Dr. Linda Genen Of ProgenyHealth On How to Improve the Birthing Experience
…Make cultural competence a centerpiece of care. It would be wonderful if all health equity initiatives included cultural competence within their efforts to standardize care quality and its access. We know just how important medical representation is in breaking down cultural barriers, addressing implicit biases, and providing the best possible care to all patients. By ensuring that practices have OBs on staff who either represent a diverse array of backgrounds and cultures, or who at least are knowledgeable in these areas, we can help our patients feel more comfortable seeking counsel and care. Not only do we help reduce potential language barriers to care, but we also work to reinforce cultural competency, ensuring our patients can feel at ease knowing they are understood…
The birthing process is one of the most significant moments in a person’s life, yet the experience can vary greatly depending on numerous factors. From the quality of care to the emotional and physical support given to the mother, there are many ways to enhance and improve this life-changing experience.
As a part of this series, I had the pleasure of interviewing Linda Genen, MD.
Dr. Genen is the Chief Medical Officer for ProgenyHealth. Dr. Genen is a board-certified neonatologist and experienced physician executive with recognized expertise in maternal child health. As Chief Medical Officer, she oversees ProgenyHealth’s medical management and quality operations. Dr. Genen earned her bachelor’s degree in chemistry and graduated with honors from Wellesley College. She received her Doctor of Medicine from the State University of New York — Downstate Medical Center.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” better. Can you tell us a bit about you and your backstory?
My name is Linda Genen, MD, MPH. I’m currently the Chief Medical Officer at ProgenyHealth and a neonatologist by training. As I reflect upon my path, I never imagined that I would have pivoted from a bedside clinician into the world of healthcare business. Having the perspective of a clinician helps give me a full view of healthcare.
I’ve worked as a physician executive for many years, most recently as Chief Medical Director and Senior Research Fellow for UnitedHealth Group Research and Development, helping to advance research and develop innovations in healthcare.
I completed a residency at Columbia Presbyterian Babies and Children’s Hospital, and a neonatology fellowship at Yale New Haven Children’s Hospital. During this time, I also pursued a master’s degree in public health from the Yale School of Public Health, with a focus on evidence-based medicine.
In the specific birthing experiences that you have been a part of or witness to, what were the key elements that seemed to have the most influence on the quality of the process, outcome, and aftermath of the birth? Can you please explain what you mean?
I think it’s our way of thinking about the birthing experience that has to change a little. I know the word is “birthing,” but I’m really thinking about the whole maternity process leading up to that time in labor and delivery. This is the time that there are elements at play that can make a night-and-day difference to the delivery itself. I’m thinking about what is going on with the pregnant person even before pregnancy. What was her nutrition like? Her stress? Which social determinants of health (SDoH) are influencing her right now? Then, I’m also wondering about her prenatal care. Was she able to attend all her appointments and screenings? Was she regularly taking prenatals? Has she continued feeling fetal movements through the third trimester?
I’m usually approaching from a high-risk perspective, so I’m often seeing moms with gestational diabetes, gestational hypertension, or maybe preeclampsia. We’re looking at preterm births and NICU stays, and from that vantage, I’m always thinking about what we could have done three or six months ago to have avoided this. How can we intervene early, get people to their prenatal appointments, and educate them on what is needed to manage conditions, prevent emergencies, and help ensure healthy, successful births?
We have to go all the way upstream and focus on access — to food, vitamins, transportation, care, sleep, etc — to help make an impact on the quality of delivery. Education is key. We need to build trust so that we can share the information needed to help set every patient up for success from the beginning.
Can you tell us about a birthing experience you were a part of as a professional that you actually wish had gone differently? Do you know exactly where it took a wrong turn? Do you think or know there is something someone, even you, could have done to improve this situation? Can you please explain what you mean?
I do have a recent story that illustrates the power of maternity management programs to get ahead of what would very likely have become a critical situation for mom and baby.
A lovely young woman with a healthy-seeming pregnancy enrolled in our program at the end of her first trimester, which is great timing for a proactive care approach. We began with a health risk assessment (HRA) to help identify the risk level and whether an intervention might be necessary.
She initially tested at low risk, but three months later, we screened her again and noticed that she had never received the tests from her glucose tolerance test. It turns out there was a mix-up at her OB office, so she had never been made aware that she had tested positive for gestational diabetes — which is considered high-risk. This information completely alters how we manage any specific case.
Luckily, because of our screening, we could reassess her, provide counseling on proper nutrition to manage the condition, and teach her to regularly check her blood sugar levels. We worked closely with her so that she would maintain a good diet and keep her sugar levels in check. Without the screening, and without this type of managed educational intervention, gestational diabetes can lead to very serious complications for the baby. For example, large fluctuations in a mom’s blood sugar can result in congenital anomalies of the heart.
