Mass General Brigham pilot program delivers care to new mothers right at home

By Hannah Reale

On May 21, 2024

A group of Mass General Brigham postpartum specialists is now traveling through Greater Boston on wheels, trying to reduce poor health outcomes for new mothers one visit at a time.

“After they deliver, the focus becomes so much on the baby’s health,” said Dr. Priya Sarin Gupta, who is the medical director of mobile health services at Mass General Brigham’s Kraft Center for Community Health. “And we really want to make sure that we’re able to support the individuals that delivered those babies in those same ways.”

The hospital system launched the effort Monday, with plans to work with a pilot group of 100 parents in its first year of operation. The new van brings additional support for parents who are at a high risk of complications after they give birth, whether that’s due to high blood pressure, trauma during birth, risk of postpartum depression or a number of other concerns. Providers aim to offer care immediately: Patients who meet the criteria for medications to manage their high blood pressure, for instance, could get a prescription in the van.

MGB’s new initiative fits into a larger shift in health care that experts say was kickstarted during the pandemic, when providers were forced to change their methods to effectively deliver care.

With a worsening maternal health crisis, some providers are looking at the postpartum period, what many call the “fourth trimester,” to offer more support and get ahead of lifelong problems that can be tied to pregnancy.

“What we learned from the pandemic is that not everyone needs to come into the big brick-and-mortar building to get their health care, and that there may be reduction in barriers if we’re able to bring that high-quality care close to where people live,” said Allison Bryant, MGB’s associate chief health equity officer. “Anyone who’s had a new baby knows, dragging your baby into the Brigham and Women’s Hospital or the Mass General Hospital can be a challenge. And so this feels like a perfect opportunity to really enhance people’s care.”

Lois McCloskey at Boston University, for one, is thrilled by the rise of postpartum mobile units. McCloskey is a director of BU’s Center of Excellence in Maternal & Child Health who helped launch a collective focused on eliminating silos in women’s health care, with a particular focus on maternity care.

“A third of maternal deaths that happen — at all — occur in that postpartum period, between one week and one year after the birth,” McCloskey said. “And those are preventable. Most, not all, most are preventable.”

She dreams of a day when health care is less fragmented and new parents’ providers — OB/GYNs, midwives and primary care doctors — are all better connected.

“Given the state of the health care system and also the particular disproportionate risk among those who are from BIPOC communities, a better solution is just going to where they live,” she said. “And not requiring new mothers to come into what’s already a system they may distrust.”

Boston Medical Center started offering its own postpartum mobile unit services with a 2021 pilot. The center officially launched the unit in early 2023, and has served about 450 patients in the past year.

The BMC and MGB programs differ in a few important ways: for one, BMC’s program offers “dyadic” care, where the mobile unit professionals care for both the parent and the baby in a single visit.

“We started thinking: ‘What if every time we saw the baby, we saw the mother? That way every mother would get a postpartum visit,’” said Melissa Nass, the founder of BMC’s Curbside Care Mobile Program. “And then we decided: what if we provided really low-barrier care? What if we went to them?”

Nass says a major goal was to increase the number of patients who get follow-up appointments after they give birth.

Nationally, about 40% of postpartum patients on public health insurance don’t have a single follow-up appointment after they give birth, even when they’re bringing their child in for check-ups. But with the mobile unit program, Nass said, every BMC patient who’s enrolled gets a postpartum visit.

The two hospital systems also diverge in how they want to interact with patients. BMC’s mobile care replaces in-person visits, while MGB’s pilot program will supplement them.

McCloskey fits the rise of mobile care units into a broader effort to integrate community health workers, like doulas, into maternal health care. That’s another aspect of MGB’s anti-racist project to reduce maternal morbidity, with a small number of doulas partnering with the pregnant patients MGB sees.

The van is the latest piece to go live in MGB’s three-year pilot to promote maternal health equity, supported by $1.66 million from the CVS Foundation. The broader project also includes pairing more MGB patients up with doulas, trained professionals who help expectant parents with informational, emotional, physical and advocacy support.

In the last decade, not only has the gap widened between health outcomes for Black and white mothers, but it’s gotten worse across the board.

Black people are 2.5 times more likely to have severe complications around childbirth than white people in Massachusetts. But even white people were nearly 70% more likely than they were a decade ago to have a significant health event that could have short- or long-term consequences to their health — conditions that include heart attacks, eclampsia, or the need for a hysterectomy.

“While I think that we are trying to aim to fix something on a global or a national scale, we really have to do it one patient at a time,” Bryant said. “And I think that this approach will allow us to get closer to individuals’ homes, to understand what their needs are, to meet them where they are.”

“A lot of work needs to be done in this space,” Nass said. “There’s space for everybody to contribute.”

This piece was republished from GBH.