Time, Trust, and Technology in Maternal Care

Dr. Jo'Ann Jackson:
As the OB-GYN, I'm often the point person for all of the patient's concerns. Right? So whether she's having challenges with mood or with breastfeeding or she has anxiety, those are all things where I can give advice, but I'm not necessarily the most thoroughly informed person. So a doula, to be able to support a family with their childbirth education needs, their emotional support needs during labor, their post-partum care, I can't be that for all of those patients, but I know just from my years of experience that those are all critical tools.

Jennifer Sargent:
Welcome to Maternity Reimagined, a podcast exploring the future of maternal healthcare through the lens of innovation and human connection. I'm Jennifer Sargent, and each episode, I'll be speaking with healthcare leaders, providers and change makers who are working to transform how we support expecting parents and families, from hybrid care models and emerging technologies to policy shifts and real-world solutions. We'll uncover insights that are shaping a more connected, accessible future for maternal care. Whether you're a healthcare leader, provider, or just passionate about advancing maternal health, this podcast is for you. Join me as we reimagine what maternal healthcare can and should be.
We are back with another episode of Maternity Reimagined. I'm your host, Jennifer Sargent, and I'm here today with Dr. Jo'Ann Jackson, Chief Medical Officer at Advantia for the Mid-Atlantic Region. She's here to share with us some frontline insights and perspectives about the maternal healthcare journey, what types of partnerships and solutions she's adopted into her own practice to improve maternal health outcomes, experiences and patient satisfaction. I've been so excited about this conversation and really looking forward to getting your perspective as a provider. So we'll go ahead and jump in.

Dr. Jo'Ann Jackson:
Hi, Jennifer. Thank you so much for having me. I've, like you said, been looking forward to this. It's great talking to you as always.

Jennifer Sargent:
Why don't we start with a broad question? As an OB-GYN, what are your biggest challenges that you face today in supporting expectant and new parents in your practice?

Dr. Jo'Ann Jackson:
Honestly, I had to answer this question for somebody recently and I realized it all kind of boils down to time. The challenge that we face is that there is a shrinking pool of qualified OB-GYN providers, but the pool of patients who are seeking to have safe births is not shrinking at the same rate. So we're finding ourselves with fewer trained providers trying to care for patients, while somehow providing the same quality of care. So it creates a little bit of a time crunch. Just in my even day-to-day office, attempting to get through a number of visits in a fixed amount of time is challenging, when each of those visits in its own right probably deserves 30, 45, 60 minutes, but it's allotted 15 on a generous day. Right? That makes it very difficult to build relationships and answer questions and provide reassurance.
Unfortunately, we have time in the sense that we have multiple visits over the course of the pregnancy, but oftentimes, I find that I often wish it was more. I wish we had that opportunity to really sit there and provide all of the education that families are looking for and answer all of their questions in the moment as the questions come up. So that's one of the things that I think I struggle with the most right now. It's obviously going to be different in different areas of the country, and there's obviously areas where the resource limitations are quite significant, where it's way beyond what you and I are talking about today, but that's a simple answer.

Jennifer Sargent:
Simple answer, but a complicated problem, for sure. Well, maybe related to that point or just in general, as you think about the challenges, what are some of the tools or technologies or additional partners that Advantia is focused on incorporating into your care delivery practice to support maternal health?

Dr. Jo'Ann Jackson:
Yeah, one of the things that I'm really excited about, we started trialing different options for scribing tools over the past couple of years, and over this past year have really formed a strong partnership with one company that has an AI scribe tool. And it sounds like a simple thing, but what it does is it allows me to spend more of those 15 minutes talking to the patient and talking to the family, rather than writing a note. Something as simple as using technology to listen to the conversation and provide me with a summary at the end, and also provide the patient with a summary, so that I'm not having to sit there and type it up. That really has been a game changer. I think it's improved the quality of the interactions that I can have with patients because it's given me back a little bit of that time that I use to document the visit.
And then on the more backend part that the patients don't see, we're also exploring options to help with a lot of the administrative work that our providers have to do. So things like coding a visit and billing a visit, submitting things to insurance. There's a lot of work that happens on the backend, creating orders, creating referrals. So we're definitely exploring all the technology tools that we can identify that would add meaningful quality to the patient experience, take some of that burden off the providers so that then they have that time to spend with the patients, and hopefully the end result will be a higher quality of care all around.

