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Cradle of Care: The Transformative Potential of Obstetrical Care in the Face of Social Needs

Bintou Diarra | Editorial Lead | MS1: Alpert Medical School of Brown University | June 24, 2024

Pregnancy is a pivotal time period marked by great physical, emotional, and social transformation. It necessitates comprehensive care and support, as the two are of utmost importance in the maintenance of the well-being of the birthing person and their growing infant. In fact, the vulnerability inherent in pregnancy renders social needs increasingly critical.

A recent New York Times article unveils that for expectant mothers facing drug addiction, these needs are amplified, and with them, the significance of unique solutions. While the piece hones in on expectant parents trudging through addiction specifically, it underscores a reality that could inform a model of care for all expectant mothers facing personal and structural issues. In the face of social needs, pregnancy stands as a transformational sphere of care with the potential to establish permanent change. It is imperative that physicians and other care providers play on this potential in their care of the most vulnerable expectant mothers and infants.

A growing body of research is unveiling the transformative potential of obstetrical care. In one study, researchers identified four main themes among birthing people and mothers—motherhood as motivation for adopting a new lifestyle, access to information from media and support from physicians as facilitators of adopting a healthy lifestyle, durability of healthy lifestyles, and aspects of lifestyle modifications. In the same study, they noted that the cessation of care and support contributed to the reversion to a pre-pregnancy lifestyle. Kim Short’s reproductive journey provides an example. In April of 2023, she gave birth to a healthy baby boy after managing her addiction throughout her pregnancy. Within months, she relapsed, and child protective services placed her baby in foster care.

One thing is clear. In the face of optimal conditions of care, birthing people achieve optimal health during their pregnancies. The finding that these changes and the state of personal health shift to a pre-pregnancy state may not seem promising at face value, but it stands as a show of the significance of continuous care, especially for expectant mothers facing great social need. This backs a disheartening observation from a 2022 Centers for Disease Control and Prevention study, which shows that deaths related to mental health conditions, including substance use disorders (SUDs), account for a whopping 23% of deaths during pregnancy or in the year following it. Evidently, we must restructure our maternal health landscape to heighten the efficacy of what is already working.

For expectant mothers facing great social need, prenatal care visits may be among the few times they receive access to care at all. The very nature and pacing of these care visits means that expectant mothers that exist at the margins will have access to quality care, at a baseline. From weeks 4 to 28, expectant mothers and birthing people typically attend prenatal visits once a month. From weeks 28 to 36, the pacing increases to every other week. Past week 36, the pace is once again heightened to every week. During these prenatal visits, physicians and other care providers typically monitor blood pressure, height and weight, genetic conditions, and other factors that play into the health and wellbeing of the birthing person. While the head goal is to ensure the health of the infant, there exists an acknowledgement of the interplay between infant well-being and that of the birthing parent. 

Ensuring that the most vulnerable parents do not slip away is a matter of extending the quality of this care into the postpartum period, which remains a long-neglected phase of the reproductive journey. After ensuring the health of the infant, care providers must double down on their efforts to maintain the standard of health established throughout the pregnancy.

Obstetrical care has great capacity to shape health outcomes for those in need, but we cannot speak to this need without acknowledging the elephant in the room. In an ideal world, people only conceive under optimal conditions. However, as care providers, our jobs are to account for situations as they present, and ensure the highest quality of care, regardless of personal beliefs. Rather than uphold stigma, we must continue to treat pregnancy as a sphere with an inherent level of vulnerability. This means working on improving our engagements with the expectant mothers and birthing people who often fall through the cracks, rather than upholding systems of morality that limit care.

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