the NEED for remote monitoring Maternal Health
leading to safer pregnancies and empowered mothers
AUGUST 2024
by Aleksandra Manolceva
Between 2000 and 2020, maternal mortality globally declined by 34%. However, trends in the US do not correlate with global standards, which raises the question of why.
We recently published two Medium blogs about women’s health needs: i) The Lowdown, a portfolio company that is solving one of the earliest needs in a woman’s life cycle: the need for contraception, and ii) (in)fertility as an area of need, where we provide some guidelines for how health technology innovators can address this need in order to maximize their chances of success. In this blog, we will focus on the next phase in a woman’s life cycle by shedding light on areas where technology can enable improvements in maternal care and a potential reduction in maternal deaths, focusing on the US.
Maternal health refers to the comprehensive care provided to women during pregnancy, childbirth, and postpartum. It includes prenatal care, which involves regular check-ups and monitoring to support the health of both the mother and the developing baby; perinatal care, which focuses on managing the mother and baby’s well-being during labor, delivery, and the immediate aftermath; and postnatal care, which addresses the mother’s recovery, infant care, and emotional support after childbirth. Maternal health aims to ensure the mother’s and baby’s physical and mental well-being, optimizing outcomes and addressing any complications or challenges that may arise throughout this critical period.
In 2018, the U.S. reported 17.4 maternal deaths per 100,000 live births, a rate more than double that of most other high-income nations. By comparison, the maternal mortality ratio in the UK was 6.5 per 100,000 live births, and the Netherlands, Norway, and New Zealand were 3 per 100,000 or fewer. This is despite the US having the highest healthcare spending, measured as a percentage of GDP.
understanding MATERNAL MORTALITY rates and their causes
Maternal deaths impose significant costs on both the healthcare system and society at large. The economic impact of maternal morbidity is substantial, with an estimated $32.3 billion in costs for all U.S. births in 2019, covering both medical and nonmedical expenses.
Healthcare System Costs: The immediate medical expenses associated with pregnancy-related complications can be significant. These include hospital stays, emergency interventions, medications, and prolonged hospital stays. Maternal mortality may also increase the long-term healthcare spending of the surviving families with a higher risk of developmental delays, chronic conditions, and psychological impact.
Societal Costs: Beyond the immediate healthcare expenses, maternal deaths have far-reaching societal impacts. Families face emotional and financial strain, mainly when a mother’s death affects her dependents, including children who may require alternative care or support. The economic implications extend to the potential loss of household income and increased reliance on social services. Furthermore, maternal mortality affects community stability and financial productivity, as the loss of a working mother can reduce household income and overall economic contributions. Moreover, the societal impact extends to the inability of the deceased mother to contribute to future generations. Her death means she will no longer be able to bear additional children, which can affect family planning and the continuity of family lineage. The societal cost also includes the broader impact on family structures and community support systems, which can experience significant strain due to such tragedies.
Hospital Reputation: Beyond financial and emotional costs, maternal deaths can significantly impact a hospital’s reputation. Facilities that experience such outcomes may face public scrutiny, loss of trust from the community, and potential legal and regulatory challenges. Negative publicity can affect patient perceptions and deter prospective patients from seeking care at the facility. Ensuring high standards in maternal care is crucial for maintaining the hospital’s reputation, preserving patient trust, and demonstrating a commitment to quality care.
There are three commonly used measures of maternal deaths in the United States, each capturing different and mutually exclusive aspects:
- Pregnancy-associated death: Death occurring while pregnant or within one year of the end of the pregnancy, regardless of the cause.
- Pregnancy-related death: Death during pregnancy or within one year of the end of pregnancy due to a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiological effects of pregnancy. This measure is specific to the U.S. and is typically reported as a ratio per 100,000 births by the CDC.
- Maternal mortality: Death occurring while pregnant or within 42 days of the end of pregnancy from any cause related to or aggravated by the pregnancy or its management, excluding accidental or incidental causes. This measure, used by the World Health Organization for international comparisons, is also reported as a ratio per 100,000 births.
A significant portion of pregnancy-related deaths in the U.S. occur after birth. To better understand the high maternal death rate in the country, it is essential to consider the timing of these deaths:
- During Pregnancy: About one-third of pregnancy-related deaths
- Day of Delivery: 17% of deaths happen on the day of delivery.
- Postpartum: 52% of deaths occur after delivery:
- 19% occur between one and six days postpartum.
- 21% occur between one and six weeks postpartum.
- 12% occur during the remainder of the year.
