New perspectives on shaping the future of pregnancy health

Doctors and Patients Agree: Pregnancy Care is Overdue for a Change

The future is bright for innovation in pregnancy health and the prenatal care journey. After decades of patients being forced into the same pathway for care delivery, doctors and patients are breaking the mold and redefining what optimal pregnancy health means for them.

Patient Perspective
Name: Jenny
Occupation: NICU nurse
Children: Three
Condition: Preeclampsia
Diagnosed: Week 36

Have you ever felt like your healthcare should be more personalized than it is? Have you ever thought that your doctor’s recommendations just didn’t make sense for you as a unique human being? As both a doctor and a patient, I have often sensed my patients’ frustrations and shared them at times. I recall a patient who transferred her care to me in the middle of her pregnancy, not because she was concerned about the quality of her care but because she didn’t like how her prior office made her feel. “Everything is so impersonal there,” she observed. “They assign me to a different provider every time, and then I wait for hours to have a 5-minute visit that I don’t feel I even needed. I just don’t feel like the care I’m getting there is very personalized.”

Unfortunately, these frustrations are becoming increasingly common due to competing pressures on healthcare providers, patients, and healthcare systems. Part of this could be because the prenatal care model and visit schedule every patient receives have not been personalized – until now. It is shocking that despite many advances in pregnancy health over the last hundred years, there has been almost no evolution in how we provide pregnancy care. In fact, the pregnancy visit schedule has remained unchanged in the U.S. since 1930, when the current model was first recommended without supporting evidence.1

This model provides what most of us think of as the ‘routine’ visits, for which patients are seen in person 12-14 times each pregnancy. While intended as reassuring check-ups, these visits can be burdensome, with patients feeling like they are sometimes waiting for hours for just a quick visit. Multiplied over the course of a pregnancy, this can add up to a lot of missed work, transportation, and childcare costs that are not trivial. Is it vital to require all of these visits in each pregnancy?

Finally, some physicians are asking the same question and aiming to overhaul the outdated pregnancy care model as we know it today. Physicians at the University of Michigan have launched the MiPATH Initiative2, a program that is reimagining what prenatal care should look like. Together with the American College of Obstetricians and Gynecologists (ACOG), the primary professional society for OB/GYNs, the MiPATH initiative will help to inform a campaign to redesign and reimagine prenatal care for the first time in almost a hundred years. Known as the Redesigning Prenatal Care Initiative,3 the group is working to develop a modern and improved pregnancy care model for low-risk patients and tailored plans for patients impacted by certain higher-risk conditions.

The group has been motivated to change the status quo after noting that many patients felt dissatisfied with their prenatal care schedule and that it didn’t fit their lifestyles and needs.1 In reflecting on the current status quo, they lament that “the United States has maintained this one-size-fits-none prenatal care delivery guideline despite drastic changes in technology and population health, evidence to support alternative prenatal care delivery, persistently worse maternity outcomes, and deepening health disparities.”1

How might pregnancy care change for you in the future?

Moving away from the “one-size-fits-none” days of the past, these pregnancy experts are reimagining a new care model in which each patient’s risk is evaluated at the beginning of pregnancy, and her doctor or midwife then makes a personalized care plan with the patient using shared decision-making.

Instead of interrupting numerous workdays or making special arrangements for childcare to accommodate pregnancy visits, some patients may be able to be seen in person as few as four times, supplementing the other visits with telehealth and remote monitoring. In other cases, for example, when patients have certain preexisting conditions or prefer in-person care, they can be seen more frequently in person on a schedule that works for them. Evidence is growing that personalized care also translates to superior care: patient satisfaction is higher with this flexibility, and outcomes are the same or even better with telehealth.4

What can you do to personalize your pregnancy health today?

The details of the Redesigning Prenatal Care Initiative are still being worked out. If you are currently pregnant, you can ask your provider about any updates to the initiative and any options to personalize your care to suit your needs. Do you have a particular day of the week that works better for you? Do you need an evening or weekend appointment? Is telehealth much easier for you? You can also ask about things like group visits, online courses & support groups, and other offerings that may help to support you in your pregnancy. Not all of these options are available everywhere, but if you open up the conversation with your provider to see what they can accommodate, you can partner to personalize your pregnancy health journey in a way that works for you – and results in optimal care for you and your baby.

21st Century Pregnancy Health: A Vision for the Future

It remains to be seen what guidance ACOG and the Redesigning Prenatal Care Initiative will finalize in their recommendations, but the very concept of personalizing pregnancy care is revolutionary and a step in the right direction. In the work we do at Mirvie, we know we will be able to help personalize care even further. With Mirvie’s RNA platform, patients and their care team will be able to predict complications months before they occur, finally enabling pregnancy care that is proactive and personalized to fit each unique individual we serve.

References:

1. Peahl AF, Howell JD. The evolution of prenatal care delivery guidelines in the United States. Am J Obstet Gynecol. 2021 Apr;224(4):339-347. doi: 10.1016/j.ajog.2020.12.016. Epub 2020 Dec 13. PMID: 33316276.
2. Peahl AF, Turrentine M, Barfield W, Blackwell SC, Zahn CM. Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Prenatal Care Recommendations: A Practical Guide for Maternity Care Clinicians. J Womens Health (Larchmt). 2022 Jul;31(7):917-925. doi: 10.1089/jwh.2021.0589. Epub 2022 May 12. PMID: 35549536.
3. Redesigning Prenatal Care Initiative. Accessed August 3, 2022.
4. Cantor AG, Jungbauer RM, Totten AM, Tilden EL, Holmes R, Ahmed A, Wagner J, Hermesch AC, McDonagh MS. Telehealth Strategies for the Delivery of Maternal Health Care : A Rapid Review. Ann Intern Med. 2022 Jul 26. doi: 10.7326/M22-0737. Epub ahead of print. PMID: 35878405.