Comparing models of maternity care serving women at risk of poor birth outcomes in Washington, DC.

Low-income African American women in Washington, DC, exhibit some of the worst birth outcomes in the United States. The authors undertook a qualitative, comparative case study of three different models of maternity care delivery to low-income women at risk of poor birth outcomes in Washington. The key study objectives were (1) to describe the organization, delivery, and content of care of the three models of maternity care and (2) to analyze how the models of care might be improved to better serve this population efficiently and cost-effectively. Our results indicate that all three models vary distinctly in how they organize and deliver care and what composes the content of care. Further, findings suggest that pregnant low-income women require the allocation of additional and nontraditional maternity care resources such as prenatal group care and breastfeeding peer counselors. These nontraditional components of care help providers address underlying social risk factors that may be negatively affecting the health of pregnant women and their unborn children. While nontraditional maternity care models may provide greater value for money than traditional obstetric models, they face funding and sustainability challenges.