In the first week postpartum, severe bleeding, high blood pressure, and infection are common causes of death, while cardiomyopathy is the leading cause of late maternal deaths. Research indicates that U.S. women experience more late maternal deaths than women in other high-income countries.
There are various reasons for maternity death, some more costly than others for the health care system. Still, eventually, the societal costs and the life of the motherless households are the same and just as devastating for society as a whole. Many of these reasons or factors can be mitigated or their risks reduced if appropriate preventative measures are implemented, and with proper intervention and care, the likelihood of maternal deaths occurring due to these reasons can be significantly decreased. Social, economic, and environmental factors, including income, education, and access to quality healthcare, all impact maternal mortality rates. Mental health issues, unsafe abortions, and suicides also play a significant role. While these broader determinants are important, our focus will be on preventing clinical causes of maternal death, such as severe bleeding, infections, and high blood pressure, which can be managed with timely and adequate medical care during the three stages of the pregnancy timeline.
Effective maternal health management involves several critical stages. During pre-pregnancy, diabetes mellitus requires careful management with regular monitoring and personalized care plans, while chronic renal diseases need consistent management. During pregnancy, hypertensive disorders are managed with regular monitoring and timely interventions, and sepsis prevention includes routine screenings and prompt treatment. Direct causes of maternal death, such as obstructed labor and anemia, are addressed through early detection and nutritional interventions. On the day of delivery, protocols for managing hemorrhage are crucial. Postpartum care focuses on sepsis monitoring, and although embolism remains challenging to predict, timely interventions can mitigate risks.
By improving the management of the most easily preventable maternal conditions with already established preventative protocols implemented accurately and seamlessly, such as hypertensive disorders, gestational diabetes mellitus, hemorrhage, and sepsis, the U.S. could potentially save between $2.22 and $3.81 billion in direct medical costs annually.
We at Nina Capital have screened over 7,000 companies in the last three years. Of these, 6% are focused on childbirth and fertility. Of these 6%, about 40% of the companies are in the space of Computing and Mobile Health, 12% in In-Vitro Diagnostics, 10% in Connected Sensors and IoT, 7% in Telemedicine, 6% in Wearables, 4% in Marketplace, 2% in Data and Databases, 2% Surgical Instruments, 2% Prosthetics and Implants and 7% in Other. Geographically, 29% of innovations originate from the USA, 19% from the UK, 42% from the rest of Europe, 7% from Israel, and 3% from Canada. There remains significant potential to leverage technology to address gaps in maternal health.
As we dive deeper into this market, based on the knowledge we’ve accrued studying and speaking with many founders, we are most interested in assessing areas of need that drive the biggest impact. We chose a comparable analysis of the US and the UK to identify these needs.
comparable analysis of MATERNAL CARE: US vs UK
Choosing the UK as a comparison to the USA for evaluating maternal health outcomes is insightful due to the distinct differences in their healthcare systems. The UK’s National Health Service (NHS), a publicly funded model providing universal coverage, contrasts sharply with the US’s mixed private and public insurance system, which involves higher out-of-pocket expenses and varied coverage levels. Despite the US investing a higher percentage of GDP into healthcare, its mortality rate is nearly triple that of the UK. This disparity suggests that greater spending does not necessarily lead to better outcomes, highlighting the need to examine how healthcare expenditures are allocated. Both countries face challenges such as long waiting times and workforce shortages, making the UK a useful case study for understanding how different healthcare structures manage similar issues. This comparison sheds light on how different systems handle maternal health, offering valuable lessons for improving care quality and cost-effectiveness.
In comparing maternal care between the U.S. and the UK, several key differences highlight why the UK generally achieves better maternal health outcomes.
Provider Availability and Care Models
In the UK, midwives play a central role in managing normal pregnancies and providing comprehensive care throughout pregnancy, childbirth, and postpartum. This midwifery-led care model has been associated with lower maternal mortality and morbidity rates, as well as fewer interventions such as cesarean sections. In contrast, the U.S. relies more heavily on OB-GYNs, with midwifery care being less accessible and inconsistently covered by insurance. Many high-income countries, including the UK, have higher numbers of midwives and OB-GYNs relative to the number of births, which contributes to better maternal outcomes.
Insurance and Coverage in Postpartum Care
The UK provides universal health insurance covering midwifery and OB-GYN services, ensuring that all women receive comprehensive care without financial barriers. In the U.S., Medicaid covers a significant portion of births but the coverage varies by state, affecting the continuity of care, especially postpartum. The Affordable Care Act (ACA) mandates Medicaid to cover midwifery care, but access remains limited due to low reimbursement rates and state regulations. Many women in the U.S. remain uninsured or underinsured, making postpartum care less accessible and affordable.
continuous care and monitoring in Postpartum Care
Standard practice in the UK includes home visits by midwives or nurses postpartum, which are associated with better mental health outcomes and higher breastfeeding rates. These visits are part of a broader maternal and infant care approach emphasizing support and continuity. In contrast, the U.S. does not guarantee postpartum home visits, although some states offer them to Medicaid beneficiaries. This lack of standardized postpartum care can lead to gaps in support and monitoring after childbirth.
