Care for every mother, at the place that fits her.
Between a mother's kitchen table and a regional perinatal center there are many places where parts of her care could happen. They include a nurse or doula at her door, the pharmacy, the local clinic, the health center and the community hospital. Many routine checks and visits could move closer to home.
Pages on this site
Every page asks the same question: which checks and visits could happen closer to her, and which stay at the regional center.
Four mothers
Follow a rural, a suburban, an urban and a professional mother through pregnancy. Each page sets how it works today beside how each visit could work.
Meet themThe ladder of place
Regional and local hospitals and OB/MFM practices, community care and home care. Move the slider to bring more of them into reach and the arrows redraw.
Explore the ladderConditions explorer
Pick a condition such as high blood pressure, gestational diabetes or perinatal depression and see what is monitored and where.
Explore conditionsManifesto and white paper
The short case for a new model of maternity care, and the longer paper on evidence, economics and the framework.
Read themWho is already doing this
Programs and pilots working on one rung or several. Filter by place and status, and add your own effort.
See initiativesJoin the conversation
A community for clinicians, programs, payers and families to compare notes and shape the next working group session.
Join inThe ladder adds places that already exist
Care today mostly happens in one or two places. Most communities already have others, and the ladder shows what could move to each.
Regional hospitals and OB/MFM practices are the anchor
Maternal-fetal medicine and the monitoring of complex or high-risk pregnancies stay with them, along with the expertise behind it. A mother can move up the ladder to that care when she needs it and back home when she can.
What could be possible
Nothing here says where any one mother's care belongs. The site lays out what could be possible, and a working group, a clinician or a mother can weigh it from there.
The visit schedule most mothers follow was set in 1930
The schedule runs monthly to 28 weeks, every two weeks to 36, then weekly to delivery. It was built around where the cuff, the lab and the records were. A trial of a reduced-visit schedule with home monitoring and nurse contact in between has already been run, and home blood pressure cuffs, cellular devices and video visits now reach most kitchen tables. The pieces have not yet been put together, place by place.
Read the manifesto or go straight to the ladder.