Some new moms never get to see their baby’s first birthday. The 2018 Texas Maternal Mortality Review found the gap between where Medicaid coverage ends at 60 days after delivery and the first year postpartum is when more than half of all maternal deaths in Texas occur. Parkland Health & Hospital System recognized the need for a program that will bridge this gap.
Using the results from the recent Community Health Needs Assessment, the health system launched the Extending Maternal Care After Pregnancy (eMCAP) program on October 1, 2020.
“The eMCAP program addresses and reframes the focus of maternal and fetal care not only at delivery but in a year postpartum,” said David B. Nelson, MD, chief of obstetrics and chief maternal medical director at Parkland and assistant professor of maternal-fetal medicine at UT Southwestern Medical Center. “The program targets a geographic area of Dallas County that has significant needs and, in some cases, has become a healthcare desert.”
“This new program offers a holistic approach to postpartum care by addressing physical, mental and environmental risks. It focuses on southern Dallas ZIP Codes with a higher number of women of color,” said Marjorie Quint-Bouzid, MPA, RN, NEA-BC, Parkland’s senior vice president of Women’s and Infant’s Specialty Health.
In the past, Parkland concentrated its efforts on helping moms receive prenatal care, with significant results. In 2018, 97% of women who delivered at Parkland accessed care prior to having their baby. With the increase in postpartum deaths, this focus has shifted to address healthcare, social and economic challenges facing women after they give birth.
Since launch of the eMCAP program, Parkland has enrolled more than 800 women to receive free services that include in-home visits by a nurse practitioner who monitors the new mother’s blood pressure, nutrition and conditions including diabetes, anxiety and depression. All care is supervised by a medical doctor specializing in care after birth. Community Health Workers help new mothers with other services they may need, such as finding health insurance, obtaining financial assistance, transportation to medical appointments and referral to other community health resources. A clinical pharmacist, behavioral health counselors and other specialists are available as needed.
Two of the most common reasons for maternal death in the first year are cardiac conditions and drug overdose. The highest risk of pregnancy-related mortality in Texas was found among Black women. Therefore, the eMCAP program is designed to offer health services to at-risk women of color in the first year after giving birth.
“Our approach involves both care coordination beginning at the hospital and discharge following delivery,” Dr. Nelson said. “Rather than asking patients to come to us, we come to them. A team of care coordinators, nurse navigators and community health workers provide a bridge of access to care for the full year following delivery.”
“This program benefits women in the transition to ongoing healthcare, even without underlying medical conditions,” Dr. Nelson added. “For those with chronic health conditions, such as high blood pressure and diabetes, follow up and ongoing coordination of care has an important impact for the future of their health, as well as that of their child and their community.”
Lack of healthcare options after pregnancy and rising maternal mortality rates are issues that reach far beyond Dallas County and Texas. Nationally, maternal mortality rates more than doubled from 1991 to 2014.
“As Parkland innovates to save the lives of mothers in our community, other health systems in the nation will be watching closely, with an eye to replicate this new model of postpartum care to save lives in their communities,” Quint-Bouzid said.
The Hamon Charitable Foundation has supported the eMCAP program with a generous $1 million donation. If you are interested in donating to the eMCAP program or other programs at Parkland, please visit www.IStandforParkland.org. For information about Parkland’s services, please visit www.parklandhospital.com