Jennifer Sargent:
That's great. When you think about wraparound, maybe services related to provider types that you maybe don't have in the office, think about lactation, behavioral health. I know we'll talk about doula because Pacify is in that space, but how do you think about potential partnerships? How do you vet them to make sure they're good quality? How do you integrate them into the referral workflow? How do you think about that space?

Dr. Jo'Ann Jackson:
Yeah, all of those providers are critical to what we do because as the OB-GYN, I'm often the point person for all of the patient's concerns. Right? So whether she's having challenges with mood or with breastfeeding or she has anxiety about how she wants her birth to go, those are all things where I can have input and I can give advice, but I'm not necessarily the most thoroughly informed person. For instance, if a patient is having a breastfeeding challenge, yes, I know a lot about breastfeeding, but I'm never going to know as much as a trained lactation consultant. Right? I can give patients advice on mental wellness issues, but I am never going to take the role of a trained therapist, a qualified psychiatrist. So a doula, to be able to support a family with their childbirth education needs, their emotional support needs during labor, their postpartum care, I can't be that for all of those patients, but I know just from my years of experience that those are all critical tools for things that almost every pregnant patient should have access to pelvic floor therapy.
There's so many parts of what makes a healthy pregnancy journey, a healthy birth experience, a healthy postpartum journey for mom and for baby. So it's vital for me to have access to all of those resources. And then the next layer becomes finding trusted resources because I can't just say to a patient, "Hey, go see this person. I see they have a shingle out that says they're a therapist." I see it as my responsibility to ensure that whoever I'm partnering with, because my patient trusts me, the reason she's asking me for a referral is because my opinion matters. So I think it's incumbent upon me to make sure that whatever advice I give her is worthwhile.
We put a lot of time and energy into making sure that we vet our referral partnerships quite as thoroughly as we can, and we also listen very closely to patient feedback. I completely understand because not every patient who sees me is going to have a great experience, right? But if I get consistent feedback from a patient that a particular referral partner just is not meeting their needs, that's something I take very seriously. And very often, the way that referral partners will come to our attention is sometimes a patient will be like, "Hey, I met this person, or I saw this person, so-and-so." And I will always ask. If a patient is like, "I found this therapist and I love them," every single time, I ask. If one of my patients finds a primary care doctor that they love, and I add them to my list. And that is how I've built my referral base in the area where I practice for the past 25 years, largely word of mouth because I understand the value of that.
But yeah, the goal is to have that trusted network of all of these wraparound services that complement what the providers do, that have the capacity to work together as a collective to meet the needs of this population of patients that we all care so deeply about. And it's an evolving task, but that is the job.

Jennifer Sargent:
It sure is, and I think from a Pacify perspective, that's something that's core to how we want to do business is we don't want to add fragmentation into the journey. We want to provide a service that complements and supports the care that they get through their provider. And so for us, the provider relationship is extremely important. And maybe on that point, and shifting gears a little bit, I think doulas have been around for a long time. I think this is getting better and we're hearing it less, but there still is sometimes a bit of resistance from providers in using doulas, perhaps from past experiences, et cetera. Maybe share a little bit more about what your thoughts are related to that dynamic, why that is, is it changing?

