Brainstorm Health 2024: The State of Postpartum Care
Dr. Christina Harris, Vice President and Chief Health Equity Officer, Cedars-Sinai Medical Center Leslie Schrock, Author, Bumpin': The Modern Guide to Pregnancy; Fertility Rules; Investor; Advisor, Maven Clinic, Alife, Origin, Reverence Dr. Alice Zheng, Principal, RH Capital Moderator: Deena Shakir, Lux Capital
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00:00 Hello everyone
00:02 So happy to be here again, you know last year when we had a discussion on maternal health
00:06 It was a special moment for me because I announced my pregnancy on stage and here I am
00:11 Postpartum for the postpartum care panel. So thank you all for joining me today
00:16 It's such an important conversation and we have an incredible group of women here to address it
00:21 So I want to start with my good friend Leslie who is known for many things
00:27 Including two best-selling books one on fertility called fertility rules and one on pregnancy called bumpin
00:34 But we're here today to talk about neither of those things. We're here to talk about the thing that comes afterwards
00:39 Which is postpartum so talk to me about perhaps what might be your next book
00:44 What does postpartum mean in the context of this conversation? Well, so I'm actually really fortunate
00:50 I am updating bumpin currently, so it's coming out in its second edition in January and
00:56 It was published five years ago, and I'm really sorry to say that not that much has changed in five years
01:01 80% of maternal mortality is avoidable and that stat has stood for the five years that I have been writing about this topic
01:09 Thinking about this topic it became very clear to me in revisiting this material that the big gap actually was
01:16 For most people what happens in the postpartum period the unfortunate surprises we all encounter weird hair stuff, you know sweating
01:24 incontinence all of that, but also
01:27 Really I know you've never talked about this publicly, but I actually revised my book
01:33 To reflect an experience that the Dina had that she's never really spoken about
01:40 but
01:42 Do you want to?
01:43 Sure. Well, I guess the moderator is gonna spend a few minutes talking about an experience that happened to me
01:48 so I just had my third child and
01:51 eight days postpartum
01:55 Was back in the hospital with severe postpartum preeclampsia
01:59 And almost didn't make it
02:02 So as someone who you know lives and breathes health care
02:05 We're here today in the bastion of privilege with access to you know
02:08 Many ob-gyn's on speed dial when I was admitted to the hospital
02:12 I was told I was minutes away from having stroked out and having had absolutely no
02:18 Pre-existing conditions that would have contributed to that and if I wasn't someone who lived and breathed health care who recognized those signs
02:25 I wouldn't have made it
02:27 And so for me that was just another moment that makes us realize why what we do is so important and also, you know
02:33 Just how many?
02:35 People who don't have those access and don't have those resources are at risk and how much of maternal mortality actually happens postpartum
02:42 So with that I want to turn it to you Christina to talk about a topic last year
02:47 We had a whole panel on the black maternal health crisis. I don't think enough has improved
02:52 It's still a critical topic where black women in America are three to four times more likely to die in childbirth and afterwards
02:59 Tell us a bit about some of the work that that you're doing in the health equity space to address these challenges
03:04 Particularly in the context of postpartum. Yeah
03:06 Thank you for sharing your story
03:08 I think about you know
03:10 Situations like this all the time as the only physician in my family and feeling these calls from my friends
03:15 And I think how lucky you know, we are to have me and my family and to be able to answer these questions
03:20 But so many women don't
03:22 And for you know one statistic that I think is very important as we think about
03:26 The the challenges that we're facing in the black equity space is the fact that 40%
03:32 At least 40% of our births in this country are to women with Medicaid
03:37 That's astonishing if you are a black woman, that's 65%
03:41 So in our in my role at the Cedar Sinai, I think a lot about access to care
03:46 I think a lot about the innovative things that we'll hear about later and that we're producing to help close this gap
03:52 And I think is this going to be available to the women that need it most?
03:55 You know when you really think about these inequities, unfortunately, we are in America
03:59 It follows socioeconomic lines
04:01 And if we're not thinking about how we meet the needs of those who don't have access and don't have the means and don't have the education
04:08 Then we're really gonna miss the mark
04:11 Absolutely. Well, you alluded to some innovations in this space and we've got a fellow VC here on the panel Alice who?
04:17 Invests with a fund that focuses specifically on women's health and I know I think a third of those investments are in maternal health
04:25 So tell us a little bit give us some bright spots some some things to look forward to
04:29 What are some of the innovations that you're seeing in the areas?
