Conventional wisdom says that most maternal deaths in the U.S.—which are two to three times higher than those in other high-income countries—result from cardiovascular conditions such as hypertension and preeclampsia. But researchers who have divided the postpartum time into early (from childbirth to 42 days) and late (43 days until one year) periods have learned that other factors become especially prominent in the second phase, with significant changes in the prevalence of mental health and substance-use related concerns.

“More than 40% of pregnancy-associated deaths in Pennsylvania are attributed to mental health conditions, with substance use disorder as a contributor in most of these,” said LDI Senior Fellow Meredith Matone, director of PolicyLab at Children’s Hospital of Philadelphia and Associate Professor of Pediatrics at Perelman School of Medicine.

Recognizing the importance of this later postpartum time span, Wisconsin officials in February became the 49^th state to extend postpartum care under Medicaid for a full year. But even with enhanced coverage, many services are seriously underused by busy, overburdened new mothers who may have trouble getting to a medical office. The lack of utilization is especially problematic for women of color, who are about three times more likely to die of pregnancy-related causes than others.

“We know there are targeted interventions that could improve the mortality rates,” said LDI Senior Fellow Rebecca Hamm, an Assistant Professor of Obstetrics and Gynecology at the Perelman School of Medicine. Recent innovations focus on increasing the accessibility of services by bringing health care directly to birthing parents—via telehealth, remote monitoring, community health workers, and other strategies.

Telehealth Postpartum Visits Improve Maternal Health Access

“Telehealth for postpartum care has been a game changer,” said Hamm. During the COVID-19 pandemic, a natural experiment occurred when the Department of Obstetrics and Gynecology at Penn began offering postpartum care through telemedicine, via video and audio or audio only. A study by Hamm and colleagues showed that women in the telehealth group had 90% increased odds of attending a postpartum visit compared with those in the earlier in-person-visit group. The telehealth group was also much more likely to get screened for postpartum depression.

Significantly, a follow-up analysis found that the availability of telehealth sessions erased racial disparities in postpartum visits. Before implementation of the virtual service, Black new mothers were less likely than non-Black ones to make it to the OB-GYN’s office (64% vs. 89%). But after the implementation of telehealth, the discrepancy was erased.

What’s Next: An advanced algorithm that identifies new mothers at high risk of going to the emergency room or returning to the hospital within 30 days of giving birth.

Developed by a team led by LDI Senior Fellow Elizabeth Howell, Chair of Obstetrics and Gynecology at the Perelman School of Medicine, the equity-focused score relies on both social and medical determinants. “The risk score was developed from data on New York City births, but we also validated it on different datasets in South Carolina and Florida,” said team member Kimberly Glazer, Assistant Professor of Obstetrics and Gynecology and Epidemiology at Perelman. Identifying new mothers at high risk is the first step in providing interventions to improve their health.

Remote Blood Pressure Monitoring Shows Promise in Maternal Health

Most strokes and maternal morbidity from pregnancy-related hypertension happen within 10 days of childbirth, but few new mothers diagnosed with high blood pressure return to a medical office for testing within that time frame. An innovative and award-winning program, The Heart Safe Motherhood Project, cofounded by LDI Senior Fellow Sindhu Srinivas, Executive Director of Penn Medicine-HUP-Cedar Avenue campus, has successfully confronted the problem by providing twice-daily, text-based remote monitoring of blood pressure to high-risk women in the first 10 days postpartum.

Six months after delivery, the monitored group experienced fewer adverse medical events, emergency room visits, and hospital readmissions than the control group, according to a study in Obstetrics and Gynecology. A secondary analysis in the American Journal of Obstetrics and Gynecology found that remote monitoring eliminated discrepancies in blood pressure ascertainment between Black and non-Black patients. “This is a major success story of Penn research positively impacting racial disparities,” said Hamm.

What’s Next: Remote monitoring of other measurements.

For instance, Hamm, alongside Nadav Schwartz, Professor of Obstetrics and Gynecology at the Hospital of the University of Pennsylvania, is working on a study in which women with high-risk pregnancies wear a belt that does fetal monitoring at home during their last trimester, letting them avoid frequent in-person visits.  “We just finished a 400-person randomized trial, with the goal of showing that home monitoring will result in a significant improvement in disparities around access to care compared to the control group,” said Hamm.

Doulas Postpartum Could Give Key Support for Maternal Health

Doulas are non-medical personnel trained to provide practical advice and emotional support to women before, during, and after childbirth. “A doula hired postpartum might come to a woman’s house and provide, for instance, infant care and feeding education and support,” explained LDI Senior Fellow Rebecca Clark, Assistant Professor of Family and Community Health at Penn Nursing. A Lancet study found that women who used a doula in childbirth had 58% lower odds of postpartum depression and postpartum anxiety than others. LDI Senior Fellow Sindhu Srinivas is currently spearheading a research project on the impact of doulas on maternal care.

Doulas are often hired privately, but payment by Medicaid is becoming more common. According to the Doula Medicaid Project, Medicaid actively reimburses doulas in 22 states and D.C., and in another six states, implementation is in progress. Pennsylvania has yet to fully implement Medicaid coverage for doula services.

What’s Next: Community health workers.

