Coordinated Care for Maternal Health and Birthing People
Overview: Understanding the problem of US maternal mortality and morbidity
The US maternal mortality rate is currently over ten times that of other high income countries with 32.9 maternal deaths per 100,000 live births in 2021. In addition, the US struggles with high levels of maternal morbidity, defined by the WHO as “any health condition attributed to and/or complicating pregnancy and childbirth that has a negative impact on the woman’s wellbeing and/or functioning.” It is estimated that for each maternal death, up to 30 birthing people will experience maternal morbidity. Pregnancy in the US does not come without its risks.
Pregnancy is particularly dangerous for marginalized pregnant and birthing people; black people are 2.6 times more likely and American Indian and Alaska Native people are 2.5 times more likely to die from pregnancy-related causes compared to their white counterparts. These differences are not biological in nature, but rather due to social factors such as structural racism in the medical field as well as issues with geographical or financial accessibility.
Accessibility to maternal care, although previously limited for many groups, has become even more restricted after the overturn of Roe v. Wade. In 2022, maternity care deserts (counties in the US that lack maternity care resources such as birth centers or hospitals/providers equipped for obstetric care) affected almost 500,000 births nationwide. More than half of OBGYNs across the country say that the Dobbs decision has worsened pregnancy-related mortality as well as their ability to manage pregnancy-related emergencies.
Source: March of Dimes
Even for those able to access care, the CDC reports that over 80% of maternal deaths are completely preventable, with the leading cause of death being mental health conditions. Surprisingly, 53% of deaths occur during the “fourth trimester”, or after the birthing person has left the hospital. This demonstrates that the six-week postnatal checkup dictated by the current care model is much too late.
The current prenatal care model was published in 1930 by the Children’s Bureau and little has changed since then, demonstrated by the Guidelines for Perinatal Care, Eighth Edition published in 2017 by the American Academy of Pediatrics. The model recommends up to 14 visits during pregnancy, but provides no evidence that this is the most effective model for prenatal care. Oftentimes, pregnant people will skip many of these prenatal visits, often encountering obstacles such as finding a ride, securing child support, taking off of work, etc. Compounded by the shortage of OBGYNs our country is facing, the current maternal health crisis is in need of a new prenatal care model.
Coordinated Care Model
The goal of care coordination is to increase the safety and effectiveness of care received by a patient. This is done by sharing information among all members of the patient’s healthcare team in a timely manner to anticipate needs and subsequently organize activities for care. Originally created for children with special needs and later developed for people with chronic health conditions, the care coordination model is now being used across the healthcare system, including in prenatal care. The goal of prenatal care coordination, specifically, is to improve birth outcomes by providing medical, social, and educational resources to pregnant people. This might include providing equipment and training for at-home monitoring to reduce in-person visits, or creating a messaging platform that allows 24/7 access to a care team to handle any questions or concerns that arise throughout pregnancy and postpartum. The boom in telehealth due to the COVID-19 pandemic has increased access to healthcare for many people, and there are several companies that are taking this opportunity to provide increased support throughout pregnancy.
Market Map: Digital players in prenatal and maternal care coordination
Source: Coyote Ventures Venture Fellow Emily Chen
We're excited to see the many approaches to coordinating the care birthing people need - it truly takes a village. In the next blog post, we'll explore further how marginalized communities are impacted by higher risks in the birthing process.
Company Descriptions: Continuous Pregnancy Support
Baby Live Advice connects families to a nationwide network of maternal-infant care professionals to provide support and health education.
Birthify is a company dedicated towards helping families achieve the most optimal pregnancy, birth, and postpartum outcomes by offering evidence-based tools, services, and education.
Cayaba Care provides local (in-home or virtual), interdisciplinary care for pregnant people to supplement care provided by the patient’s OB. Cayaba Care is currently supporting pregnant people in the Philadelphia and Newark areas.
Cleo provides specialized care teams for one-on-one support as well as evidence-based content for families, including family planning and pregnancy.
