If I meet a patient for the first time at 32 or 34 weeks of pregnancy, I’m already behind.
By that point, chronic diseases like hypertension, diabetes, or undiagnosed preeclampsia may have already been quietly damaging the mother or the baby for months. For high-risk patients, the concern is even greater, since delays in care can limit available treatments. The March of Dimes’ recently released 2025 Report Card confirms that these scenarios, once the exception, are now reality for thousands of women across the country.
For the fourth year in a row, the United States earned a D+ for preterm birth, with nearly 380,000 babies born too early in 2024, or 10.4% of all births. Among other concerns, the report also highlighted that nearly a quarter of pregnant people didn’t begin prenatal care in the first trimester.
Behind those averages are stark, systemic inequities. Preterm birth now affects babies born to Black mothers at a rate of about 14.7%, almost one-and-a-half times the overall rate. Babies whose parents are covered by Medicaid have a preterm birth rate of 11.7%, compared with 9.6% among those with private insurance. These are not randomly occurring results, but the predictable result of historical policy choices, workforce shortages and the way we allocate scarce specialty care.
As a maternal–fetal medicine (MFM) specialist, I care for pregnancies that carry the highest risk. The patients I worry about most aren’t just medically complex, but many are also geographically and systemically isolated.
Many of the pregnant women who are delayed seeking care live in maternity care deserts, areas with no clinician to deliver babies and/or outpatient clinics or birthing hospitals to provide pregnancy care.
More than one-third of U.S. counties fit that definition, impacting over 2 million women of reproductive age. Not surprisingly, March of Dimes’ own data links maternity care deserts and low-access counties to over 10,000 excess preterm births between 2020 and 2022.
One important driver of these concerning statistics, which isn’t included in the March of Dimes report, is the stark lack of access to maternal-fetal medicine specialists for high-risk pregnancies.
Nationally, there are roughly 2,000 MFM specialists, physicians trained to manage the most complex pregnancies. Most are clustered in large cities and near academic medical centers, so for many rural regions and marginalized urban neighborhoods, there is not a single practicing MFM.
Those numbers would be concerning even in a low-risk population. They are alarming in a country where advanced maternal age is common, and obesity and chronic disease is rising.
Access to MFM care matters. Studies have linked specialist involvement to lower rates of preterm birth, low birthweight, and neonatal intensive care admissions, particularly when we can engage early to identify risk factors, optimize management of chronic diseases, and institute preventative measures. Yet for many high-risk patients, seeing an MFM in person would require taking unpaid time off work, arranging childcare and driving several hours each way — if there is an appointment available.
That is where telehealth comes in.
TeleMFM, or virtual consultation, instantly connects MFMs with local obstetric teams and their patients. Patients can be counseled appropriately, make informed decisions regarding their care, and co-managed with their local obstetrical provider for conditions like severe hypertension, preeclampsia, pregestational diabetes and prior spontaneous preterm birth. This service can provide smaller hospitals and rural clinics with the support that they need, so that more high-risk care can be delivered close to home.
While technology isn’t a substitute for Medicaid expansion, paid leave or community-based support, it’s one of the few tools that can immediately extend MFM expertise into places where recruiting full-time specialists is unrealistic.
In my own practice, I’ve seen the difference just a single timely virtual consult can make, whether helping patients improve control of gestational diabetes through lifestyle modifications or medications, performing testing on a growth-restricted baby, or identifying a significant pregnancy complication and coordinating transfer to a facility with appropriate resources. TeleMFM helps patients better understand what is happening to their pregnancy and feel empowered to make the best health decisions for their family. Rather than patients feeling isolated or abandoned, they can feel seen and heard by becoming active participants in their care.
If we take the March of Dimes report card seriously, we must move beyond naming the crisis and start using every opportunity to create effective change.
This starts with prioritizing the full suite of March of Dimes’ policy priorities: expand and extend Medicaid, guarantee at least 12 weeks of paid family leave, reimburse support from doulas, increase mental health screenings and sustain robust maternal mortality review committees. It’s also essential to build regional high-risk care networks. Every birthing hospital should have a defined pathway for teleMFM consults, whether through academic hubs, large health systems, or contracted networks. Payment models should treat teleMFM not as a luxury, but as part of risk-appropriate care.
And finally, we must protect and grow the MFM workforce. We need more fellowship positions, loan-repayment programs tied to service in high-need regions, and team-based models that allow MFMs to focus on the highest-risk pregnancies while midwives and hospitalists manage low-risk care.
The March of Dimes report should be a national wake-up call. For a country with our resources, accepting a D+ for the fourth year in a row is a choice. But so is building a system where every pregnant person, regardless of zip code, ethnicity, or insurance status, can access the level of care their pregnancy demands. We must improve access to care, confront our own biases, and collaborate with one another.
Now is the time to embrace technology and virtual services as the future of maternal-fetal medicine to ensure that where you live will never determine whether you or your baby survive childbirth.
Photo: KidStock, Getty Images
Dr. Jeffrey Chapa is a board-certified maternal-fetal medicine specialist, OB-GYN, and medical geneticist. With over 20 years of clinical experience, he is a recognized leader in managing complex, high risk pregnancies. He currently serves as the National Medical Director, Maternal-Fetal Medicine for Obtelecare, the nation’s leader in obstetric telemedicine where he works to increase timely, safe, and accessible specialty care.
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