Most health systems are working within a maternity care framework designed nearly a century ago – one built around brief physician-led visits, episodic touchpoints, and hospital delivery. That model is now colliding with forces it was never designed to accommodate: critical workforce shortages that make traditional staffing unsustainable, patient populations with more complex medical and social needs, and families who expect coordinated, relationship-based care. The strain on health systems stems from a fundamental mismatch between an outdated care model and today’s clinical and workforce realities.
Across the country, patient behavior is signaling these structural limitations. Families increasingly seek additional support outside the system, supplement their care, or reconsider their choices for future pregnancies – not because of a single adverse event, but because the cumulative experience of care doesn’t meet their needs.
The structural challenges in episodic care models
Traditional maternity care within health systems is typically organized around episodic visits, functionally siloed roles, and narrowly scoped appointments. Today we understand far more about what comprehensive maternity care requires – the integration of mental health, pelvic floor therapy, nutrition, and continuous support – but the care model hasn’t evolved to match that knowledge, even as critical workforce shortages strain the system further.
From a system perspective, the result is an inconsistent patient experience and operational friction across the care journey. Patients may receive high-quality medical oversight while still experiencing gaps in communication, limited continuity, and insufficient holistic support. These gaps affect trust, engagement, and ultimately outcomes, even when clinical protocols are followed.
Structural gaps also impact clinician satisfaction and retention. OB/GYNs often express frustration about inadequate time with patients and limited ability to provide comprehensive support. When care feels transactional, providers experience this friction alongside patients, contributing to burnout in an already constrained workforce.
Why patient expectations have evolved
Patient behavior increasingly reflects a mismatch between how maternity care is delivered and how pregnancy is experienced.
Work with thousands of families has revealed consistent patterns in what drives engagement and retention, including clearer guidance integrated into clinical care rather than provided separately, care teams that communicate seamlessly with one another, and continuity that extends beyond delivery into the postpartum period. Families want education and decision support woven throughout their care, not treated as an add-on. When systems cannot provide that coherence, patients often compensate by layering in outside support or planning differently for future pregnancies.
This shift is especially pronounced among younger patients, who are more likely to share experiences publicly and less willing to tolerate fragmented care. For health systems, this represents a long-term retention and brand challenge. Losing patients during maternity care often means losing future pregnancies and downstream gynecologic care as well.
What collaborative care offers health systems
Collaborative maternity care is a system-level care model designed to address these structural gaps. At its core, it organizes care around a coordinated team that may include midwives, OB/GYNs, nurses, mental health professionals, and care navigators working together within a single, aligned framework.
This approach pairs holistic, relationship-based care with the clinical depth and safety infrastructure of a health system. Patients benefit from continuity, education, and comprehensive support, while systems maintain access to high-risk obstetric expertise, escalation pathways, and quality oversight.
In practice, collaborative models reduce fragmentation by clarifying roles, improving handoffs, and ensuring shared accountability across the care team. Communication becomes proactive rather than reactive. Patients spend more time having meaningful interactions with providers who understand their full context and preferences.
From an operational standpoint, collaborative care addresses efficiency challenges that plague traditional models. Longer initial visits and integrated education reduce downstream inefficiencies and improved appointment adherence. Care navigators handle coordination that often falls to clinical staff, allowing providers to practice at the top of their license. This structure supports both provider satisfaction and workforce sustainability.
Crucially, collaborative care aligns with how patients already engage with maternity care. Collaborative models bring that coordination inside the health system, improving experience while preserving clinical excellence and safety-net capacity.
The pressure facing maternity programs represents an opportunity to evolve care delivery in ways that benefit patients, providers, and health systems simultaneously. Collaborative maternity care offers a tested framework that preserves clinical rigor while addressing the structural gaps that drive operational friction and patient attrition.
For health systems looking to strengthen maternity programs, enhance provider satisfaction, and meet evolving patient expectations, collaborative models provide a path forward – one that builds on existing expertise and infrastructure rather than replacing it. The question is no longer whether the traditional model needs to evolve, but how health systems will choose to adapt to the realities of 21st-century maternity expectations.
Adrianne Nickerson
Adrianne Nickerson is Co-Founder and CEO at Oula.