Dr. Jo'Ann Jackson:
It's definitely changing, but I'm old enough that I've seen both ends of this, and I think it comes down to trust. Doulas and physicians as examples are trained very, very differently. They have a different area of focus, they have a different skill set. And I think just thinking back to some of my early experiences, I was very fortunate in that where I went to medical school in New York at Albert Einstein College of Medicine, one of the hospitals that I trained at had a very strong midwifery program. So I always say that I was raised by midwives. So I have always worked with providers who had that non-traditional approach to birth.
So for me, it's easy to understand how the different perspectives complement each other. I came down to GW for a residency, and again, they have midwives. Mary Kendall, who was one of the... She's moved out of the country now, but she was this amazing nurse practitioner who was one of the people who helped to train me. So I've always had that knowledge that doulas and midwives and nurses and all of these people are part of the team and that we all complement each other. I think for a provider who was trained in a space where they did not work with folks who have that alternate perspective, I think sometimes there's that hesitation of, "I don't know what this person does and I don't know how their role intersects with mine," and that sort of competitiveness, I think that comes into it.
I think one of the benefits of social media is that now information like that is much more readily available. Even if you have never had the experience of working with a doula or a midwife, you should now have enough exposure to understand that they serve a very vital role and they're an amazing resource, and that if you work together with them, you can actually meet the needs of your patients a lot better. So I think now that that knowledge and awareness is more readily available, it doesn't matter so much the background that a clinician trained in because hopefully they are aware enough to understand that, "This is something I should be open to."
So that's my theory on why it's changing. I know definitely within our practice, we have been very, very fortunate in the DC area where there's always been a strong population of midwives and doulas who we've all had amazing experiences with. So it's an easy sell for me.

Jennifer Sargent:
Right. I know Advantia has practices across the broad DMV area, so Baltimore, DC and Virginia. I also know you have practices in the Midwest. Do you see differences in how doulas are used depending upon the geography across Advantia?

Dr. Jo'Ann Jackson:
Yeah. I've only ever practiced in the Mid-Atlantic, but from just conversations with my colleagues, Dr. Schifano Who is my counterpart, he's our Chief Medical Officer for the Midwest Division, which covers Illinois and Missouri, I do know that from a resource standpoint, they face very, very different challenges, and out of necessity, very different priorities. Obviously, all the patients are just as worthy, right? Everybody needs care. Everybody deserves care. But the difference between a patient in a... For instance, one of our Midwest populations that has a heavier percentage of Medicaid patients, those patients then are more dependent on Medicaid covering doula services in order for them to have access to a doula. Whereas in the Mid-Atlantic, you're more likely to have patients who have commercial pay insurance and have resources to self-pay for a doula. Those are two very different populations of patients with two very different needs, and those doulas are going to serve different roles and functions, but equally vital. Right?
So it becomes a little bit of a question of identifying the urgent need in the population of patients that you serve, and figuring out how to then look at all the resources available to you. Okay, you have physicians, you have midwives, you have nurse practitioners, you have doulas, and how does that team of people then divide and conquer in order to meet the needs of the population that they serve? And that's going to look different in different locations, but that is the job. That's our responsibility to figure that out.

Jennifer Sargent:
You spoke about when we talked about the landscape of providers and doulas working together, changing, and you said a big component of that was building trust, which I completely agree with. What advice would you give an organization like Pacify who has a broad doula network or just doulas in general around how to build that trust, how to develop better relationships and work with providers?

Dr. Jo'Ann Jackson:
Well, I have inside information because I've had the privilege of working with the Pacify team, and I think what you guys do very well is just be yourselves. Every single person I've met on your team is an amazing human who obviously cares very deeply about patients, and I think as a physician, that resonates with me. That's what builds that trust, knowing that this person is coming from a place of genuine caring, and you guys have always led by asking, "How can we help? What is it that your patients need?" And that's the thing that I have appreciated working with the Pacify team. And that would be my advice to any doula, really form a team with the clinicians that you're working with because I promise they need you. They absolutely need you, but it may take a conversation between the two of you to figure out, well, what is that need and how is it best served?
The thing that a clinician or a patient in space A may need, it might be very, very different from what a clinician, a patient in space B might need. So I think being flexible, being open, really communicating and understanding that we as the healthcare providers, the doulas, the nurse practitioners, the midwives, the physicians, we all need to be a team, and it's on us to figure out how to build that team.

Jennifer Sargent:
Yeah, that's great. Maybe shift gears and talk a little bit about the fourth trimester. I think the good thing that increased focus on that, and I always describe when I became a mom for the first time, you're pregnant and everybody's excited and they want to support you, and then you have the baby and they're like, "Yeah, you had the baby." And then you go home, you're like, "What just happened to me and my life?" Right? And it's such a critical time to get support for the new parents. Can you maybe share a little bit about how you think about that, some of the services and support you provide through Advantia?

