Coordinating wraparound postpartum support for new moms in Travis County, TX
Texas has the sixth highest maternal mortality rate in the U.S., with the majority of deaths taking place in the months after birth. In our Service Design class, we identified opportunities to buck this troubling trend within Travis County's CommUnityCare patient population.
Our solution was Mama Care, a community health worker-based model of care and service coordination aiming to improve health outcomes by rightfully putting mothers at the center of their postpartum journey.
(For a fantastic, interactive map of how healthcare is funded in Travis County, check out the Design Institute for Health's Ecosystem of Care.)
MY ROLE
Design research, synthesis, ideation, photography, video editing
TEAM
Amanda Wu, Bonnie Du, Emily Rowe, Julia Taylor, Sandy Rodriguez
DATES
Fall 2020
RESEARCH
Over the course of two weeks, we analyzed current postpartum care standards—or lack thereof—and conducted ten in-depth interviews with new mothers, OB/GYNs, other healthcare providers, and a midwife. Due to COVID-19 precautions, we conducted interviews via Zoom. It became clear that women of all ages and socioeconomic backgrounds are not receiving holistic postpartum care—and providers are not adequately equipped to provide it.
Some research questions we sought to answer:
What do mothers' postpartum support systems (both formal and informal) look like?What resources do expecting mothers have to prepare them for what comes after birth?What are currently the biggest challenges in accessing and delivering quality postpartum care?How would patients and providers change the current postpartum experience?What are the most difficult and best parts of patients' postpartum journeys?How supported do new mothers feel by their providers in the postpartum period? Do they feel as though they have enough check-ups?
“There should be more visits for mom—maybe as many as for baby, even if they’re virtual.”
— New mother
“I don’t ask patients questions I don’t have a good solution for.”
— Provider
SYNTHESIS
From our research into current medical practices and numerous interviews with providers and mothers, we created a journey map of the typical perinatal experience, identifying key pain points, highlights, and opportunities for redesign.
As we analyzed our interview data and the literature, we noticed a trend in routine maternal care: a disproportionate emphasis is placed on the prenatal period. Prenatal visits go from once a month to once a week at the end of pregnancy. After birth, traditional practice is to have one postpartum visit for the mother at six weeks. Meanwhile, separate visits with the pediatrician take up the majority of the schedule. The mother’s wellbeing can become lost in the shuffle. There is a gap in postpartum care and support for the mother, and a lack of coordination in mother and baby's care. Above all, and especially during a pandemic, mothers feel removed from crucial human contact and social support during this time.
We identified themes across our interviews, which led to four main insights about the maternal care journey:
01
Many women feel unprepared for their own physical and mental postpartum recovery.
02
A myriad of barriers to attending postpartum appointments—from transportation to childcare—contribute to gaps in care.
03
A lack of social support for new mothers leads to exhaustion and mental health challenges—while also preventing them from receiving routine care.
04
Obstetricians want the best for their patients, but the systemic tensions of time and money create barriers to patient connection.
In the current maternal care paradigm, new mothers arrive to the postpartum period underprepared, unsupported, and inadequately cared for—with often devastating consequences.
Before we moved into brainstorming, our team settled on three key design criteria, determining that our solution:
Must provide personalized, culturally sensitive support to the mother within the postpartum period
Must not add to providers’ already burdened workload
Must provide services that are accessible to all moms and bridge gaps between various providers
IDEATION
We asked ourselves—how might we:
increase the frequency and value of postpartum touch points for moms without increasing provider burden?
create a sense of community, support, and knowledge exchange among mothers during the postpartum period?
not contribute to a culture that places an ever-growing list of societal expectations on mothers?
Using rapid prototyping, we came up with a wide variety of ideas and digital prototypes. Early on, we agreed that our solution would not solely rely on an app, though it would likely involve some form of technology for communication and information purposes. This was important to us for reasons of accessibility across socioeconomic strata and, well, not every impactful solution needs to be tech-ified.
Educational magazine
Text communication system
Redefining and expanding the postpartum care team
A community health worker program with in-home visits
OB/GYN clinic redesign
PROTOTYPING
We settled on a wraparound community health worker program that helps mothers who want to be supported in the postpartum period by providing in-home visits, a trusted community, and easier access to needed resources. Given the constraints of the pandemic and class duration, we were unable to physically prototype or pilot our service with the community. To illustrate the initial version of the MamaCare service, we created a brief walk-through video (shown above). I co-scripted, photographed, and edited the video.
FEEDBACK
To gather feedback, we shared the video walkthrough with the mothers and providers we had initially interviewed. We knew that mental health was one of the most important aspects of the postpartum period, but it wasn’t until we explained our service’s emphasis on the new mom’s wellbeing that we understood just how sorely this support is needed. The aspects of connectivity, giving space to disclose complicated feelings, and normalizing anxiety seemed to greatly appeal to many of the mothers we spoke to—indicating that this is a common issue.
We decided to shift our focus from general postpartum care to primarily support for mental health and substance abuse treatment. While physical health is still vitally important, if we were to further develop this service prototype and explore piloting it, Mama Care would provide specialized mental health support for new mothers, while serving as the conduit to existing, localized services for everything else.