10.8: Maternal Health

Prenatal care

Prenatal Health Care is medical care provided to a pregnant woman from the time of conception until the birth process occurs. One common measure of population health is the percent of pregnant women (or birthing parents) who receive prenatal care in the first trimester.

Why is prenatal care so important?

1. It is fundamental to safe pregnancy and delivery.
2. It is associated with better health outcomes for mother and baby.
3. It reduces the likelihood of complications of pregnancy and birth.
4. It allows for monitoring of blood pressure, blood sugar, medications, nutrition, and other factors that can affect both the pregnant parent and the fetus.
5. It reduces the rate of preterm birth and low-birth-weight.
   • Definition: a low birth weight infant (LBW) = one that weighs less than 2500 grams or 5 lb. 8 oz. at birth; a very low birth weight infant (VLBW) = one that weighs less than 1500 grams or 3 lb. 5 oz. at birth.
   • Definition: preterm birth is a birth before 37 completed weeks of gestation.

The Affordable Care Act expanded access to prenatal care by making it an essential covered service, meaning most people can access it without a copay or deductible. This includes the prenatal visit itself, screenings or tests, and folic acid supplements. Folic acid, taken during the first trimester, can help prevent neural tube defects. Vaccinations can also be an important part of prenatal care.

Culturally-tailored and community-focused programs expand access to prenatal care among populations that have been underserved by the mainstream health system. Here are a few examples:

• The Black Infant Health Program
• The Community Health Representative program within the Indian Health Service
• The Centering Pregnancy approach, which is implemented in many clinics and hospital systems and seems to be especially well received among Latinas/x

For those interested in reducing health inequities in maternal health in California, this 2025 report has some interesting suggestions. 

Safe Births

Safe births can happen through vaginal delivery or by Caesarian section (C-section). However, C-sections often have more complications, as they are a form of surgery. The World Health Organization recommends that no more than 10-15% of births be C-sections but in the US, the rate is much higher, and has tended to increase over the years. Almost one third of US babies are delivered by C-section (32.3% in 2023, according to the CDC). Public health efforts are aimed at reducing the rate of C-sections, both by addressing the factors in maternal health that can lead to necessary C-sections and by addressing the hospital policies and practices that can lead to unnecessary C-sections.

Part of safe births is responding to the choices of the birthing parent. For some, that can mean having a birth attended by a midwife or a doula (a nonclinical birthing assistant). So many factors are related to a person's ability to make their own choices related to reproduction, including insurance, access to day care, good employment with family leave benefits, access to information and education, support for chronic conditions that may precede pregnancy, social support, and more. The presence or absence of these translate into different levels of stress, choice, and ease for the birthing parent, the infant, and the family as a whole.

Postpartum Care

There has been an increasing focus on postpartum care in recent years, in part due to an awareness of the seriousness of postpartum depression and due to the increase in maternal mortality (with many of those deaths in the postpartum period). Postpartum means "after birth" and it refers to the period immediately after birth up to a year after.  Some providers speak of the "fourth trimester," with a focus on the first three months after giving birth.  

Postpartum care should be holistic in nature, monitoring the physical health of the new mother (or parent), the emotional or psychological health, and the social health. According to the American College of Obstreticians and Gynecologists, "The comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance." Assessment for social risks, from housing insecurity to domestic violence, is also an important component of postpartum care. 

References

American College of Obstreticians and Gynecologists. (2018, May). Optimizing Postpartum Care. Committee opinion, 736. https://www.acog.org/clinical/clinic...ostpartum-care

CDC. (2026). Births - method of delivery. https://www.cdc.gov/nchs/fastats/delivery.htm

Eunice Kennedy Shriver National Institute for Child Health and Human Development. (2017). Pre-pregnancy care. https://www.nichd.nih.gov/health/top.../prenatal-care

Seabert, D., McKenzie, J. F., Pinger, R. R. (2021). McKenzie's An Introduction to Community & Public Health. United Kingdom: Jones & Bartlett Learning.