Redefining prenatal care: An interview with Dr. Alex Peahl, Maven’s Visiting Scientist

Maven’s Visiting Scientist program invites academic and clinical experts to accelerate Maven's clinical research roadmap and drive key innovations within our unique care model for women's and family health.

We’re fortunate to have Dr. Alex Peahl, MD, MSc, joining us as Maven’s first visiting scientist. Dr. Peahl is an Assistant Professor and physician-investigator in the Department of Obstetrics and Gynecology at the University of Michigan, and a nationally recognized expert on prenatal care redesign and innovation. Dr. Peahl has led some of the most influential research on redesigning prenatal care, including a recent study of the impact of COVID-19 on the evolution of prenatal care delivery guidelines in the United States.

We sat down with Dr. Peahl to learn more about her work, her thoughts about how to transform prenatal care, and why she’s excited about working with Maven.

Tell us a little about your background and what made you interested in partnering with Maven

I am an OB-GYN at the University of Michigan, practicing full-spectrum obstetric care, and I’m also a health services researcher, looking at how we can redesign care to better meet patients’ needs. As a provider, I have seen how our traditional maternity care models often don’t match our patients’ needs–we were providing too much or too little care, and for many patients, it wasn’t the right care at the right time.

I’m excited to work with Maven because it’s such a promising platform for providing care outside of what we’re able to deliver within the confines of the traditional medical system. Maven facilitates more comprehensive care plans that flexibly meet patients’ unique and nuanced needs. In-depth patient education and support are often hard to squeeze into the 15-minute visits that OB-GYNs are afforded with patients in person. Maven’s model helps fill in those gaps. Additionally, mental health and other important support services are often challenging for patients to access in many parts of the country: access to providers can be limited, and patients may not recognize that they have a need for services.  Maven addresses these issues by providing robust screening and management of comprehensive patient needs. 

Much of your research centers around “right-sizing” perinatal care. What does that mean for expecting parents, and how can telehealth support this new model?

Right-sizing care starts with knowing the diverse needs of patients–including their medical needs, mental health needs, social needs, and support needs. Screening for these factors at the beginning of pregnancy can help us provide patients with the right services. In the past, we’ve addressed all pregnancies with 12 to 14 in-person prenatal visits. This model could often be burdensome for patients and not provide the right care to address their medical and non-medical needs. For me, right-sizing care is moving away from a one-size-fits-all model to care tailored for individual patients.

I think telemedicine and digital services can also help advance the concept of right-sizing care by eliminating barriers of time and space. In areas where there is no access to specialists like nutritionists or lactation consultants, virtual care allows us to connect patients to professionals who can provide targeted help. Digital visits also allow patients to connect with providers wherever they are, using a tool they carry in their pocket. This convenience can reduce barriers to care like transportation, need for missed work, and childcare.

For me, right-sizing care is moving away from a one-size-fits-all model to care tailored for individual patients.

Why do you think we’re finally seeing a shift in how we provide prenatal care?

The traditional prenatal care schedule used until recently was put in place in 1930 by the Children’s Bureau, and had remained unchanged for almost a century. These guidelines didn’t fully account for the experience of birthing parents. We’re now at the intersection of a maternal health crisis and an increasingly digital society, which generated a demand for rethinking how we provide care.

COVID was a huge accelerator of this shift, as well—the changes we talked about for decades were finally put into action, driving an increase in virtual visits and home monitoring. We’ve reimagined how we think about prenatal care. These new approaches were finally codified into new perinatal recommendations in October 2021. My team at the University of Michigan partnered with the American College of Obstetricians and Gynecologists (ACOG) to lead the process of establishing the new recommendations, which looked at the appropriateness of care: what care was needed for patients to be safe and get the services necessary in pregnancy. These new recommendations also account for individuals’ pregnancy journeys and the increased movement towards virtual appointments and remote patient monitoring.

The US has the highest maternal mortality rate among developed countries, and rates are even higher for Black, Hispanic, and American Indian & Alaska Native parents. What are some key changes that can be made to the perinatal care model to help reduce these disparities?