In most cases, this situation would have resulted in a very different outcome. We would have likely seen a large for gestational age baby with high sugars, who might require a preterm delivery subsequent NICU admission. By building a rapport with this member, regularly checking in, and following her dietary plan, we helped ensure she delivered her healthy baby full-term at 39 weeks.
Which of these do you feel physicians are most in contention with, if at all: lack of time, lack of resources, lack of information regarding a patient’s specific case, healthcare worker burnout, compassion fatigue, or something else entirely? Can you please explain what you mean?
I’d say burnout is a huge concern right now for all caregivers, especially obstetricians. The American College of Obstetricians and Gynecologists (ACOG) conducted a survey in 2017 that found burnout affects 40–75% of all OBs — and this was conducted prior to the pandemic when burnout peaked, and its magnitude truly came to light.
Firstly, there’s a great administrative burden that has fallen on physicians, including paperwork, billing, and charting, all of which detract from face time with patients. For OBs, in particular, demanding 24/7 schedules add another layer of stress. You have night shifts, you’re on-call during weekends and holidays, and you have irregular schedules to contend with. That’s hard because it makes it difficult to live your own personal life.
On a professional level, there is just so much knowledge you need to possess. You may find yourself providing early gynecological care for a young teenage patient, doing a third trimester check-up, overseeing deliveries, and even performing hysterectomies — all in the same week. Some have focus areas, but others are doing it all. For all physicians today, there is a high litigation fear, and OBs contend with high risk for medical malpractice each day.
There is a big push for reform to help support physicians and encourage resilience in training and residency programs. However, we need more than massage breaks and meditation rooms, as lovely as they are. We’re seeing higher rates of suicide in medical school residency as well as among attendings. So, this is a big challenge, something we’re all facing. I don’t think we have the full cure yet, but if we don’t make more sweeping reforms — enact a work-life balance, more protection for physician time, better balance of pressure, lower fear of litigation — we will likely see this pattern continue unabated.
In your dream world, what would a perfect shift at work be like for you? If you had a shift with back-to-back births, what else would be in place structurally that would make you feel as if you are fulfilling your dream for birthing parents? Now, how can we take this out of your dream world and root it in reality?
If we’re talking about a dream world… we’ll need to hire an architect! I know there are a lot of moms-to-be who love the idea of a home birth. However, as a neonatologist, a setting that is too far removed from emergency medical intervention makes me nervous. So, in my perfect world, we’d have a serene, home-like birthing center environment connected to a hospital setting by a discrete tunnel or hallway, so that when we needed to move quickly for a C-section or other emergency care, we wouldn’t waste a second.
If we’re talking about the perfect shift, and these have definitely happened, we’d begin with communication. The perfect day for a neonatologist, as it relates to the labor and delivery area, starts with a clear handoff. So, if you’re coming in for the evening shift or arriving for the morning one, there’s a team huddle. We cover all admitted patients and emphasize those who are already designated high-risk, so that the NICU team knows what will likely require their attention. But it’s all about communication — your nurses, nurse practitioners, physician assistants, anesthesiologists, doulas, midwives — everyone is ideally involved in these shift change hand-offs.
During these sessions, we cover everything. How long has each mom been in labor? Who has other medical histories, other concerns, birthing plans, or preferences? Who is high-risk? Who is extra anxious? You have to understand that it’s very scary during labor. So, during the best shifts, every delivery nurse goes in knowing her patient and how she can best support that mom.
For our patients, we want to always understand their birth plans, their hopes and desires, and we always work to be respectful of them. But we try to make sure on both sides there’s an understanding that things change very quickly on the labor and delivery floor, and sometimes birth plans can and must change. This always goes over a lot better when everyone feels informed, respected, and part of the process from the beginning. Again, this all comes down to communication, process, and trust. When there’s any downtime, whether you have medical residents or nurses, the best days involve sharing knowledge, teaching, and learning from each other. For instance, everyone should know how to resuscitate a baby. Having this time to teach would be an essential part of a perfect shift.
These best days, it almost goes without saying, involve a perfect caseload balance, so that no one is too burdened, and we don’t feel a shortage. If we’re talking perfect, this day also has no big patient complications — but even if there are any, those early diagnoses make a huge difference. So we know if we’re dealing with a shoulder distortion or a postpartum hemorrhage, we know how to act immediately to ensure the best outcomes for mom and baby. Strong team dynamics with frequent communication, clear leadership, and well-rehearsed policies and processes are the absolute best way to make these perfect days more routine.
Are there any innovative practices, technologies, or policies that you believe can significantly enhance the safety and comfort of the birthing process?
I think anything that can help with communication — between care team members and with the patient herself — can help support healthy outcomes.
