Every patient, Every time: Breaking down barriers to maternal care access
By Rose L. Horton, MSM, RNC-OB, NEA-BC, CPCHE, FAAN, Founder and CEO of NotOnMyWatch
As a nurse who has spent years caring for mothers and babies, I’ve seen how systemic gaps, bias and social and economic barriers to health place some women at far greater risk. I’ve met mothers who delayed prenatal visits because there was no clinic nearby, families who arrived in labor without an interpreter and patients who feared the hospital itself—fear rooted in past experiences of being judged, dismissed or losing control over their care. These moments happen every day, and they put lives at risk. The numbers reflect this reality: in 2023, the U.S. saw nearly 19 maternal deaths for every 100,000 births,1 the highest of any high-income nation.2 For Black and American Indian/Alaska Native women, this rate is nearly three times higher than for White women.1 The most tragic part: many of these deaths were preventable.3
But data can never tell the whole story. That takes a whole community of clinicians: as nurses, clinical leaders and trusted care staff, we are uniquely positioned to share stories, advocate, and change the narrative to ensure that every patient feels fully seen and cared for, every time.
How collaboration can help bridge care gaps
Care gaps rarely arise from a single cause. As clinicians, we know there are a whole host of factors that determine when, how and even if our patients can make it to an appointment. Transportation and language barriers, social support, existing conditions and resource allocation all make an impact on clinical outcomes.
Fragmented maternity care has an outsized impact on maternal outcomes, not only because of where care is delivered, but also how it is delivered. When care teams are working across silos, inconsistent protocols and rushed handoffs, critical warning signs can be overlooked. Research consistently shows that these breakdowns disproportionately affect Black women and other historically underserved populations, where bias, variability in care delivery and lack of continuity serve to compound existing risk.4,5,6
Access to high-quality maternal care also depends on how well care teams work together. Even the most experienced clinicians can struggle to maintain attentiveness when staffing is thin, burnout is high, or workflows are fragmented. Consistency in high-acuity care, including shared protocols, timely handoffs and clear communication across nurses, physicians and ancillary staff is what keeps small issues from becoming emergencies. When those collaborative systems break down, especially in communities already facing systemic barriers, disparities widen. Strengthening care team coordination and operational readiness can help deliver safer, more equitable outcomes.
Placing nurses at the center of change
I believe nurses have the power to help change the trajectory from the inside-out. We have hands-on experience, insight and the lived perspective that earn attention. I’ve seen bedside nurses create PowerPoints, gather stories and advocate for real change just by showing the “why” behind their ideas.
My company name and the hashtag #NotOnMyWatch was born from this idea, to help build momentum behind this belief that every nurse can make a personal commitment that moves the needle. It is like a mantra to assert at the start of each shift: For the hours I’m caring for you, I will be your advocate. I will be your voice. I see you.
To get started with driving change, ask yourself or your team to reflect on questions like:
- What’s one challenge we face every shift that we’ve just accepted as normal?
- If I could change one thing to make care safer or smoother, what would it be—and why?
These questions may start as personal reflections, but they do so much more: they open the door to advocacy. When you bring those insights to your leaders, you’re not just reporting a problem—you’re offering a solution. And that’s powerful.
This kind of sustained presence and advocacy builds trust and changes outcomes. It’s important to note: I know that such care is demanding. To maintain it without burning out, nurses need support, both from colleagues and from thoughtfully designed systems that keep care consistent and reduce unnecessary cognitive load.
How thoughtfully developed technology extends our impact
For those of us on the frontlines, we know that even the most committed nurse can’t close these gaps alone. That’s why technology has become an essential ally in the highest quality maternal care.
Early warning and predictive tools may help flag risks such as hemorrhage or preeclampsia sooner, granting us a critical window to act earlier and more proactively. Telehealth and remote monitoring solutions may help reduce missed appointments and help patients stay connected when transportation or childcare coverage is a barrier. Real-time data platforms may support continuity across care teams so that every member of the care team is working from the same, most up-to-date information.
But technology is only as equitable as its design. As AI continues to emerge, it offers great potential to support nurses in proactive, life-saving care—but AI is built by humans, and humans hold implicit bias. As we continue to embrace AI models in clinical settings, we have a necessary and awesome opportunity to intentionally train and validate these tools with diverse data sets and input from an array of clinicians, especially those caring for underserved populations. Otherwise, we risk reinforcing the very disparities we are trying to fix.
Transparency will matter more than ever before. We must always ask: Was the tool tested on real patients? Evaluated by a diverse clinical group? Is it designed to learn from new data or simply repeat old patterns? In this way, we can use our voices and our learned experience to ensure the tools we bring in to support our equitable care standards, reinforce rather than undermine them.
For every patient: A shared responsibility
Ensuring safe, equitable births is not the responsibility of any one individual or tool. It requires care teams that listen and respond to patients’ lived experiences, operational systems strong enough to deliver consistent, evidence-based care and technology that is designed and validated to serve every population equally.
From nurses and physicians, doulas, lactation consultants to community health workers and policy leaders, each has a role in creating seamless, respectful care that offers every mother and baby the same bright, healthy start. By combining patient-centered advocacy with inclusive innovation, we can move beyond fragmented care toward a reliable standard that meets every pregnant person where they are. When these elements align, we are doing our collective best to ensure that the everyday reality of maternal care involves supporting fully and advocating equally for every patient, every time.
The author is a GE Healthcare Consultant and was compensated for contributing to this blog. The views expressed are the author’s own and do not necessarily reflect the views of GE HealthCare.
Citations
- Centers for Disease Control and Prevention. (2023). Maternal mortality rates in the United States, 2023 (Health E-Stats). U.S. Department of Health and Human Services. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/Estat-maternal-mortality.pdf
- The Commonwealth Fund. (2024, June). Insights into the U.S. maternal mortality crisis: An international comparison (Issue Brief). https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison
- Centers for Disease Control and Prevention. (n.d.). Preventing pregnancy-related deaths. U.S. Department of Health and Human Services. https://www.cdc.gov/maternal-mortality/preventing-pregnancy-related-deaths/index.html
- Saluja, B., & Bryant, Z. (2021). How implicit bias contributes to racial disparities in maternal morbidity and mortality in the United States. Journal of Women’s Health, 30(2), 270–273. https://doi.org/10.1089/jwh.2020.8874
- Montalmant, K. E., & Ettinger, A. K. (2024). The racial disparities in maternal mortality and impact of structural racism and implicit racial bias on pregnant Black women: A review of the literature. J Racial Ethn Health Disparities. https://pubmed.ncbi.nlm.nih.gov/37957536/
- Centers for Disease Control and Prevention. (2019). Racial and ethnic disparities in maternal mortality in the United States. Morbidity and Mortality Weekly Report (MMWR), 68(35), 762–765. https://www.cdc.gov/mmwr/volumes/68/wr/mm6835a3.htm
Maternal & Infant Care Products & Accessories: Helping to send moms and babies home healthy
The material presented in this blog represents the opinion of the author(s) and not necessarily the views of Synova Associates. Synova Associates does not endorse any specific products or organizations but strives to connect its industry partners with leaders interested in product/educational innovation.
