ASHEVILLE, N.C. – When Hannah White showed up at the Mountain Area Health Education Center here three years ago, she was in trouble.
She was 20 years old, a couple of months into her first pregnancy and on the run from an abusive husband in Texas who already had broken her ribs in an attempt, she said, to kill her unborn child. She also has a form of hemophilia that prevents her body from producing platelet granules that stem bleeding. That disease had robbed her of her Malawian mother when Hannah was 3 months old, which ultimately led to her adoption by American missionaries.
"I was a mess," White recalled when she first showed up at MAHEC, which serves a 16-county area of western North Carolina. "I was worried about the abuse and was having this bleeding and afraid I was going to die or lose my baby."
MAHEC's OB-GYN program is part of a statewide initiative in North Carolina that identifies low-income women whose pregnancies present a high risk to either the baby or mother. All the women receive care through "medical homes," in which teams of providers work together to provide coordinated care.
The medical homes provide the most advanced obstetric care, but they also seek to alleviate nonmedical circumstances that could put mother and child in jeopardy, such as addiction, domestic abuse and a lack of secure housing and healthy food. North Carolina's program is the only statewide pregnancy medical home model in the country.
Officials in the state already have fielded inquiries from California, Michigan, Minnesota, South Carolina and Tennessee, according to Belinda Pettiford, head of the Women's Health Branch of the state's Department of Health and Human Services.
Among developed nations, the U.S. ranks last in maternal mortality and infant mortality, largely because of its high rate of untreated chronic disease and a decline in access to obstetric care, particularly in rural areas.
But many think North Carolina's approach could be the key to reversing that trend. The rates of low birth weight babies (also a proxy for preterm births) and Caesarean deliveries are all lower among women participating in the program vs. those who didn't. North Carolina has reduced the rate of unplanned pregnancies, by educating new mothers about birth control and spacing babies. The state also has seen a decrease in racial disparity in maternal mortality (although part of that is the result of an uptick in white maternal mortality).
Today, there are 380 pregnancy medical homes in North Carolina. According to Community Care of North Carolina, the nonprofit group hired by the state to oversee the program, 94 percent of obstetric practices that serve the Medicaid population participate in the program. Nearly 55 percent of all deliveries in North Carolina are by women who are Medicaid beneficiaries. Although the mission of the program is to reduce the number of preterm births, the benefits don't end there.
The program connected Hannah White with a legal aid lawyer who was able to secure a restraining order against her husband and help her file for divorce. It enrolled her in a class for first-time parents. And it gave her intensive medical care to assure that her bleeding was controlled, particularly during delivery when doctors gave her a transfusion of platelets.
She delivered a healthy daughter, Nala, in 2015. This fall, with a new boyfriend, she had a second baby girl, Maddilyn. "I was very happy with the care I got here," she said last month at the end of an hourlong postpartum visit to MAHEC, during which she was screened for postpartum depression and received advice on birth control options, a particularly complicated issue for White because of the need to avoid any methods that would increase bleeding.
White held a sleeping and swaddled Maddilyn in her lap while Nala, in pink sneakers and polka-dot pants, impatiently pulled on her grandmother Breta's hand. With them was Denise Duckett, White's care manager, who has spent far more time with her in the course of her two pregnancies than anyone else in the care team.
"She's been my sounding board," White said of Duckett.
