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500,000 fewer births next year? Here's what we know about Covid-19's implications for pregnancy.

September 10, 2020

Six months ago, Covid-19 drastically altered the patient experience and standard of care for pregnancy. In our first installment, we outlined the impact of Covid-19 on virtual visits, OB unit protocols, and out-of-hospital births. These original implications largely remain true—but there's one new trend that will greatly affect health systems over the next one to two years.

Alternative birthing programs: 6 tactics for launching midwifery services

What we've seen happen over the past 6 months

Several of the trends we identified earlier are continuing. For instance, telehealth has continued to grow in popularity and is now readily available and encouraged for many prenatal visits. In fact, a recent article in the Journal of Telemedicine and e-Health has established guidelines for creating a telehealth system de novo.

In addition, many hospitals are still restricting obstetric unit access to one visitor per patient, though we have seen a shift in guidance to support rooming-in with appropriate precautions from the American Academy of Pediatrics and the Journal of Perinatology. And finally, interest in out-of-hospital births has remained high, with Google searches for "home births" maintaining a high monthly average since March, and midwives reporting overwhelming requests for out-of-hospital deliveries. We've even seen the establishment of temporary out-of-hospital birthing options, such as the Brooklyn Birthing Center opening the Jazz Birth Center, as means to meet this demand.

However, beyond these initial implications, there is an important new impact of Covid-19 on obstetrics to consider: a significant projected decrease in births, which in turn could deal a potentially critical blow to OB unit volumes.

According to a survey by the Guttmacher Institute, over 40% of women changed their plans about when to have children and how many children to have because of Covid-19, with 34% wanting fewer children or a later pregnancy. A separate report by the Brookings Institute projected a decrease of up to 500,000 births in the United States for 2021. These projections will only exacerbate the challenging obstetrical landscape examined in our 2020 women's health market trends.

Declining births threaten OB unit sustainability, which was a challenge before Covid-19. For hospitals that were already struggling, the pandemic is likely to push them over the edge, as was the case for Falmouth Hospital's maternity unit and Mercy Hospital. These closures will decrease patient access to care and may result in additional "birthing deserts" in both major cities, such as Chicago, and rural areas.

So what should you do in response?

Despite these bleak projections, there are several steps hospitals can take now to position themselves for success in the OB landscape:

1. First, it is imperative that hospitals emphasize their Covid-19 safety protocols and safety of an in-hospital birth. As patients continue to show interest in out-of-hospital births and the number of available births decline, health systems must reassure patients of safety and quality to have any chance of capturing volumes. Guidance on Covid-19 safety protocols can be found in a recent outline by the American College of Obstetricians and Gynecologists.

2. Second, compete on consumer preferences for pregnancy care. As births decline, the OB landscape will become increasingly competitive, as health systems compete for a slice of shrinking pie. To appeal to patients, meet top preferences for metrics such as quality, access, and reputation.

3. Third, consider opportunities to offer alternative birthing options or partner with nearby birthing centers. A subset of women preferred alternative birthing services prior to the pandemic, and Covid-19 has certainly increased their interest in alternative/non-hospital options. Meeting these preferences may allow some organizations to compete for low-risk delivery volumes in an increasingly competitive market. And while some organizations might opt to open a freestanding birthing center, for most health systems, this investment is not financially feasibleHowever, there is still opportunity for health systems to invest in hospital-based midwifery or develop partnerships, including transfer agreements, with existing birthing centers, as 20% to 30% of birthing center births require transfer to a hospital.

Your Covid-19 service line impact guide

See our take on the major implications for elective procedures within cardiovascular, orthopedics and spine, general surgery and urology, gastroenterology, imaging, oncology, and OB/GYN.

Learn about the top elective procedures within each service line, the recommended phasing of services based on clinical urgency, barriers to clearing the backlog, and mid- to long-term demand implications.

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