Maternal health is a customer journey

Congratulations! If you are reading this, you have a mother. Whether it was 20 years ago or 50, you emerged from the womb of a human woman whose job it was to carry, feed, cradle, shape, grow, and shepherd you until you were ready at last to be born. Your mother, if you were born within the last 100 years in the United States, went to her doctor once every four weeks or so, while she was shaping and growing you, to be weighed and measured and to hear the reassuring thump-thump of your heartbeat. That’s because the way we approach maternal health in this country hasn’t changed in over a century.

Think about that for just a moment. Think about all the advances that society has benefited from in the past 100 years — or even the last 20. And let it sink in that none of those have in any way helped reshape or reimagine the way a pregnant woman gets care in 2020.

Our model is simple: it’s based on monthly appointments, geared towards getting a series of measures of mom: weight, blood pressure; as well as a status on baby: fundal measurement, heart rate, position. It’s a highly clinical, diagnostic-focused, transactional approach that typically lasts about 9–10 minutes — all you really need, it would seem, to check a series of boxes. And why are those particular boxes being checked? Because our model was created in service of a single goal to which those items ladder up: reducing rates of low birth weight.

If you’re wondering whether or not low birth weight is something that the United States should still be worried about given our focused care model and the fact that we spend more per capita on healthcare than any other developed nation, the answer is a resounding yes. The United States has much worse rates of infant mortality, preterm birth and low birth weight babies than other industrialized countries. We also are the only developed nation with rising rates of maternal mortality and morbidity — both of which have been on the uptick for decades.

So how is it that we are failing women and babies so miserably?

I began this article talking about mothers — the humans at the center of this entire phenomenon called pregnancy and birth, the people who shepherd and deliver life, the women who come to pregnancy and motherhood each with different health, socio-economic, support systems and educational backgrounds, and who experience it with their own unique perspectives and feelings. To be sure we don’t need AI to tell us that many aspects of pregnancy are predictable and occur with frequency across a wide range of women. But we also can imagine that a one size fits all care model, one that assumes all women need, want, can get to and can understand an in-person appointment, one that offers nothing in the way of connective tissue between those visits, and one that puts the burden so fully on the woman herself to guide any non-clinical discussion, is probably not right anymore, if it ever was.

Through my work with pregnant women and their support partners as well as doctors, nurses and midwives, I have come to believe that the first and most important thing we need to do to improve maternal healthcare and outcomes in this country is shift our understanding of it from a clinical journey with a doctor at the center to a customer journey with a woman at the center. This would enable us to focus on her needs, pain points, goals, and motivations, and surround her with the resources she needs to navigate them. Our understanding of the journey would allow us to proactively answer questions, quell anxiety and provide education and preparedness, and technology would help us create just-in-time tools to fill in the gaps.

Let me give you a quick example. Last year I helped launch a text messaging support program pilot that was available to women for the first two weeks after they went home with their babies, on behalf of a maternity hospital. Engagement was unbelievably high, particularly in the first 24–48 hours post discharge but remaining pretty consistent throughout the duration. Moms asked questions about a range of subjects. Number one was breastfeeding. Typically women learn about breastfeeding either at a one and done class before they have an actual baby to practice with, around the 28th week of pregnancy; or from a one time visit to their hospital room from a lactation consultant when they are exhausted and hormonal about 12–24 hours after giving birth. Just like our pregnancy model, these presentations of critical information are holdovers from a time when in-person learning from clinicians was considered the holy grail. During our pilot we were able to provide support, answers, and comfort to women as they sat at home, baby at the breast, easily using voice to text to get exactly what they needed.

In this proof of concept, and in the future model I imagine for maternal health, mom is at the center. Rather than being purely clinical, our model could become purposely human. Healthier women and babies can be positively correlated with higher rates of high school graduation and increased income in communities. As a society, we have skin in the game to rethink our old paradigms, and create the future we all deserve. A customer journey can provide the framework. Our hearts and minds as the children of mothers, can help fill in all the rest.