Louisiana has the highest rate of maternal morbidity and mortality in the United States. While approximately 43% of births occur under Medicaid nationwide, in Louisiana approximately 63% of births are covered by Medicaid. As a health plan that serves the Medicaid community, we have a responsibility to listen to these mothers and help them get the care they need.
In 2019, we teamed up with the Urban League of Louisiana to host listening sessions with moms across the state who were pregnant or recently birthed a baby. In partnership with the City of New Orleans Health Department, Office of Youth & Families, we then hosted a Maternal Child Health Symposium to share our findings with providers, community-based organizations and policymakers to discuss long-term plans to reduce negative maternal health outcomes.
Listening to the real needs of mothers
In all three of our listening sessions across the state, the top request from moms was easier access to home visits and advocates during and after pregnancy. Community health worker programs are just one way we can meet this need. To date, we are actively pursuing Medicaid reimbursement for home visits and doulas, having case managers attend prenatal visits with mothers, offering group prenatal appointments and improving transportation options for moms.
In all three of our listening sessions across the state, the top request from moms was easier access to home visits and advocates during and after pregnancy.
Combatting driving forces behind negative maternal health outcomes
Hemorrhaging and hypertension continue to be the leading causes of death in both pregnant and postpartum mothers in Louisiana, and Black mothers are more likely to die from these complications compared to White mothers. Negative care experiences stemming from bias and racism can impact the trust Black, Indigenous and people of color (BIPOC) birthing people have in our health system. These individuals may have concerns about whether their health needs will be taken seriously and if they will receive quality care at their prenatal and postpartum appointments.
To educate providers on the role of implicit bias and increase awareness regarding its role in maternal health outcomes, we offer trainings such as "Addressing Health Equity" and "Addressing Maternal Mortality." We developed our "Addressing Maternal Mortality" training in partnership with the Centers for Disease Control and Prevention (CDC), Morehouse School of Medicine and March of Dimes. Additionally, we offer training on adverse childhood experiences (ACEs) and the use of shared decision-making rubrics as tools that may increase providers’ awareness of a mother’s health history and ensure each birthing person's preferences are understood.
There are many other drivers impacting maternal health across the state. For example, many mothers do not have stable access to care. Without reliable internet, it is difficult for moms to attend telehealth appointments, which have been a large source of care during the pandemic. Even as we return to in-person care, many moms do not have easy access to a care facility. When they do have access, some have reported that they felt they didn’t have sufficient time with their provider, making it difficult to bring up questions and concerns.
A lack of information around chronic disease prevention and the importance of care during and after pregnancy has also made it difficult to get mothers the care they need. For example, while hypertension is one of the leading causes of mortality for mothers, many mothers do not know if they are at risk for this condition, nor do they see their provider regularly to manage this condition consistently during their pregnancy.
The stigma surrounding behavioral health — including depression, anxiety and substance use disorders — also contributes to negative health outcomes, as many moms are reluctant to share their concerns with their provider. While behavioral health resources are available in most communities, many of these offerings do not have options for pregnant moms. Without a way to compassionately educate moms on where they can go for help, they are more likely to live at higher risk.
Taking action to improve maternal care
Moms who receive care throughout their pregnancy have been shown to have babies with healthy birth weights and less risk of neonatal abstinence syndrome. To improve health outcomes for both mom and baby, we are committed to helping Louisiana moms:
- Schedule and attend their prenatal and postpartum visits
- Manage hypertension and medicine adherence
- Access breastfeeding resources
- Connect with local resources, such as housing and behavioral health services
- Receive in-home care both during and after pregnancy
Through programs like Guiding Recovery and Creating Empowerment (GRACE) in Baton Rouge, we are connecting pregnant moms who are struggling with opioid addiction to resources in the community that can help them through recovery. Our Healthy First Steps program connects high-risk moms across the state with a case manager advocate who will follow them through their pregnancy and postpartum. We are also fostering hands-on engagement across the state through our Wellhop app, which helps mothers access health and pregnancy resources and connect with other moms virtually. Through all of these programs, we are monitoring impact to ensure that what we are doing is truly meeting the needs of our members.
When we give our members a safe environment to speak freely, we are more likely to identify the challenges they are facing. With this information, we can work within our communities to help moms get the care they need in a way that works for them.