Delivering Lifesaving Maternal Healthcare

The health of new mothers and moms-to-be matters and has mattered for decades at the University of Illinois College of Medicine. A national leader in maternal health research, education, and clinical care, the College of Medicine serves on the frontlines of what has been dubbed a maternal health crisis in the United States. For a developed nation, the U.S. has one of the highest rates of maternal death as well as complications due to pregnancy and childbirth compared to global peers.

“People are going into pregnancy and coming out of it less healthy,” says Rachel Caskey, MD, the Earl M. Bane Professor and head of the Department of Medicine. “The good news is that the majority of poor health outcomes are largely preventable.”

In July 2024, the National Institutes of Health awarded an $11 million, six-year grant to UIC for the establishment of the new Maternal Health Research Center of Excellence in an effort to reduce health inequities in maternal morbidity and mortality. Led by Caskey along with co-principal investigator Anne Elizabeth Glassgow, PhD, research assistant professor of medicine and pediatrics, the Center’s research focuses on social epigenetics such as the influence of environment and social experiences on maternal health disparities. For example, Black women are three times more likely to die from a pregnancy-related cause than white women.

This award builds on the significant inroads UIC investigators have already made in studying maternal morbidity and mortality through a non-traditional maternal health research lens.  Founding member of two maternal mortality review committees (MMRCs) led by the Illinois Department of Public Health, Stacie Geller, PhD, director of the College of Medicine’s Center for Research on Women and Gender (CRWG), started to note a disturbing uptick in the causes for maternal death beyond the usual direct ones like hemorrhage, sepsis, and pre-eclampsia.

“We began seeing deaths from suicide, substance use disorders, and homicides due to community and intimate partner violence,” says Geller, the G. William Arends Professor of Obstetrics and Gynecology and director of the National Center of Excellence in Women’s Health within the CRWG. “My work with the state formed the basis of my research, which focuses on the upstream factors affecting the health and welfare of women during pregnancy and the postpartum period.”

The University of Illinois Hospital and Clinics serves patients from all walks of life. Improving maternal health outcomes for all women drives Geller’s work to enhance women’s healthcare in general. She says, “At UI Health, not only do many of our pregnant patients come in with preexisting conditions but they also may be dealing with poor housing, limited transportation, and/or food scarcity that can adversely impact both the wellbeing of the woman and their child.”

Mistrust of the healthcare system has historically kept many women of color from accessing adequate prenatal services, according to Geller. In an ongoing study, her team has developed a model to improve patient engagement in prenatal care for pregnant Black women by making them feel as welcomed as possible. Funded by the Patient-Centered Outcomes Research Institute (PCORI), the researchers ask the question: Does a Black Midwifery Program Improve Maternity Care for Black Woman? The study involves Black midwives providing care to Black patients. Additionally, a Black nurse navigator helps patients—many with comorbidities—to coordinate other clinical appointments as well as handle, if necessary, obstacles to care such as adequate transportation by paying for parking or arranging rides. A Black social worker assists with broader range social and community issues such as housing or food insecurity.

“We are providing these women with more than a warm handoff from provider to provider,” says Geller. “They are receiving a warm hug and embrace.”

The postpartum period describes the 12 weeks that follow childbirth. For many new mothers—and providers—the health of the newborn rather than the mother is typically the focus of follow-up care.

“The general feeling has been, ‘Well, mom is done with pregnancy, and everything is fine,’ when in actuality women face significant health risks postpartum,” says Caskey. “We need to prioritize the health of mothers in this vulnerable time just as much as we care about the health of their babies.”

Making it easier for new mothers to access maternal healthcare, UI Health created the Two Generation Clinic in 2020. This one-stop destination provides both adult and pediatric primary care and behavioral health support. The team features physicians in internal medicine, pediatrics, and psychiatry, a lactation specialist, and a licensed clinical social worker.

“The need for mental healthcare is particularly high, from treating postpartum depression and underlying disorders exacerbated by the pregnancy to entirely new diagnoses like acute postpartum psychosis,” says Caskey. “Our aim is to create a parallel model of longitudinal care that we can provide indefinitely for the health and wellness of new moms.”

UIC’s leadership in maternal health goes well beyond Chicago to benefit pregnant and postpartum people throughout Illinois. One current Center for Research on Women and Gender study focuses on filling gaps in maternal health care education for emergency departments (EDs), of which there are 187 in the state, according to key study investigator Geller. Per startling statistics from the Illinois Maternal Mortality Review Committee, 66 percent of individuals in Illinois who succumbed to a pregnancy-related death from 2018 to 2020 had visited an ED at least once before they died.

“Perinatal women were going to the ED for care, but they weren’t getting the maternal healthcare they needed,” says Geller. Adds Caskey, who contributed to a UIC Maternal Health Emergency Department Toolkit, “ED providers and staff are very good at asking if a person is currently pregnant but not so good about asking if a patient has had a baby in the past 12 months.”

Piloted at six hospitals from May 2023 to June 2024, the toolkit was established as evidence-based. It is now available to all emergency departments in Illinois.