Our ProgenyHealth app is a great example of this. Our members can encounter educational information in bite-sized pieces, which are very easy to review, digest, and take action on.
Engagement is proving super directional for our case management team, as well. We can see what members are clicking on, what catches their interest, and what questions they have. It helps our team know what topics to prioritize with members during their recurring phone calls and screenings. We find the blended approach is highly effective. The app is amazing for sharing educational information and resources, but it is the personal touch — our case managers who build relationships with our members — that makes all the difference.
Let’s move on to the heart of the discussion. Can you please share “5 Things That We Can Do to Improve the Birthing Experience for Mothers”? If you can, kindly share a story or example for each.
Labor is scary. There are probably countless things we can do to help improve the pregnancy journey and delivery experience for new and expecting moms, but here are my top five:
- Build trust through effective communication
I alluded to it earlier, but truly, communication is paramount in a hospital setting. There are so many moving pieces, and communication among all members of the care team is so, so important — but equally critical is the connection we have with our patients. Ensuring a healthy birthing experience for our mothers depends heavily on how we communicate with them. Can we share educational information, do we know about their backgrounds, their expectations, their fears?
Unfortunately, it’s not as simple as it sounds. You hear a lot about “white coat syndrome” and the fear people have of doctors and the medical establishment. This sounds dramatic, but it’s real, and regardless of age, race, or background, it limits the information we receive from our patients themselves and the rapport we’re ultimately able to build with them.
Without that connection, it’s hard to admit to anyone — let alone your OB — that you might be living in an unsafe environment, or that maybe you are having some intrusive thoughts or are at risk of losing your job. It’s not easy to say any of that aloud, let alone in a clinical setting.
The flip side of this communication coin is education. When you have developed a healthy, trusting relationship, you can share information that makes an outsized impact on mom and baby when it comes to delivery. I can’t tell you how many times I’ve had to tend to a premature baby, or a baby who had less movement in-utero, and then ended up with oxygen deprivation at birth. In those situations, the mothers say to me, “I didn’t know, I didn’t know.” And it’s true. They were not made aware of the signs and symptoms of preterm labor, or they didn’t know how they should count the fetal movements through the third trimester. Quality education is the best prevention tool we have, and it all hinges on the dynamic you’re able to build with your patient over time.
We have to start working to nurture an environment that feels safe and open, so that we can earn our patients’ trust. Only then can we deliver the best kind of birthing experience for our mothers.
2 . Provide comprehensive mental health support — throughout all “four” trimesters
We are seeing more and more mothers present with anxiety and depression, and unfortunately, a lot of it is going untreated. Thankfully, there has been a huge movement around postpartum depression. It’s been normalized; there are screenings, and even new pharmaceutical solutions are available on the market. But, if we think about how society has changed, we’re seeing a lot of our members reporting unmet needs when it comes to behavioral health through their pregnancies. We’re working to solve that.
We’re not just talking about a referral if someone self-identifies. We’re conducting screenings throughout pregnancy, before delivery, and postpartum and identifying women who may score high — and right away we act. We work to find them the right type of professional to see, and we don’t just hand them a list of phone numbers. We stay with them on the phone, and often, we set up a language line when needed, and we make sure they can make an appointment with the right provider without a wait.
There’s not enough access to mental health support in America, period — but we’re working to help solve for it.
3 . Help bridge gaps in access and create oases in maternity care deserts
While we’re speaking about access to care, access to maternity care is poor — and worsening across the country. Between 2006 and 2020, more than 400 maternity services closed nationwide; over one-third of all US counties are considered maternity care deserts. That means that more than two million women are living in areas without hospitals or birth centers offering OB care and without any OB providers.
This is devastating to both mom and baby. The lack of prenatal care results in poorer outcomes at delivery, including higher rates of preterm birth. Broader policy shifts are needed to encourage the reopening of clinics and birthing centers in the thousand-plus counties lacking maternal care resources.
While there is no true substitute for local, trusted care, there are steps we can take in the interim to help bridge gaps in access, support the women and families living in these deserts, and create “oases” — my way of defining case managers who can remotely help connect pregnant women with trusted, high-quality care that is close by, affordable, and culturally competent. These outreach programs help ensure everyone can receive the prenatal care they deserve to ensure a healthier pregnancy and healthier outcomes — for the long term.
4 . Embrace expansive care teams — and increase reimbursement
There’s a wonderful shift happening in maternity care. More and more health plans, both Commercial and Medicaid, are providing coverage for midwives and doulas, granting broader access to an expansive type of caregiver who can be more focused on the mom, her needs, and what will help make her delivery a success.
Research shows that their support is associated with a range of positive delivery outcomes, including reduced C-sections, premature deliveries, and lengths of labor. The personalized level of care makes a powerful impact, both emotionally and physically.
