In this week’s blog, we get real about maternal health. Jennifer Dressler, WebMD Health Services’ Clinical Director and member of our Clinical Advisory Board, shares her thoughts on the state of maternal health in the U.S., how WebMD solutions provide support for pregnant women, and what employers can do to care for women during and beyond pregnancy.
WebMD Health Services (WHS): Let’s dive right in! Recently, you shared data with our team that the U.S. maternal death rate was 21 deaths per 100,000 live births in 2020. This is almost double the Organization for Economic Co-operation and Development (OECD ) nations’ average of 10.9, and more than double that of several European nations.1 It’s pretty shocking data. What are your thoughts?
Jennifer Dressler (JD): I guess I wasn’t exactly shocked. In an ideal maternal health system, all women would have access to comprehensive, seamless medical care with links to behavioral, economic, and social supports. But that just isn’t the reality in the U.S. today. Nearly half of rural counties do not have a hospital with obstetric services.2 Chronic health conditions like hypertension and diabetes increase a woman’s chance of developing pregnancy complications like preeclampsia; prolonged stress can cause miscarriages.
Pregnancy complications also disproportionately affect Black and American Indian/Alaska Native women.3 This is in part due to the conditions in which people are born, grow, live, work and age—called “social determinants of health”—which can profoundly affect maternal health. In fact, the maternal mortality rate for Black women is almost 70 deaths per 100,000 live births—more than three times the national average.4
There’s an urban/rural divide, too. One study found that rural residents had a nine percent greater probability of severe maternal morbidity and mortality, compared with urban residents.5
WHS: Can you elaborate a bit more on the crisis of maternal health care in rural areas?
JD: Yes, it’s a big problem. Many communities in the United States have few or no clinicians providing maternity care services, contributing to a national maternal and infant mortality rate that is much higher than that of comparable developed countries. The March of Dimes calls these communities “maternity care deserts (MCDs),” which is defined a county that has no hospitals providing obstetric care, and no practicing obstetrician-gynecologists (OB-GYNs) or certified nurse midwives (CNMs). Currently the March of Dimes estimates there are over 1,000 MCDs in the U.S.6 This isn’t to say that there aren’t family physicians who provide maternity care, but the lack of specialists and the need to drive long distances to the nearest hospital or provider puts women at risk.
WHS: These are pretty significant problems, many of which are beyond our ability as a corporate well-being provider to impact. But helping participants navigate complex health conditions is something we do all the time. What types of lifestyle support does WebMD Health Services offer to pregnant participants?
JD: I first want to say that our programs are largely set up to support healthy, uncomplicated pregnancies and there will obviously be times when we need to refer participants back to their OB-GYNs or primary care physicians. That said, our 56-day Maternal Health Daily Habits Plan, a digital self-management tool, does help women navigate all three trimesters of pregnancy with specific action items and follow-through catered to each stage of pregnancy.
In the first trimester, we emphasize getting early and regular prenatal care. In trimester two, it’s all about managing lifestyle changes to promote a healthy pregnancy for baby and mom. And during the final trimester, the program is dedicated to what a new mom needs to know to welcome her baby.
We also support partners with our 28-day Pregnant Partner Support Plan. We know that for a partner to be supportive, they need to understand what’s happening to the pregnant woman as well as take care of their own well-being so they’re ready when the new baby arrives.
WHS: What about coaching—do we offer specific maternal health coaching to participants?
JD: Yes, we offer lifestyle health coaching to pregnant participants. When they take our Health Assessment and indicate interest or reach out to our coaching staff, we can match them with a coach who is certified for all stages of pregnancy and can offer support during this time period.
WHS: According to the CDC, about 1 in 8 women will experience symptoms of post-partum depression.7 What type of support do we provide to women to support their well-being after the birth of the baby?
JD: We are equipped to help women with post-partum blues as well. We have coaches who are trained in mental health and can screen for post-partum depression, offer support and skill-building, and refer participants for additional support.
WHS: These days most women continue to work until just before their due date. Which means that there undoubtedly things an employer can do to support the pregnant mother. How can workplaces better accommodate the unique health needs of pregnant women?
JD: Fortunately, this is one area where there are many laws in place to protect pregnant women. Some newer regulations people may not be familiar with include the Pregnant Workers Fairness Act that went into effect last year. This law entitles pregnant women to “reasonable accommodations” like the ability to telework and take time off for health care appointments. There’s also the PUMP Act, which guarantees breastfeeding parents time and a private, non-bathroom place to pump. The Pregnancy Discrimination Act has been around since 1978 and prohibits pregnancy discrimination of all forms in the workplace. The 1993 Family and Medical Leave Act (FMLA) protects women’s jobs for 12 weeks after giving birth.
There is one area where we still have a long way to go, though, and that’s paid parental leave. We’re the only developed nation that doesn’t have a federal paid parental leave policy, though some states do offer it and more are set to pass this kind of legislation. There’s no disputing that being able to take time off after giving birth without accompanying financial stress would be a huge benefit to the physical and mental health of women—and benefit the new baby, too.
WHS: Aside from laws in place that employers must adhere to, what other actions can employers take to create an environment that is supportive of pregnant women?
JD: Offering flexible work options is a big one. Accommodating time off for medical appointments is another. Time off should also extend to the partner so they can attend doctor appointments, too. Managers can model healthy work-life behaviors by using company resources themselves and fostering psychological safety on their teams so pregnant workers feel comfortable. Stress has been linked to an increase in the risk of miscarriage, preterm labor, preterm birth, low birth weight and preeclampsia, so it’s important for managers to make sure pregnant women aren’t overloaded with work.8 And if the employer requires a uniform, by all means have some options so pregnant women can be comfortable throughout these nine months.
WHS: What about when women return to work? Any advice for employers?
JD: There was a great article recently in Harvard Business Review that addresses this issue. It notes that about a quarter of women return to work within two months of giving birth9 and about 10% return in 10 weeks or less.10 Women are still healing physically at that point in time and emotionally adjusting to being a new parent. Thankfully, we are starting to see acknowledgement that mothers shouldn’t bear all the responsibility for these challenges and that managers and coworkers can play a critical role in supporting new mothers. It all comes down to being an “ally” for pregnant women, validating them as both a worker and a mother, and ensuring they know about and can use any supports the employer puts in place, whether that’s pumping rooms or shipping breast milk or simply ensuring managers are empathetic and supportive.
WHS: Jennifer, thank you so much for sharing your thoughts on the important issue of maternal health and how we can better support pregnant and post-partum women in the workplace.
JD: Thank you!
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To learn more about how WebMD Health Services can help your organization provide the support and resources to help pregnant women thrive both during pregnancy and after childbirth, contact us at connect@webmd.net.
