BENTONVILLE – Tackling Arkansas’ maternal mortality rate, the highest in the nation, requires collaboration and caring for mothers where they are, whether physically or virtually, participants at the Arkansas Maternal Health Roundtable said Thursday.
U.S. Senator John Boozman (R-Rogers) and other panelists spoke about maternal health issues during the event at the Crystal Bridges Museum of American Art in Bentonville.
The panelists agreed that improving accessibility to health care for mothers is an important step.
Boozman said the state is working to raise funds for mobile maternal health units in rural areas of the state so that women in those areas have access to obstetric care nearby.
The senator also talked about going to places like churches and schools and educating women about government-funded programs like the Special Supplemental Nutrition Program for Women, Infants and Children.
Zenobia Harris, executive director of the Arkansas Birthing Project, said she trains community volunteers and emphasized the importance of having support systems in place in local communities.
Lisa Woods, Walmart’s vice president of physical and emotional well-being, talked about how the company integrated primary care via telemedicine for all employees a year ago and how primary care provides access to obstetric care.
She said that by adopting virtual primary care, Walmart began offering virtual doula care to its employees by partnering with an organization that offers that care. Walmart has seen great results by adopting the virtual doula option, but there are still not enough doulas at the local, state and national levels, Woods said.
Olivia Walton, founder and managing director of Ingeborg Investments, described the various roles in professional maternity healthcare – doulas, midwives, general practitioners, obstetricians and specialists – as a ladder and said there were gaps in the workforce between the rungs of that ladder.
There is frustration that the workforce problems in obstetrics are not being “solved,” says Cara Osborne, senior fellow at Heartland Forward. She says the majority of professionals work in hospitals, which have become the default workplace for health professionals, which she says is unsustainable.
Osborne said she is working with some of the more community-based care providers, such as community health workers, doulas and support groups, to create “birth villages” for people. She added that a midwifery program is being developed at the University of Arkansas for Medical Sciences.
Arkansas Health Secretary Renee Mallory said the state is looking into licensing options for midwives and community health workers. She said while regulations are not popular, they provide assurance that someone has proper training and “really knows what they’re doing.” She said insurance companies are more likely to reimburse services if they are state-regulated and licensed.
SHARED CARE
Sharmila Makhija, dean and CEO of the Alice L. Walton School of Medicine, said the school is incorporating teamwork into its curriculum because it’s difficult to create a collaborative mindset in health care if it’s not prioritized. She said it’s important for doctors and specialists to work together when complications arise and for doulas and community health workers to support mothers before, during and after birth. Collaboration can lead to better outcomes, she said.
Communication can be taken for granted, Makhija added.
“However, when we look at the problems associated with medical malpractice cases, the root cause is a lack of communication, a lack of understanding and a lack of cooperation,” she said.
Pearl McElfish, director of the UAMS Institute for Community Health Innovation, said the health profession needs collaboration from people at all levels of care. She said doctors should work with doulas and doulas should work with health facilities and hospitals. She said there is a strong willingness to collaborate in the state, but the procedural aspect of how that will look still needs to be worked out so that all health care providers can work together while keeping women at the center of their efforts.
Osborne mentioned that maternal mental health could be improved if the mother had good mental health “well before” pregnancy. She said a discussion about the mother’s mental health should be held at every appointment with the obstetrician.
Doctors have the opportunity to create generational change during pregnancy by caring for all aspects of women’s health, Osborne said. She added that doctors also need to look after themselves and their mental health because “doctors need to be healthy enough to provide good care.”
Boozman said all health professionals and politicians need to think creatively and consider what the field will look like in five to 10 years as technology advances. He cited as an example how he tried to push through a telehealth policy before the Covid-19 pandemic and how other politicians were skeptical of the concept. Then, he said, emergency powers were used to push it through during the pandemic.
“And lo and behold, vendors realized this is a great tool in their toolbox,” he said.
