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New maternal mortality strategy relies on 'medical homes'

Michael Ollove, on

Published in News & Features

ASHEVILLE, N.C. -- When Hannah White first showed up at the Mountain Area Health Education Center here three years ago, she was in trouble.

She was 20 years old, a couple months into her first pregnancy and on the run from an abusive husband in Texas who already had broken her ribs in an attempt, she said, to kill her unborn child. She also has a form of hemophilia that prevents her body from producing platelet granules that stem bleeding. That disease had robbed her of her Malawian mother when Hannah was 3 months old, which ultimately led to her adoption by American missionaries.

"I was a mess," White recalled when she first showed up at MAHEC, which serves a 16-county area of western North Carolina. "I was worried about the abuse and was having this bleeding and afraid I was going to die or lose my baby.

MAHEC's ob-gyn program is part of a statewide initiative in North Carolina that identifies low-income women whose pregnancies present a high risk to either the baby or mother. All the women receive care through "medical homes," in which teams of providers work together to provide coordinated care.

The medical homes provide the most advanced obstetrical care, but they also seek to alleviate nonmedical circumstances that could put mother and child in jeopardy, such as addiction, domestic abuse and a lack of secure housing and healthy food. North Carolina's program is the only statewide pregnancy medical home model in the country.

Among developed nations, the United States ranks last in maternal mortality and infant mortality, largely because of its high rate of untreated chronic disease and a decline in access to obstetrical care, particularly in rural areas.

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But many think North Carolina's approach could be the key to reversing that trend. The rates of low-birth weight babies (also a proxy for preterm births) and cesarean deliveries are all lower among women participating in the program versus those who didn't. North Carolina has reduced the rate of unplanned pregnancies, by educating new mothers about birth control and spacing babies. The state also has seen a decrease in racial disparity in maternal mortality (although part of that is the result of an uptick in white maternal mortality). Other states, such as Oregon, Wisconsin and Texas, have pregnancy medical homes, but North Carolina is the only one with a statewide program.

The Institute for Healthcare Improvement, an independent nonprofit health policy research organization in Massachusetts, calls North Carolina a leader in this area. Jeffrey Rakover, a senior researcher on maternal and infant health said the "well-defined and rigorous" program will likely become a model for other states.

North Carolina officials already have fielded inquiries from California, Michigan, Minnesota, South Carolina and Tennessee, according to Belinda Pettiford, head of the Women's Health Branch of the state's Department of Health and Human Services.

Rebekah Gee, the Louisiana secretary of health and an ob-gyn, said, "I think it's one of the most exciting models in the country with very promising results on preventing premature births. It's a model I always suggest people look to when they design their programs." She said Louisiana is particularly interested in modeling North Carolina's coordinated care approach for pregnant women.


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