04:31 You're excited about investing in and particularly in the in the postpartum space sure
04:35 Yeah
04:35 You know
04:35 We've made over 20 investments and indeed one third of that is in maternal health and there's different solutions
04:41 To different parts of the problem. So we have a couple companies that are in devices
04:45 For delivery as well as prenatal monitoring in terms of postpartum care
04:50 Four of our companies are delivering some type of care around that period this includes a virtual mental health care like virtual therapy
04:58 as well as doula support
05:01 maternity navigators and
05:03 Actually, I'll call out one company in particular called Millie and we're excited about this company because they have postpartum care that I've actually never
05:09 Seen anywhere else
05:10 So they actually have a midwife for a model and you get a visit in your home within a few days of discharge from the hospital
05:18 Another visit two or three weeks later and this is all before the six-week visit
05:22 Which is all you get in the US and most women a lot of women actually miss that visit
05:25 and we know that this matters because over half of maternal deaths actually occur between seven days out up to a year and another quarter actually
05:33 Occurs in that period if you add in delivery through the first seven days
05:37 So the post random period is really critical to the maternal health experience. And that's why it's a fun. We look at that quite closely
05:44 One last comment I'll make in terms of Medicaid is that's a huge part of our investment strategy as well
05:49 So all four care delivery companies actually accept Medicaid
05:52 One of them actually has an exclusive Medicaid strategy and there are some investors who might ask how could you make that work?
05:58 But you can make it work financially and you'd be missing half the market if you don't do that
06:02 so
06:04 Anyone who's following elections knows that women's health has actually made it to the top of the agenda
06:08 For the US election in many ways and and related to that there have been efforts by the current administration to address not only the maternal
06:17 mortality
06:18 Crisis that we have in this country, but also the gap in women's health research Leslie
06:23 I know you've been involved in some of these efforts coming out of the White House
06:25 Could you share a little bit about the the plans coming out of these discussions?
06:29 Absolutely. I don't think that the core problems are unknown at this point. I don't think anyone
06:36 can say with a straight face that we don't all know that paid leave is a necessary part of the solution and
06:43 Extending the hours one can access care which is so critical, especially in the populations
06:48 We're talking about, you know, if you can only do it nine to five and you're a shift worker
06:51 How are you supposed to access prenatal care?
06:54 so I was actually very fortunate to be part of the maternal mental health task force that HHS and OS and a lot of other
07:01 Various acronyms within government are putting together and we just put out a report to Congress
07:07 actually last week and
07:10 Many of the solutions are things that we know right? It's it is paid leave
07:13 It's better access to a more diverse set of you know providers. It's providers that look like the patients themselves
07:20 It's increased access to midwives doulas all of those
07:22 But I am actually really excited about the ARPA-H as well the real commitment to
07:28 Research in these areas because the sad truth of it is, you know as as we just heard from Dina
07:33 We don't even know what causes postpartum preeclampsia
07:36 We don't really know what causes prenatal preeclampsia with but which by the way, I also had 38 weeks
07:42 I had preeclampsia and help syndrome with my with my second son. No one really understood why they're either
07:47 So I think that you know, we know that as women go into pregnancy, they're unhealthier than ever
07:53 They have more chronic conditions comorbidities things that really cause these complications to you know
07:59 Be more likely but we still don't actually know so ARPA-H
08:03 I think it's like 65 million dollars that's been earmarked for women's health research
08:07 They tried to make the grant process easier for companies
08:10 Which as we know is a very big barrier for many of these startups that have very limited resources
08:14 But to anyone who's building in this space, you know as someone who's been working in it for a long time
08:20 I would really encourage you to take policy seriously
08:23 There is only so much that we in the private sector can do without working with government and there is a real
08:30 willingness
08:31 Among folks in government right now to work together with the private sector
08:35 And if you want to know who those people are come find me afterwards
08:38 I'm happy to connect you but I would encourage you to have someone on your team who actually is, you know
08:43 Understands that world because that's the only way anything is really going to change
08:47 I'm just gonna say it's like just thank you so much for sharing
08:52 It's really an incredible time to be in medicine and thinking about this space for so long
08:57 I mean, I'm a physician and in some ways medicine looks very similar than it did a very long time ago
09:02 But you know as I think about health equity
09:04 It's truly just patient-centered care like giving people what they need and everybody needs something a little different
09:11 Somebody might need a doula
09:12 Maybe I don't need a doula and we're asking different questions and we're looking at our data differently to understand the differences that are inherent
09:20 Between us and make a difference in our outcomes
09:22 And then we're taking the opportunity to innovate on that
09:26 And so I agree getting involved from a policy standpoint is amazing
09:30 and so so necessary and you know, really thinking about how are we designing to
09:37 Solve these very intractable problems and I'm thinking about health inequities that if it was a simple solution
09:44 We would have been done it
09:45 It takes everybody in this room to think about something differently and think about how we're designing for everybody
09:52 and allowing access
09:55 Innovations through pair diversity racial and ethnic diversity and how we're getting it out to the people
09:59 Absolutely jumping on the policy. I do feel like in this country
10:03 It's a tale of two cities on one hand. You have the White House jumping all in it's amazing. There's an ARPA age grant
10:09 There's the executive order for women's health
10:11 Jill Biden is going around to lots of events speaking about it and that's incredible
10:15 We've never had an administration have this much
10:17 Interest in women's health on the other hand women's rights are being rolled back on a number of geographies and you know as investors the way
10:23 We think about it is no matter what side of the debate you're on in terms of women's others reproductive rights
10:29 It's gonna have a huge impact on maternal health. We need to prevent more pregnancies
10:33 We need to treat pregnant women better because there will be more of them no matter what
10:37 Going back to you know, some of the data around maternal mortality
10:41 What would you identify as the primary driver in in a in a country where we have so much technology?
