October 2020
Taelor Brown was ecstatic when she found out she was pregnant and delivered a healthy baby girl at Parkland. But a few months after giving birth she had back pain so severe that she would freeze in place. She was helpless and wanted to go to the doctor but couldn’t. Her Medicaid coverage ran out 60 days after having her baby.
This meant she had to pay out of pocket for any doctor visits – money she didn’t have. A new program at Parkland is filling the gap left by Medicaid, extending care after delivery to a full year to ensure women receive the healthcare they need after childbirth to address complications before they become fatal.
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 and the first year postpartum is when more than half of all maternal deaths in Texas occur. Parkland 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 Oct. 1.
“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, the chief of obstetrics and chief maternal medical director at Parkland. “The program focuses on a geographic area of Dallas County that has significant needs and, in some cases, has become a healthcare desert.”
In the past, Parkland has focused 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.
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 will focus on offering health services to at-risk women of color in the first year after giving birth.
The new program offers a holistic approach to postpartum care by addressing physical, mental and environmental risks. It will focus on southern Dallas ZIP codes with a higher number of women of color.
“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 will come to them. A team of care coordinators, nurse navigators and community health workers will provide a bridge of access to care for the full year following delivery.”
“This program will benefit 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 both their health 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.
As for Taelor, she had pains for a long time after her delivery. Thankfully she didn’t have any serious complications, but as a first-time mom she wishes she could have made an appointment to get checked out.
She added, “I would have felt more comfortable telling people I’m going to the doctor even if they told me it was normal after pregnancy. Not being afraid whether Medicaid was going to cover it.”
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