Rebecca Hamm is co-director of AMETHIST@Penn, an NIH-funded effort that serves as a hub for 12 Centers of Excellence providing maternal health services and doing research on equity. AMETHIST supports these projects by providing consultations on how best to perform their studies and engage the local communities in their work.

Some of the more than 25 local projects rely on community health workers to take services directly to clients’ homes.  “Community health workers are trusted members of the community who may not have a medical background but can be trained to do specific tasks at in-home visits, such as health education, blood pressure readings, and facilitating links to necessary medical services,” said Hamm. “Using people already embedded in communities helps to overcome the distrust in the healthcare system common in underserved areas.”

She added, “Researchers are just starting to study community health worker interventions in maternal health at scale.”  While it’s too early for the AMETHIST programs to be evaluated—they are in year three of seven-year projects—other studies have shown the benefits of these workers in different contexts.

Screening for Mother’s Postpartum Depression Could Occur at Well-Child Visits

In the postpartum period, new mothers are much more likely to visit pediatricians for their infants’ health than go to their own providers, according to research at CHOP’s PolicyLab led by LDI Senior Fellow Emily Gregory, Assistant Professor of Pediatrics at the Perelman School of Medicine. Partly for that reason, there’s been a new emphasis in some pediatric practices on treating mothers and infants as dyads—a combination of two parts—rather than focusing solely on young children.

“The most successful effort on that front has been screening for postpartum depression in pediatric settings, which is now reimbursed by Medicaid and private insurers,” said Gregory.  Unfortunately, only 10% of women referred to treatment actually receive it, noted an Academic Pediatrics study coauthored by LDI Senior Fellow Meredith Matone.

What’s Next: Virtual parenting groups for postpartum mothers with depression symptoms.

In a study at PolicyLab led by LDI Senior Fellow James P. Guevara, new mothers who screened positive for mild to moderate depression at pediatric clinics were put into an experimental group (parent training on a Facebook platform, plus an online cognitive behavioral program for depression) or a control group (only the online psychological program). Over the course of three months, depression symptoms fell more quickly for those in the social media group.

Extended-Release Buprenorphine for Opioid Use Postpartum Could Prevent Maternal Deaths

Drug overdoses are a significant cause of death postpartum, especially in the seventh through the 11^th months. While medications for opioid use disorder (MOUD) after childbirth significantly reduce mortality, many women don’t receive them or use them intermittently.  

“Our research shows that a third of women who take MOUD fail to get treatment for 90 or more days,” said LDI Senior Fellow Meredith Matone. One way of boosting availability and continuity is for doctors to prescribe a long-acting, injectable version of buprenorphine rather than a sublingual version that requires multiple daily doses and may not completely eliminate cravings.

In the largest study of its kind to date, the PROUD Clinic, a stand-alone Penn Medicine center for birthing people with substance use issues, examined the effect of injectable buprenorphine on pregnant and postpartum (up to one year) women with SUD.

“We found that the long-acting drug was very effective in increasing uptake of MOUD. It also decreased use of unprescribed opioids and, interestingly, lowered the use of non-opioid unprescribed substances,” said lead study author LDI Senior Fellow Nia Bhadra-Heintz, whose research team included LDI Senior Fellow Margaret Lowenstein. Bhadra-Heintz, Assistant Professor of Obstetrics and Gynecology at the Perelman School of Medicine, is Co-Director (with Navid Roder, Associate Professor of Clinical Family Medicine and Community Health) of the PROUD clinic.

What’s Next: Studying the effect of telehealth MOUD prescribing on rates of maternal mortality and morbidity in the 50 states.

In 2024, the Substance Abuse and Mental Health Services Administration (SAMHSA) finalized a rule adopted during the COVID-19 pandemic that allowed physicians to prescribe medications for opioid use disorder via telemedicine. Matone and team are currently doing a 50-state analysis with Medicaid claims mapping maternal mortality and morbidity in conjunction with state telehealth policies. “We are looking at how changes in accessibility of telehealth for prenatal and postpartum care, and MOUD specifically, relate to changes in maternal morbidity rates at a population level.  Early work suggests that more permissive telehealth policy environments are protective of access to care,” explained Matone.

Improving Access to Postpartum Care in Pennsylvania: Policy Recommendations

Access to health services is an important determinant of postpartum outcomes. But the availability of hospital-based childbirth care has fallen across the U.S., with Pennsylvania being especially hard hit. Between 2010 and 2022, Pennsylvania lost 31 hospitals with childbirth services—a 28% decline across the state and a 46% drop among rural hospitals.

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For Further Reading

“Understanding Postpartum Hospital Use Among Birthing People With Medicaid Insurance,” was published on January 22, 2026, in Obstetrics & Gynecology. Authors include Sarah M. Lindley, Kimberly B. Glazer, Teresa Janevic, Molly Passarella, Angelina Malenda, Natalia N. Egorova, Jennifer Zeitlin, Scott A. Lorch, and Elizabeth A. Howell.

“Navigating Opioid Use Disorder Treatment for Pregnant and Parenting People: Composite Narratives for Policy Action,” was published January 8, 2026 in Substance Abuse Treatment, Prevention, and Policy. Authors include Jennifer Whittaker, Katherine Kellom, Anyun Chatterjee, Rebecka Rosenquist, Douglas Strane and Meredith Matone.

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