How Ochsner Health is working to improve maternal health

Maternal health in America is a national tragedy, but Louisiana is struggling more than most states.

Dr. Veronica Gillispie-Bell, MD, of Ochsner Health has been leading efforts to improve maternal health in Louisiana. She talked about Ochsner's efforts and how other health systems can improve maternal care.

Louisiana trails the nation as a whole in terms of maternal mortality, with 37 deaths per 100,000 births from 2018-2022, compared to the national average of 23, according to data from the Centers for Disease Control and Prevention. Nearly one in five (18.6%) of Louisiana’s birthing people didn’t get enough prenatal care, according to a March of Dimes analysis.

Dr. Veronica Gillispie-Bell, MD, of Ochsner Health has been leading efforts to improve maternal health in Louisiana. She’s head of Women's Services at Ochsner Medical Center-Kenner also serves as the medical director of the Louisiana Perinatal Quality Collaborative.

Ochsner Health is making some strides in reducing pregnancy-related complications, but as Gillispie-Bell says, efforts to address maternal health also involve tackling other social factors affecting health.

“In Louisiana, we are really struggling when it comes to things like economic stability, when it comes to health and healthcare access, when it comes to even the environment … compared to other states,” Gillispie-Bell says.

Louisiana has made strides in reducing its maternal mortality rate, she says, but concedes much work needs to be done.

In an interview with Chief Healthcare Executive®, she talks about some of the ways Ochsner Health has reached out to track patients during pregnancy, a pilot program to visit patients after delivery, and steps health systems can take to improve outcomes.

• Read more: Maternity care deserts are becoming more common

Connected MOMs

Ochsner Health has been seeing success with its “Connected MOM” program (“MOM” stands for Maternal Online Monitoring). In the program, patients receive Bluetooth-enabled blood pressure cuffs at the beginning of pregnancy.

Patient blood pressure readings are uploaded into electronic health records. If patients have an abnormally high blood pressure reading, they’ll get an alert to come to the hospital. If patients aren’t regularly checking their blood pressure, they’ll get “annoying text messages until they do,” Gillispie-Bell says.

Getting regular blood pressure readings is invaluable in helping identify patients at risk of complications. “We know that's an important part when we look at what's causing maternal morbidity and mortality,” she says.

“It's been so good for our patients, and being able to diagnose preeclampsia early and being able to give our patients a little bit more autonomy and to be able to follow their vital signs,” Gillispie-Bell says.

Patients stay in the program through the postpartum period, she says. Ochsner clinicians are able to stay in touch with patients through the program, even in the event of storms and hurricanes, which is a fact of life in New Orleans.

The program received funding from the U.S. Department of Health & Human Services as part of the agency’s Hypertension Innovator Award Competition. Gillispie-Bell says the recognition is gratifying, but the impact on patients is more rewarding.

“It’s just really promising for what it can do for maternal health, and things that we've already seen it do for maternal health, and I think it’s also a model for what other health systems can do as well,” she says.

• Read more: Federal plans to reduce maternal mortality draw praise, and some criticism

A dangerous time

For many patients suffering maternal complications, the most dangerous time comes just after patients have given birth, and not long after they’ve left the hospital.

“If we look nationally, the majority of deaths are happening after discharge from hospital up to one year postpartum, with the majority of those happening during the first six weeks,” Gillispie-Bell says.

That’s a particularly problematic time, and it’s why Gillispie-Bell says the monitoring program has such value. Many patients don’t visit the doctor again until six weeks after they’ve given birth, she says..

“Clearly, there's a lot of things happening between delivery and six weeks postpartum, and so this is another way that our moms can stay connected to care without having to physically come into the office,” Gillispie-Bell says.

She says the program is also designed to address the social factors affecting the health of patients. In addition to the blood pressure monitoring, patients receive virtual visits to help see how they’re doing.

Instead of having to arrange for transportation, or possibly child care to watch other small children, patients can stay in the comfort of their home, Gillispie-Bell says.

Much of the biggest obstacles to ensuring maternal health are related to the social determinants of health, she says.

For many patients, it’s a lack of transportation, or a lack of convenient access to grocery stores.

“I can write out the best plan for a patient for how she needs to care for X, Y and Z, but if when she leaves my office, she doesn't have access to the resources that she needs to do those things, then it doesn't really matter,” Gillispie-Bell says.

Plus, some patients put their own needs behind their family.

“When you're having to make choices between taking care of your health and other things, then, you know, as women, we choose to take care of our family and some of those other things,” she says.

• Read more: More than 4 in 5 maternal deaths can be avoided

‘Bring care to the patients’

In order to improve material health, Gillispie-Bell says it’s not enough for health systems to focus on improving offerings at their facilities.

“We really have to find ways to bring care to the patients, instead of making the patients come to care,” Gillispie-Bell says.

To that end, Ochsner Health has recently launched a pilot program sending a nurse home to visit patients after giving birth.

Ochsner just launched the program a few months ago, but she has high hopes for the program.

“The United States is one of the only high-income countries that does not have guaranteed home visiting in the postpartum period,” Gillispie-Bell says. “And for the reasons we've already said, it's important to keep our patients connected to care, understanding that every patient is not going to be able to walk into the office.”

Beyond making it more convenient for the patients, visiting nurses can see if there are other needs, such as patients struggling with food insecurity.

"For a lot of patients, it's more important to be in their environment so you understand the social factors that may be impacting their health outcomes,” Gillispie-Bell says.

Improving maternal care

Health systems looking to improve maternal health need to focus on four primary areas, she says: reliable clinical processes; respectful patient care; effective peer teamwork, and engaged leadership.

It’s also tempting to try and push for sweeping changes quickly, but with a problem as difficult as improving maternal health, hospitals should consider focusing on addressing a few critical problems with tangible solutions.

“Sometimes we want to boil the ocean,” Gillispie-Bell says. “And we have to think about, really, the one bite at a time, understanding that change is hard, and changing workflow is hard. And so you have to do it in incremental changes, and you have to do small changes so that you can get to the big change.”

Some hospitals, including those in rural areas, have closed obstetric units in the past few years, often to reduce costs.

But all hospitals, even those without labor and delivery units, can work on improving care for pregnant patients, Gillispie-Bell says.

“I would say every emergency room can implement obstetric readiness for the leading causes of maternal morbidity and mortality,” she says. “There's readiness around hemorrhage, readiness around hypertension, having those things in place so that you are able to recognize and respond quickly, even if that means transferring patients. But every hospital should be able to do those things.”