Paid Maternity Leave
The UK provides paid maternity leave, with most employees eligible for at least 39 weeks of paid leave, contributing to better maternal health and recovery. Conversely, the U.S. is the only high-income country without a federally mandated paid maternity leave policy, which places additional strain on new mothers who may need to return to work sooner than medically advisable.
To summarize the differences between the different countries, we have aggregated the information in the following table:
multiple solutions can address the different care gaps in the US and we named a few of them
Given the noticeable care gaps that contribute to the increased likelihood of maternal death in the US, we are looking for solutions that will close the gaps and empower providers to deliver better care to women.
drivers for enhanced accessibility, consistency and standardization of personalized maternal care: the PATIENTS perspective
access to care and early detection. Better access to continuous monitoring by increasing the capacity of care providers such as midwives and nurses or enabling remote monitoring tools may improve the quality of care and reduce the risk of late diagnosis for situations needing immediate intervention. This is regardless of location: increasing capacity and access to providers in remote areas is key. Integrating virtual platforms that enhance the capacity of midwives and other complementary care providers ensures the delivery of consistent care and timely advice, overcoming the challenges of geographic isolation. Monitoring tools have been primarily focused on the fetus’s health, while the mother’s health is often neglected. Continuous monitoring with early detection of potential health problems is also key to enabling timely interventions by providers.
improved access to Postpartum Care. 52% of deaths occur after delivery. Access to continuous monitoring and holistic support, including home visits and mental health resources after birth: A new mother requires both physical and emotional support during the postpartum period. Leaving the house postpartum is challenging for any new mother who is, in most cases, left alone with a newborn while still physically recovering. Enabling home visits by healthcare professionals, remote monitoring, and access to mental health resources may reduce the waiting time to perform necessary, timely interventions and reduce the risk of postpartum complications resulting in death.
transparency: Empowering Patients with Knowledge. Access to interactive, real-time educational resources that support informed decision-making: Expecting parents need timely and relevant information about pregnancy and childbirth. Often people find themselves dependent on their community and network for pregnancy-related information. This information may often be misleading and lacks clinical grounds. Enabling a way to provide people with trusted information personalized to their needs is key to improving care and empowering people to demand immediate interventions when needed and when any other clinical resources are lacking.
mental health and pregnancy. Approximately 1 in 8 women in the US experience postpartum depression (PPD). Postpartum depression can often be diagnosed early, as early as during the pregnancy. There is a need to identify the risk factors early to reduce the load of PPD. Community might not be the best tool for obtaining data to support clinical decisions, but it is crucial for identifying and reducing the risk of PPD. Fostering peer support and community connections may reduce the overall risks without overloading providers.
standardization of care delivery. Reliable and uniform care standards across different healthcare providers can reduce the risk of mistakes when providing care across every specialty. Standardized practices enable providers to adopt objective measurements and ensure consistent, high-quality care regardless of different insurance coverages and social backgrounds.
drivers for improved care and reduced risk of maternal death: the PROVIDERS perspective
standardization of care delivery. Standardizing care improves operational efficiency and significantly reduces costs associated with errors, variability in care, and potential legal liabilities. Effective implementation of standardized protocols can help manage preventable maternal conditions such as hypertensive disorders, gestational diabetes mellitus, hemorrhage, and sepsis, thereby lowering direct medical costs and improving overall patient outcomes. Standardization will enable providers to adopt automation tools and centralize patient information more easily. Thus potentially lowering administrative costs by reducing the need for repeated interventions, unnecessary testing, and inefficient workflows.
SUMMARY
The biggest opportunity for improvement lies in integrating patient-facing and provider-facing technologies to create a cohesive care coordination platform through standardization of care in the US healthcare system. However, without regulators’ support, this change is hard to implement.
Multiple gaps in maternity care are driving an increased maternal death ratio in the US when compared to other countries. Improving access to constant monitoring and alternative care providers is critical to enabling both prevention and early diagnosis that may reduce maternal death ratios and align the US with the rest of the world.
There is a vast opportunity for innovation in healthcare, so if you are a founder working on building something that alleviates any of these needs, please contact us at Nina Capital.
We are looking forward to meeting you.
