Mass. General Brigham launches mobile postnatal care unit

“Our overall work in our clinical community portfolio of work is really about how we bring our high quality, brick-and-mortar care closer to where individuals live, work, and play,” said Dr. Allison Bryant, associate chief health equity officer at Mass General Brigham.

Making wraparound health services more accessible in the weeks after childbirth — when a new mother is less likely to monitor her own health — for moms that are least able to access it, the program’s practitioners say, can be a matter of life or death.

“It sort of reminds me of when you board the airplane, how they always say if you have a child and the [oxygen] masks drop, you should put yours on and then care for your child,” said Dr. Priya Sarin Gupta, medical director for clinical community programs at Mass General Brigham. “We know that healthier moms will help their families and their babies.”

The mobile postnatal care unit is emerging in a region with proven maternal health disparities. In Massachusetts, Black women have the highest rate of severe maternal morbidity, or life-threatening health complications that occur after childbirth, according to a Boston Indicators reportpublished earlier this year.

As recent as 2020, out of every 10,000 deliveries by Black women, 191 resulted in severe maternal morbidity, or SMM, the report showed. That’s the highest such rate among all races and ethnicities. Asian and Latina women are closest with rates of 115 and 112, respectively, and it’s more than double the rate of white women. (Due to the small sample size, there isn’t enough data on SMM rates for Indigenous women in the same year, but they experienced roughly 79 SMM cases for every 10,000 deliveries between 2011 and 2020.)

The idea for mobile services emerged during the pandemic. Sarin Gupta said Mass General Brigham would announce vaccination and testing services at public sites in communities hit hardest by COVID, but they weren’t successful as they could’ve been.

“We were just noticing that even when we had the system [in place], even when we had put up these pop-up COVID clinics, still people weren’t coming,” Sarin Gupta said.

Around the same time, the hospital had launched its United Against Racism initiative to address health inequities, and honed in on four health crises to tackle: colon cancer, hypertension, substance use disorder, and maternal health. From that effort emerged the hospital’s Birth Partners program, which has paired 180 high-risk moms with doulas since 2021. Based on individual patient outcomes, Birth Partners has addressed some existing maternal health disparities by reducing Black women’s cesarean section rates, which often lead to health complications.

But Mass General Brigham thought they could do more, Sarin Gupta said, by bringing “them a DPH-licensed clinic on wheels.”

The mobile care van has treated roughly 40 moms in its medically-equipped camper vans since its May launch. Mass General Brigham hopes to enroll 100 moms in the program within its first year, but that’s just a start.

Mass General Brigham’s program isn’t a novel idea; it’s joining a growing number of hospitals nationwide who have started similar programs in recent years. Last year, Boston Medical Center and the Celtics launched Curbside Care to provide postnatal appointments for both mothers and children in the first six weeks after childbirth. March of Dimes, a national maternal health nonprofit, has also launched mobile care units in Arizona, New York, Ohio, and Washington, D.C.

Postpartum patients referred to the program are those that live within a five-mile radius of Mass General Hospital or Brigham and Women’s medical centers. All of the program participants are high risk, meaning that they had hypertensive disorders or non-gestational diabetes during pregnancy, as well as a high likelihood of developing postpartum depression or mood disorders.

The program’s goal was to “think about individuals who might need an extra touch in that postpartum period,” Bryant said.

Moms are scattered throughout Boston and its neighboring cities. Many live in Dorchester, East Boston, Hyde Park, and Roslindale. A few are also in Chelsea and Revere. Most of them speak English, and a fraction of them speak Spanish and Haitian Creole. Mass General Brigham’s providers make their rounds every Monday and Thursday on 9-hour shifts, and visit roughly five patients across the metropolitan each day, Sarin Gupta said.

It is unclear how many patients might be enrolled in both initiatives, but Bryant and Sarin Gupta said the medical team is ironing out how to create a pipeline for moms to partake in both. Ieshia Lee, a private doula on contract with Birth Partners, said that giving moms of color access to doula and mobile care could be impactful.

There, “they would have a no judgement zone,” Lee said. “They won’t feel like they’re going in the hospital, and maybe their anxiety won’t be as heightened.”

The new initiative is still figuring out how they can best meet high risk moms’ needs. Some moms would prefer that the healthcare team attends to them in their own home, and others would prefer to meet at a middle point. They’re figuring out ways that they can spread the word to more Boston moms by making information available in more languages. And the mobile care van’s schedule is dependent on Boston traffic, meaning that appointments can run as much as a half-hour behind.

That was the case during the mobile van’s four-person team during a recent Thursday afternoon run. The drive from Anyely’s appointment in Dorchester to the next visit in Roslindale took roughly 40 minutes. Moments after the medical camper parked along the busy throughway, Jeandri, a mother who recently emigrated from Venezuela, entered the exam room.

Sarah Enteen, a registered midwife nurse, checked Jeandri’s vitals. The first time mother’s blood pressure and heart rate were impeccable. But her living situation hung heavy.

Tearing up, Jeandri, with the help of a Spanish interpreter, said the burdens of motherhood and settling in America were taking their toll. She was working several hours, and pumping breast milk for her baby during her breaks. Her son’s father was doing as much as he could, but they weren’t sure how long they would be able to stay in their semi-basement unit.

Seyda Kilic, a Mass General Brigham community health worker, scribbled information for the HomeBASE emergency assistance program on a sheet.

“I understand that you’re going through some very emotional times, but you seem very strong and like you’re handling it well,” Kilic said. “You’re not alone in this.”

Jeandri descended the camper van’s steps and ducked into the pouring rain once again, heading towards the exciting, yet tumultuous task of motherhood.

This story was produced by the Globe’s Money, Power, Inequality team, which covers the racial wealth gap in Greater Boston. You can sign up for the newsletter here.

Tiana Woodard can be reached at [email protected]. Follow her @tianarochon.