10:48 We have advancements certainly there are policy
10:51 Regresses as well as progresses that have been made. Why is it that maternal mortality has only
10:56 actually gotten worse I
10:59 Think we have to think about how we as a country support our women
11:06 Or maybe how we don't support our women. How do we meet the mental health needs?
11:10 Unfortunately mental health and substance abuse is one of the largest drivers of mortality
11:15 I don't know if anyone has tried to find a therapist or psychiatrist lately. I have a commercial PPO
11:20 It is not easy right and so for those patients that I care for that have Medicaid, it's virtually impossible
11:25 And that's a problem because what we know what happens when mental health and substance abuse goes unchecked and then you throw in a newborn
11:32 Baby, I mean, it's literally a recipe for disaster
11:35 and so I mean that's we have to do things differently, it's
11:40 I've spoken to thousands of women in the last five years thousands of pregnant women postpartum women women
11:47 I'm you know going through fertility journeys and what's very clear is we not only don't know the basics of our own bodies
11:53 We also don't know how to know if something is wrong, you know
11:57 You knew that you felt off you knew you had a headache that wasn't going away and you had
12:02 The wherewithal to reach out to people and to say I don't know if this is right for so many women who end up
12:09 You know dying postpartum because of preeclampsia or something else
12:13 They don't even know what to look for. They pass it off as oh, I'm just tired because the baby's not sleeping and whatever
12:20 I'm supposed to feel weird because you know, I'm postpartum and that is simply unacceptable
12:24 I had to one of the decisions I had to make as a writer
12:28 Everybody wants a pregnancy book
12:30 What to expect when you're expecting has soul has been in like the top 100 on Amazon for a million years
12:36 And there's a good reason why every pregnant woman wants a book
12:39 So when I revisited this content, I had a decision to make how scary do I want to be in this book?
12:44 And I have received notes from readers over the years who have told me
12:49 Actually, like you saying this thing about miscarriage has really like changed my life you writing about your experience openly
12:56 And I have to say like Dina when you went through what you did. I made a decision. I actually like lovingly referred
13:03 It's the Dina page. I had to make a decision and say you know what?
13:07 Even if it's a little bit scary if I can save a life by putting a page of postpartum warning signs
13:13 Into this book that has been sitting on someone's bedside table for nine months that they trust and they like
13:19 That is something I'm willing to do even if it does feel a little scary
13:23 But women just simply aren't told they're discharged with like a piece of paper and that's all they ever get and then they pass it off
13:29 Because either they feel gas lit they feel like oh, it's just not sleeping
13:33 They think it's just completely fine, and it's not fine like if you find yourself in this situation
13:38 You should always call for help again like I think the asynchronous support telemedicine more flexible formats
13:44 It's why innovation is so important like Millie what Millie is doing
13:47 I think is so powerful this for this reason and there's absolutely a gap between
13:50 When the morbidity and mortality is occurring and when care is delivered so you know once you have the baby you're home
13:57 There's really very little clinical care whether asynchronous or live, and that's that's a huge gap in a driver
14:03 I want to we have a few minutes left
14:05 And I want us to share some glimmers of hope here things that we are excited about
14:09 We touched on Medicaid, and I think one of the exciting things about Medicaid
14:12 Innovation in general is that when you're looking at a value-based care space and you're designing for outcomes
14:18 The data drives the innovation and we've seen much more reimbursement of things like doulas for example in Medicaid
14:25 That would actually are harder to get reimbursements for in a fee-for-service model
14:29 Would love for each of you to share maybe one or two things that give you hope that you're excited about when it comes
14:34 to women's health and postpartum care
14:36 One thing I'm excited about is that in 47 states and more to come
14:42 There's expanded Medicaid coverage after delivery for 12 months, and that's that's I think it's amazing absolutely
14:49 I will say in the last five years one thing that has been a positive
14:52 Change is when I used to ask people if they were getting a doula they would say what is that?
14:57 Nobody knew what a doula was
14:59 And actually there was a lot of misinformation even about midwifery which I find is really changing
15:04 I think like a lot of people understand whether it's because people in Hollywood talk about their doulas, or we're just having more conversation
15:11 but I think the role of doulas and the
15:13 Tremendously improved outcomes that happen when you have a doula or a midwife as part of your coordinated care team is now something people no
15:21 Longer debate it is just an accepted fact
15:23 And I will say thinking about the the mental health task force that just came out in the recommendations the idea that
15:30 Someone is writing down that six months of paid. You know paternal care or leave is
15:37 Incredible the statistic is insane
15:40 25% of working women go back to work within ten days of having a baby
15:47 And then you want me to follow up with my primary care and the postpartum like that's impossible
15:52 And so you know the idea that we will be able to protect our
15:56 Birthing people to be able to spend time on themselves and on their babies. Hopefully is incredible
16:03 And California's made some strides in that standpoint. I know we have a long way to go, but it's so necessary
16:08 And I will say the fact that we're having this conversation on this stage right now gives me a lot of hope so thank you
16:14 To all three of you and to all of you for your time and attention and I appreciate it. Thank you
16:19 [applause]
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