Those who gave testimony, representing decades of experience working with the pregnant and postpartum residents of DC at every level of care, identified multiple areas of focus to improve maternal health.
Though the hearings were specifically directed to challenges in the District of Columbia, the insights of the speakers could be considered a blueprint for better maternal healthcare across the U.S.
Better reporting and data collection were highlighted as critical for identifying trends and disparities, as well as getting financial support and moving the needle on initiatives like Medicaid expansion. And it isn't just better reporting writ large that is needed. It's better reporting of social health determinants, insurance coverage, substance use, and behavioral health issues, to name a few -- areas that are traditionally overlooked in the short space of a doctor's appointment, where clinical risks are typically the focus.
Towards the goal of improved reporting, participants called to expand the criteria to classify maternal deaths. One also voiced a request to add a perinatal mental health provider to the DC Maternal Mortality Review Committee, citing the rise in maternal suicides and death rates related to mental health issues.
Eighty percent of maternal health outcomes in the District of Columbia are caused by non-clinical risks, yet care is still primarily informed by clinical risk identifiers. A recurring theme at the roundtable was the need for solutions that address social health determinants such as housing, food insecurity, and transportation; but emphasis was made on the importance of doing so as a part of the clinical care plan, in dialogue with a clinical care provider.
The subject of community-based support systems came up several times, with many calling for funding for doulas and other non-traditional solutions. One speaker highlighted the need for comprehensive support for parents outside of the delivery room, emphasizing proactive and accessible solutions, including virtual platforms, to prepare parents for postpartum challenges specifically.
Access to quality prenatal and postpartum care, especially for Medicaid patients, was discussed as a challenge, with particular attention to racial disparities. As an urban maternity desert, DC presents unique challenges to access - for example, transportation is available, but a patient may need to take several modes of transport to get to a hospital, transferring from busses to Metro and back again. The time it takes to travel to an appointment can be prohibitive, especially for working patients in an hourly job or those with children at home. And these are the events that a patient can plan for -- medical emergencies present even greater complications.
The need for perinatal mental health care was raised several times, with many citing the rising rates of mental health complications in pregnancy and postpartum, which account for 1 in 5 maternal deaths. Mental health conditions are common but often go untreated, particularly among minority women, due to stigma and the lack of culturally competent solutions. One speaker advocated for intensive perinatal psychiatric programs where mothers and babies receive treatment together, noting the lack of such services in DC.
Some testimonies shared success stories and models of care that have positively impacted maternal health outcomes; including use of virtual programs to circumvent barriers of access, enable connection between providers, and support patients with comprehensive care solutions.
To build on these successes, participants emphasized the importance of policy changes to encourage tools that address our expanded understanding of maternal health risks. Proposals included expanding Medicaid, improving insurance coverage for mental health services, and investing in perinatal mental health education.