancy complication that disproportionately affects Black mothers in the United States. When identified early, interventions can be put in place to avoid the worst outcomes.
Not all of Northwell’s innovations for maternal health are high-tech. Some are “high-touch,” meaning these interventions are designed to increase the level of interaction between caregivers and those who are pregnant. At the Center for Maternal Health, caregivers are using the Maternal Outcomes (MOMs) Navigation program to increase interactions, providing additional support to high-risk women outside the health care setting, with a mandate to address underserved populations like Black women.
To get the message out that everyone deserves proper pre- and postnatal care, the MOMs program is part educational, part transformational and part community outreach. By partnering with community leaders and faith-based organizations to disseminate valuable information on pregnancy risks through trusted resources, Northwell is increasing community awareness, thereby removing the educational barrier to pre- and postnatal care. To help increase access to care during and after pregnancy, Northwell is providing care monitors who identify problems and offer real-world solutions. For example, if a pregnant woman needs a specific medicine but has transportation issues that prevent her from accessing it, Northwell’s care monitors will make sure the medicine is delivered.
The transformational aspect seeks to solve chronic shortcomings on the health care side, specifically implicit bias that lies at the root of why many Black women have worse health outcomes during pregnancy. Through the MOMs program, if a pregnant woman develops worrisome symptoms, the care monitor will help make sure the patient’s voice is heard in a medical setting. By tackling this implicit bias head-on, educating its health care workers to be hyper-aware of potential complications in historically underserved populations, and providing these populations with better educational tools and care support, the MOMs program is already proving effective. Results from a 20-month pilot program at three of Northwell’s largest facilities show the MOMs Navigation program reduced hospitalizations caused by pregnancy-related life-threatening problems by 47% among participating women — and by 69% among participating Black women.
It's not just the MOMs program helping to increase interactions between those with high-risk pregnancies and health care. At facilities across its integrated system, Northwell is expanding its midwifery program. As experts in women’s health, Northwell’s board-certified midwives are a dynamic high-touch and cost-effective solution, providing an increased level of care and expertise throughout the birthing process. Midwives embrace many holistic and non-medical tools to support labor but are well-equipped to use interventions should they be needed, always in collaboration with the patient. Multiple studies have shown that for low-risk pregnancies, midwives have the same or better outcomes than obstetricians while utilizing fewer interventions.
Northwell recognizes poor maternal outcomes have been a problem in this country for too long. Solving such a multifaceted challenge requires a multifaceted approach.
“The high rate of severe maternal health problems among Black women is a complex, multivariant problem, and we know it will take a complex, multilayered approach to address this health inequity,” says Michael Nimaroff, MD, who leads the MOMs Collaborative. “This is a learning process, and Northwell will continue to adapt as needed. We are in this effort for the long haul.”
Innovations in tech and increasing patient-caregiver interaction are just the beginning. As the Center for Maternal Health expands its programs and initiatives, expect Northwell to lead the way nationally in reducing the maternal mortality rate across all demographics.
To learn more, visit Katz Institute for Women’s Health.
“Women in the United States face an unacceptable level of risk during pregnancy and childbirth, and the danger facing Black women is a national crisis,”
Results from a 20-month pilot program at three of Northwell’s largest facilities show the MOMs Navigation program reduced hospitalizations caused by pregnancy-related life-threatening problems by 47% among participating women — and by 69% among participating Black women.
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