Diana Health creates a personalized plan and collaborative care team to support pregnant people in their physical, mental, and social well-being. Dianna Health can be used by pregnant people, but it is not specific to pregnancy and can serve anyone in need of women’s health care in the state of Tennessee.
Mae is a pregnancy tracker that is designed specifically for black women to provide culturally-specific information and support from licensed professionals.
Mahmee is a HIPAA-secure care management platform that makes it easy for payers, providers, and patients to coordinate comprehensive prenatal and postpartum healthcare from anywhere. The platform allows patients to message their care team and have access to resources around the clock.
Maven Clinic provides critical support across fertility, pregnancy, adoption, parenting, and pediatrics. With their own providers, and care advocates, Maven provides continuous support for a variety of needs.
MyLÚA is a virtual maternal care platform that supports providers and birthing people through pregnancy and postpartum by promoting evidence-based solutions and bridging access to care with more frequent virtual touch points.
Oula delivers an evidence-based and personalized pregnancy experience. With their own collaborative medical team and remote care platform, they help pregnant people in the NYC area.
Ovia is an app that allows the pregnant person to track their health, contact Ovia’s in-house coaching team, and explore other financial benefits that they receive from their employer.
Partum Health provides pregnant people with a personalized care team and resources to help through pregnancy and postpartum.
Phoebe provides pregnancy and postpartum support by providing resources, connecting individuals in small groups, and providing on-demand support from a doula. Phoebe can also refer patients to specialized services for more personalized care.
Pomelo Care provides unlimited access to an expert care team for support before, during, and after pregnancy.
Ruth Health provides on-demand personalized care for patients through pregnancy and parenthood as well as a video library of educational courses.
SoShe supports women and families with comprehensive childbirth preparation, lactation support, and one-on-one coaching covering pregnancy through postpartum.
Company Descriptions: Continuous Pregnancy Support with At-Home Monitoring
Aster provides a platform that makes it easy for providers and specialists to monitor patients from home and provide continuous support throughout pregnancy.
BabyScripts is a platform that provides support to patients throughout pregnancy and postpartum, including at-home monitoring, educational resources, and continuous access to healthcare professionals, including the pregnant person’s healthcare provider.
Bloomlife is a platform that allows clinicians to monitor high-risk patients who need additional care. The clinician selects patients that qualify, and “prescribes” Bloomlife for continuous at-home monitoring.
Delfina is an app that allows patients to track their pregnancy with the help of at-home monitoring devices and share the information with their provider. The app also provides personalized educational resources to the patient.
e-Lōvu is a digital wellness platform and marketplace that allows OBs to provide continuous care for their patients, including at-home monitoring, and seamlessly connect their patients to third-party services.
Millie provides in-house OB-GYNs, midwives, and doulas for continuous support through a modern approach to holistic pregnancy care. Also providing at-home monitoring, Millie serves pregnant people in the Berkeley area.
Wildflower provides continuous support during pregnancy and postpartum while also integrating with the patient’s clinician and remote monitoring.
Company Descriptions: Continuous Pregnancy Support for Specific Conditions
Boram provides dedicated time and space for postpartum recovery while experienced professionals guide the transition into parenthood.
Malama Health provides a patient-facing app and provider portal that allows pregnant people and their providers to track glucose and meal data with the goal of better managing and preventing gestational diabetes.
MamaMend is the provider of postpartum knowledge and resources intended to be a digital health companion. The company's resources offer a personalized, evidence-based and week-by-week guide to childbirth recovery and postpartum health as well as connects users to a curated network of expert practitioners, enabling new mothers to get answers to health and wellness questions.
Poppy Seed Health is an online platform that allows continuous access to advocates, doulas, midwives, and nurses during pregnancy and postpartum, with an emphasis on emotional and mental health.
Progeny Health provides continuous support to a pregnant person and their families through their specialized care team, with an emphasis on NICU case management.
Robyn is a digital platform for aspiring, expecting, and new parents featuring 200+ meticulously selected providers across specialized fields. Robyn providers collaborate with the patient’s clinician to complement primary care.