Q&A on maternal health care with Rachel Caskey 

Dr. Rachel Caskey, professor of medicine and pediatrics at the University of Illinois Chicago, highlights the critical importance of maternal health care. In a conversation with Science Sparks, she discusses the current state of maternal health in both the city and the state and outlines key areas for improvement to better support families.

Why is maternal health care important? 

Mothers prioritize their babies, right? We prioritize our children, the well-being and health of our children, sometimes over our own care. Ten or 12 years ago, I was observing in the practice of medicine in my own practice, these newborn infants coming in for care, routine care, and they were generally doing fine, beautiful bundles of joy, growing, developing well. But what was so striking to me was how often mom was not doing as well. And I would sometimes ask: Does she have care? Does she have a doctor? How is she doing? But it really started to get under my skin. What’s going on here? Why is there such a disconnect?

So one of my colleagues, who is an OBGYN and had been a research colleague of mine for years, I asked her about this, and she had been observing a similar trend. So we pulled the data for care at University of Illinois Hospital and among mothers who got their prenatal care and delivered at our hospital, so we were their place of care for their obstetric care. We found that less than half were getting any postpartum care six months after delivery.

What are the most critical factors impacting maternal health?

Many of the people going into pregnancy are not healthy going in, maybe due to some underlying conditions, chronic health disease, mental health disease. And so many are at risk of adverse outcomes related to the pregnancy, whether that’s medical exacerbation of underlying diseases, mental health, substance use, all sorts of things.

We also see a lot of increased risk of violence and adverse outcomes related to violence across the state during the pregnancy or postpartum period. So despite the fact that, yes, the majority of new families generally are healthy and doing well, we have a larger-than-expected number of mothers who are at very high risk for adverse outcomes.

What is the current state of maternal health in Chicago?

So many of our new moms have faced persistent disparities their whole lives, and we know that infiltrates into all outcomes, as you’d expect, including maternal health outcomes. We also have really a striking increase in mental health needs over the last few years, probably related to the pandemic, perhaps, but we’ve seen a big spike in both mental and behavioral health care needs, including support for substance use disorders. So I think we have many things that have been going on for generations, and then we have some new layering on top of that with, unfortunately, decline in mental health.

We need policy-level changes. We need policies to support new moms and families, whether it’s financial, access to care, access to comprehensive care. One of the things that is available in Illinois, not available in all states but has been available in Illinois for just the last few years, is expansion of Medicaid out to a year postpartum. And that’s just one example of something small but important, right? Historically, it was just for six weeks after delivery. And again, we’re talking about people that could be at risk for months after delivery for adverse health outcomes. So those are the types of things we need more of across the city and state.

And then, of course, at the more individual level, we need to just make sure we’re providing care in a way that’s accessible, that meets the needs of new families and tries to minimize the inconvenience. Our health care systems are not efficient to navigate. We all know that. As a patient, as a clinician, we all know that. And so, anything we can do to make that sort of life stage a little easier on families, I think, goes a long way.