Dr. Jo'Ann Jackson:
That is honestly one of the areas where I think there's such a huge role for doulas because it's just not built into the typical healthcare model. I was having this conversation with a patient who was pregnant with her first child, and she was like, "But what do you mean I only get one postpartum visit afterwards?" I was like, "That's it. According to the powers that be, who provide your healthcare insurance and have a contract with my practice or any other practice to provide care for you. After a C-section, you get two visits. After a vaginal delivery, you get one." Do I think that's adequate? Absolutely not. Right? But the resource simply is not there. And again, I am very privileged to practice in a population where we have resources and we can provide services, but it's very, very common in other parts of the country that patients never get seen for even a single postpartum visit.
So this is where I think having doulas and lactation consultants and night nurses and all of the behavioral health specialists, all of the other resources that can continue to support that patient and remain available to them, but in my world, it's fairly limited. If the patient reaches out, if she flags a concern, obviously if she has a complication, that's very, very different. But I worry a lot about the patients who struggle in silence, who don't know to reach out and say, "Hey, my mood is low," and I don't know what the answer to that is. I agree that it's something we need to address, but I think it's something that as a country, we have to make the decision to pour resources into, and that's not happening right now.

Jennifer Sargent:
Yeah, I agree. I think we have a big focus on trying to get our doulas to engage with a new parent within a week of their birth, and sometimes, and oftentimes we'll be talking to them even before their postpartum appointment. And so it's a really good connection point for us to be able to assess how that new parent is doing and potentially get them connected into care and reinforce the importance of making sure they get their postpartum visit with their provider as well.

Dr. Jo'Ann Jackson:
Yeah, I would love to see an evolution to the model where patients had more coverage postpartum and more resources, but that is, as you said earlier, a complicated problem.

Jennifer Sargent:
Well, anything else that you'd like to share about what you're thinking needs to be improved or reimagined in maternal health?

Dr. Jo'Ann Jackson:
Well, I'm encouraged by some of the recent changes that ACOG proposed, which gives I think a little bit more flexibility. Telemedicine has been really helpful for a lot of my patients because that's always been one of the challenges, right? When you're pregnant, you have to come in for all of these visits, but you also have a job and carving out large portions of your day to come in for visits that sometimes are very quick and very routine can be difficult. So I think things like us leaning into telehealth, which again, complicated issue because coverage for that is maybe going away, which I think would do great harm to a lot of patients, but especially to our obstetric patients, because that means we're right back to them having to come in for every single visit.
Things like more coverage for the postpartum visits, like we were talking about, better access to mental wellness and all of the... Pelvic floor therapy. That's something I would love to see every single pregnant person have access to. It should not be a question. It should just be part of your, "Here's what happens." Doula services, the fact that patients in my population have to pay for it because most commercial payers don't cover it. I could go on.

Jennifer Sargent:
Well, I agree with everything you shared, and I guess the good news is there's still lots of opportunity for us to make a positive impact and see changes.

Dr. Jo'Ann Jackson:
Yes.

Jennifer Sargent:
Well, Dr. Jackson, thank you so much for joining us today on Maternity Reimagined. I really enjoyed the conversation and really appreciate the approach that you take in supporting maternal health and partnering with us at Pacify.

Dr. Jo'Ann Jackson:
Thank you, Jennifer, and thank you for all of the good work that you and your team are doing. It's been amazing to watch you guys grow, and I look forward to continuing to partner with you.

Jennifer Sargent:
Thank you.

Dr. Jo'Ann Jackson:
Thanks for having me.

Jennifer Sargent:
Thank you for listening to Maternity Reimagined. I'm your host, Jennifer Sargent. If today's conversation resonated with you, please subscribe and listen wherever you get your podcasts. And be sure to share this episode with those who like us are passionate about reshaping the future of maternal health. Until next time, as we continue to build bridges and transform maternal care together.