This is a big question! There are a few areas to focus on in perinatal care that could help start addressing this crisis:

1. Ensuring all patients have access to evidence-based recommendations. We don’t need new and innovative care, we need to put into practice the interventions that we know work. This concept could look like ensuring that patients that have high blood pressure have access to a high-quality blood pressure cuff, or helping patients who want genetic screening access available and affordable testing. These basic facets of care should not vary, regardless of what clinic or what provider a patient visits.
   
   
2. Provide additional opportunities for care matching. Giving patients the opportunity to see providers who share their same background, language, and cultural experiences can make a huge difference in outcomes and the quality of care received. This need is where digital can really shine—if there’s no local provider that shares a patient’s background, telehealth can expand the provider pool nationwide, ensuring patients are able to connect with a provider that can best understand their unique needs.
   
   
3. Increase screening for social determinants of health (SDOH). 40% of outcomes can be attributed to patients’ social and structural determinants of health, so it’s essential for these factors to at least be acknowledged in clinical care settings. Beyond screening for SDOH, we need to develop more robust strategies for connecting patients to the services they need to address those adverse SDOH.
   
   This concept, unfortunately, is easier said than done. Many prenatal care providers don’t ask these questions because they don’t feel prepared to help patients address these needs. We were trained to deal with high blood pressure and pregnancy complications, not housing and food insecurity. Addressing SDOH requires, in part, a strong infrastructure of partners that providers can refer patients to, whether it's a social worker, specialists, an online platform, or even a simple resource list of community partners.
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4. Listen to pregnant people. One of the most concerning causes of maternal morbidity and mortality is when patients come to their provider with issues and aren’t heard. As healthcare providers, we need to be much more attuned to patient symptoms and do a full investigation when they say that something isn’t right. But while we wait for the healthcare system to adapt, we also need to better equip patients with the right information to identify potential complications when they appear and advocate for themselves accordingly. Increasing health literacy and self-advocacy is another critical place where Maven has huge potential to influence our members.

You’ll be working with the team at Maven for the next year. How do you see your expertise making an impact on the care Maven provides for our members?

In my clinical world, the support services I’m able to offer patients are limited by time, space, and money. I can only offer what’s available through my health system and covered by my patient’s payer. But with Maven, we have this incredible platform where patients can access any resource they need for their prenatal care, mental health, nutritional advice, and education. I’m excited to understand how patients utilize services in this digital environment so we can design care pathways that address all aspects of our members’ needs.

As an example, let’s look at a member who has a history of preterm birth and has pregnancy-related anxiety. Following traditional care guidelines, the patient would show up for her prenatal appointment, we’d talk to her about her options for preventing another preterm birth and give her a list of pregnancy support groups, and then we wouldn’t hear from her again until her next appointment. However, with Maven, she would sign on, meet with her Care Advocate who would identify her pregnancy anxiety and recognize her uncertainty around preventing another preterm birth. For each of these areas, she would have a menu of options—maybe her needs would be met by reading articles on the app or joining the Maven forum to chat with pregnant parents dealing with the same issues. Or maybe she could get a second opinion from an OB-GYN on the Maven app so she could go to her next in-person appointment armed with the knowledge she needs to advocate for herself. As the pregnancy progresses, she could talk to additional specialists, like a mental health provider or a nutritionist, all while receiving continuous care from her Care Advocate in a way that her in-person prenatal care office couldn’t provide.

Another area that I’m excited to explore at Maven is SDOH screening. When my team was building out the new prenatal care guidelines, we placed an emphasis on screening for social and structural determinants of health. At the conclusion, the team felt like we needed more information on how to best implement this increased screening in practice. And this is what we’re diving into at Maven: we have the ability to screen for and address these issues better than the traditional care model can. This aspect is what made me excited to join Maven as the Visiting Scientist, studying how we can create wraparound services in a way that no one has done before.

To learn more about how Maven is building the next generation of prenatal care, contact us today.