On the flip side, that level of hands-on care, by design, means that any doula or midwife can only take on a few patients per month. While that means we have caregivers who are truly dedicated to and focused on you, it also means we don’t have enough of them to cover the need — and growing demand.
We’ll need to continue encouraging coverage of these valuable services and ensuring that reimbursements adequately compensate them for their time, training, quality of care, and impact. Only then will we see more and more individuals training in these professions and enough qualified individuals available to meet the need.
5 . Make cultural competence a centerpiece of care
It would be wonderful if all health equity initiatives included cultural competence within their efforts to standardize care quality and its access. We know just how important medical representation is in breaking down cultural barriers, addressing implicit biases, and providing the best possible care to all patients.
By ensuring that practices have OBs on staff who either represent a diverse array of backgrounds and cultures, or who at least are knowledgeable in these areas, we can help our patients feel more comfortable seeking counsel and care. Not only do we help reduce potential language barriers to care, but we also work to reinforce cultural competency, ensuring our patients can feel at ease knowing they are understood.
How can physicians ensure that there is effective communication between healthcare teams and expectant mothers to reduce anxiety and build trust during labor and delivery?
This is so important! Healthy, open communication can make the difference between a successful delivery and one that requires emergency intervention. I believe it’s all about opening the dialogue and asking questions. It may seem simple, but studies have supported what I’ve seen time and again in the delivery room: women may hold back from asking questions for a host of reasons: fear of seeming difficult, of being discriminated against, of triggering a conflict over a care plan. The list goes on and on. Yet, this reticence comes at a cost — these same women are more than 5 times more likely to report feeling coerced to pursue an intervention than those who were more active participants in their deliveries.
I think we, as caregivers, have a huge opportunity to put our expectant mothers at ease from the get-go. When we walk into that delivery room, we’re making a first impression. We know we’re meeting our patient when she’s already in pain, stressed, likely scared, and not sure what to expect.
At that moment, it’s our responsibility to help put her at ease. I’d recommend getting her to speak first with a series of questions that let her tell us what she’s feeling, hoping, and thinking — instead of the other way around. So much of medical care is physicians talking to patients. At this moment, we need to listen.
I think this very simple practice helps establish a sense of openness, receptiveness to dialogue and questions, and an understanding that she may have certain preferences, hopes, and dreams — and that they matter to us. That we will do what we can to honor them.
If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
I’d like to help connect the various state-level task forces evaluating maternal morbidity and mortality. I think almost every state has enacted a review board specific to the maternal mortality crisis, but I’m not aware of any governing or reviewing body connecting this work at the national level.
I think there are so many things we could gain from zooming out and taking a birds-eye view of the lessons learned by each regional and state-level institution. For instance, I know New York City has a review board that takes a look at the factors and lived experiences impacting its pregnant residents — and that many of their findings are night-and-day different from what a board in, say, rural Louisiana is finding.
While this state-level work is essential to change, every month we continue without a national review board that facilitates knowledge-sharing feels like a missed opportunity. Without it, we’re living in a silo. While the day-to-day lived experiences of the women in these two locales are unique, surely we can isolate factors and broader societal experiences that are driving the troubling outcomes.
I think every state-level investigator would benefit greatly from conversations uniting us in seeking answers to the crisis. From there, we could work as a unit, more powerful together, to help propose policy changes and process improvements that we could seek federal funding or support for — and then drill down and enact interventions at a state level for change that truly makes an impact.
How can our readers follow your work online?
I often share interesting findings, articles, and insights on my LinkedIn page.
My professional bio, Chief Medical Officer at ProgenyHealth.
Our Resources page at ProgenyHealth includes our research, publications, company news, and more.
A Member’s Maternity Journey is a fantastic example of how education, communication, and trust can help ensure a safer, healthier delivery even in a high-risk pregnancy.
Thank you so much for joining us. This was very inspirational.
About the Interviewer: After becoming her father’s sole caregiver at a young age, Lucinda Koza founded I-Ally, a community-based app that provides access to services and support for millennial family caregivers. Mrs. Koza has had essays published in Thought Catalog, Medium Women, Caregiving.com and Hackernoon.com. She was featured in ‘Founded by Women: Inspiration and Advice from over 100 Female Founders’ by Sydney Horton. A filmmaker, Mrs. Koza premiered short film ‘Laura Point’ at the 2015 Cannes Film Festival and recently co-directed ‘Caregivers: A Story About Them’ with Egyptian filmmaker Roshdy Ahmed. Her most notable achievement, however, has been becoming a mother to fraternal twins in 2023. Reach out to Lucinda via social media or directly by email: lucinda@i-ally.com.