Every week, women come to our hospital to give birth who have not had recommended prenatal care during their pregnancy.
Despite decades of evidence on the value and effectiveness of prenatal care, women still lack access to routine pregnancy services in South L.A.
Based on research and best practices, pregnant women should see a doctor monthly, then every week or two in the final trimester, to track baby’s development and heart rate. With these visits, doctors also keep an eye on the mother’s health. Doctors identify and treat problems that can cause dangerous complications in pregnancy, like diabetes, anemia and high blood pressure.
Although Medi-Cal, California’s Medicaid program, technically has generous coverage for prenatal care, in practice women struggle to access it because there are not enough obstetricians to serve the women of South L.A. This brings us back to a fundamental problem: low provider payments in communities like ours that prevent doctors from working here.
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The shortage of obstetricians is a symptom of the same low provider reimbursement that impacts the rest of our Medi-Cal system. Providers cannot afford to practice in places like South L.A. with a majority of Medi-Cal patients. As a result, we are missing 1,300 doctors in our community.
California is making significant changes to Medi-Cal this year, implementing CalAIM — adding eligibility for undocumented Californians and new services to address social determinants of health. I applaud these changes. However, this effort does not address the provider shortage in our community.
Among the services added by CalAIM is coverage for doulas, who provide guidance and support to a pregnant woman during labor. Doulas can be a great part of a maternity team for expectant mothers. However, women should also have access to prenatal care provided by obstetricians.
Inability to access care can have serious consequences. Without prenatal care, babies are three times more likely to be born with low birth weight (less than five pounds, eight ounces) Complications of low birth weight, which are often brought on by preterm birth, can include breathing and feeding difficulties, hearing and vision problems, and even developmental delays.
The same racial disparities that mark our separate and unequal system of care are present when you look at maternal mortality. Black women are three-to-four times more likely to die giving birth than White women.
The roots of racial disparities plaguing maternal health are broad and deep, including subpar healthcare quality for many Black mothers on Medicaid, underlying chronic conditions often untreated due to lack of access, as well implicit bias among doctors.
As a result, America’s infant and maternal mortality rates are the highest among first-world countries. It is unacceptable that the U.S. healthcare system fails so many mothers and babies each year. Despite these poor outcomes, the U.S. spends more overall than any other country on hospital-based maternity care.
We have a long way to go, but I am heartened by new efforts at the federal level.
The Centers for Disease Control and Prevention is zeroing in on preventing maternal mortality with a range of initiatives. They’re supporting activities like the Hear Her campaign and the National Pregnancy Mortality Surveillance System to better understand the risk factors for and causes of pregnancy-related deaths nationwide.
Chiquita Brooks-LaSure, a Black woman now at the helm at the Centers for Medicare and Medicaid Services (CMS), has made maternal health a national priority. CMS is implementing an initiative around “Birthing-Friendly” hospitals that adopt labor and delivery best practices along with meeting several quality benchmarks. This emulates the California Maternal Quality Care Collaborative that has made a huge difference in improving birth outcomes statewide. Seeing the California best practices model adopted at the federal level is encouraging.
MLK Community Hospital is one of those hospitals recognized by the California Maternal Quality Care Collaborative. Our award-winning model even takes this a step further to provide midwife and physician partnership throughout the delivery process.
For these reasons, I’m glad so many women are choosing to have their babies at our hospital. But the road to healthy babies and mothers starts before a woman enters the hospital for delivery and even before an initial prenatal visit. Women, especially Black women, need doctors and medical staff in their communities who they can trust. Communities need enough providers for every woman to have a safe and healthy pregnancy.
MLKCH is working to launch a prenatal program that will expand community-based prenatal care by recruiting midwives and obstetricians to practice in South Los Angeles.
Meanwhile, if you or someone you love is pregnant, make sure they see a doctor early in their pregnancy and follow up with a doctor after their baby is born.
While we fight for policy change and more doctors in our community, let’s work together to increase the number of women who receive high-quality, pregnancy related care, one healthy baby and mom at a time.
Dr. Elaine Batchlor is the chief executive officer of MLK Community Healthcare in the Watts-Willowbrook area of Los Angeles.