The United States currently faces one of its worst maternal health crises.
Not only are the rates of maternal mortality on the rise, but there remain significant racial and ethnic disparities in outcomes. Maternal mortality rates have more than doubled between 1999 and 2019, and Black women and birthing people face the greatest burden. When compared to their white counterparts, Black birthing people are three to four times more likely to die of pregnancy and childbirth-related complications. The Centers for Medicare and Medicaid Services recently made a decision that will serve to improve these outcomes.
On December 15th, the Centers for Medicare and Medicaid Services announced the new Transforming Maternal Health Model, a novel model that hones in on maternal health outcomes for people enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The target population faces uniquely devastating circumstances. When compared to those living in affluent areas, pregnant people living in impoverished communities have more than double the rates of maternal mortality and morbidity. The goal of the model is to reduce disparities in access and treatment, and is set to run for 10 years.
The model will support participating state Medicaid agencies in centering holistic care for people through pregnancy, childbirth, and the postpartum period. Under the model, they will strive to ensure that birthing people receive personalized care by supporting them in the establishment of a birthing plan. It is evident that the model subsists on what works—one study shows a unanimous opinion among patients with a birth plan that it encouraged communication with their provider and heightened birth satisfaction.
Additionally, the model will address the social determinants of health by calling for participating agencies to screen individuals during their initial prenatal visit. At this point, they will determine what, if any, additional support the birthing person may need for the dimensions shaping health long before the hospital visit—namely, mental health, social needs, and/or substance use support. Identifying these needs will enable the agency to collaborate with the birthing person to create a care plan, monitor conditions like hypertension, and/or connect them with a community health organization that focuses on their specific need.
Leaning on the understanding that structural forces create the present reality, the new model will also support relationship building efforts to assist states in addressing barriers to care access. More specifically, they will support endeavors with the goal of heightening access to midwives, doulas, community health workers, and other players leading the effort to create safe, dignified birthing experiences for all. At the foundation of this unique effort is the growing body of research regarding the benefits of engaging birthworkers—reduction in cesarean sections (c-sections) for low-risk pregnancies, shortened labor time, lower utilization of pain medication during birth, and lower rates of postpartum anxiety and depression.
Furthermore, among the three main pillars is quality improvement and safety. Participating agencies will employ interventions termed “patient safety bundles” to make the conditions of birthing safer for birthing people and their infants. According to the Centers for Medicare and Medicaid Services, the evidence-based interventions have been shown to improve health outcomes across several clinical areas, including hypertension during pregnancy, cardiac conditions, and care for pregnant and postpartum people living with substance use disorders.
It is not enough to push our nation’s birthing people to survival, and the new model accounts for this. Participating agencies and their hospitals will work towards achieving the “Birthing-Friendly” designation, the first federal quality designation with a focus on maternal health.
The Transforming Maternal Health Model calls for change in more ways than one. By improving the state of hospitals and heightening receptivity to the various players propping birthing people up all over the United States, the new model is likely to create sustainable solutions with far-reaching benefits.