Advancing maternal health: How HCA Healthcare supports moms from pregnancy to postpartum

Each year, approximately 218,000 babies are born across HCA Healthcare’s network of care — a reflection of the trust families place in our care teams during one of life’s most important moments. At that scale, we have both an opportunity and a responsibility to help shape healthier tomorrows for moms and babies across the country. That drives our dedication to supporting mothers not just during delivery, but throughout every stage of their pregnancy and postpartum journey.

From early prenatal care to postpartum support, our approach is comprehensive. By combining clinical expertise, data at scale and national partnerships, we are advancing a more proactive, evidence-based model of maternal and neonatal care. Across an integrated network of 189 hospitals, physicians, midwives, nurses and other clinicians, we strive to improve outcomes and expand access to care for more families.

At a time when the U.S. continues to face persistent challenges in maternal morbidity and mortality, health systems have an important role to help drive meaningful, measurable change. Below, HCA Healthcare experts explain how we support moms and moms-to-be through education, clinical innovation and compassionate, coordinated care.

Empowering moms with knowledge and advancing earlier, preventative care

A healthy pregnancy and optimal outcome begins long before labor and delivery. At HCA Healthcare, we’re focused on equipping women, families and communities with the knowledge and resources they need to make informed decisions early in pregnancy — especially when it comes to identifying and preventing the leading causes of adverse maternal and infant outcomes, including hypertensive disorders, hemorrhage, sepsis, preventable prematurity and diabetes. As a recent example, HCA Healthcare is at the forefront nationally in advancing both established and innovative ways to prevent and manage preeclampsia, a leading contributor to maternal morbidity and mortality. It’s part of a broader shift toward earlier risk identification, patient education and timely intervention to improve outcomes before life-threatening complications arise.

Early detection of preeclampsia  

Preeclampsia remains one of the most significant risks to maternal health, affecting approximately 1 in 25 pregnancies. “It is one of the most serious conditions we monitor for,” shared Dr. Kjersti Aagaard, a maternal-fetal medicine specialist and national physician advisor at HCA Healthcare. “Preeclampsia can be of new onset, or superimposed on existing hypertension, and persists as the leading contributor to adverse mom and baby outcomes. The hallmarks of preeclampsia are high blood pressure accompanied by damage to the kidneys, liver, brain and platelets. Preeclampsia is unique to pregnancy, but its harmful footprint can last a lifetime.”

Preeclampsia typically occurs after the 20th week of pregnancy and can also occur in the six weeks after giving birth. “When it onsets early, it can also lead to complications with the fetus, including preterm fetal growth restriction and subsequent indicated preterm birth,” Dr. Aagaard explained. “In severe cases, it can result in maternal and/or fetal death.” While the condition can be severe, early detection and prevention makes a meaningful difference.

Care teams across HCA Healthcare begin assessing patients for the risk of preeclampsia at the first prenatal visit, using standardized screening protocols to identify patients who may benefit from additional monitoring and preventive care.

Preeclampsia risk factors

Preeclampsia risk is primarily determined by medical and pregnancy-related factors, and it’s important to underscore that any pregnant woman can develop preeclampsia. Pregnant women with one major (high-risk) factor and two or more moderate risk factors are considered high-risk for preeclampsia. The strongest risk factors include:

• Developed preeclampsia in a past pregnancy
• Multiple pregnancies (twins, triplets, etc.)
• High blood pressure
• Kidney disease
• Diabetes
• Autoimmune disorders or other vascular diseases
• It’s your first pregnancy, or it’s been more than 10 years since you’ve had a baby
• Family history of preeclampsia (mother or sister)
• Advanced maternal age (being age 35 or older)
• Complications in previous pregnancies, such as having a baby with a low birth weight
• Pregnancies conceived with in vitro fertilization
• Obesity
• Limited access to healthcare
• Exposure to chronic stress or health disparities

Low-dose aspirin use for preeclampsia prevention

For women identified as higher risk, evidence-based interventions — such as low-dose aspirin — can significantly reduce complications. “When started between 12 and 28 weeks of pregnancy, ideally before 16 weeks, low-dose aspirin has been shown to reduce the risk of preeclampsia and fetal growth restriction by up to 25%,” Dr. Aagaard said.  

To help expand awareness and appropriate use of this preventive approach, HCA Healthcare has strengthened our long-standing collaboration with March of Dimes through the Low Dose, Big Benefits campaign. Supported by a $1.5 million grant from the HCA Healthcare Foundation, this initiative focuses on increasing provider education, raising community awareness and improving early identification of patients who may benefit from low-dose aspirin — helping more women access evidence-based care earlier in pregnancy.

Beyond medication, Dr. Aagard advises patients to:

• Keep all prenatal appointments
• Work hand in hand with your physician or midwife to effectively manage existing health conditions such as hypertension or diabetes with safe in pregnancy medications
• Monitor blood pressure daily or twice daily if recommended
• Report concerning symptoms promptly, including severe headaches, vision changes, swelling in your hands, face, feet or upper abdominal pain

Advancing maternal care through research and data

HCA Healthcare’s commitment to improving maternal outcomes is strengthened by a data-driven approach to care.

One of the most influential efforts in advancing maternal health is HCA Healthcare’s long-standing partnership with March of Dimes that led to the My 39 Weeks initiative. Building on research across 27 hospitals and 18,000 births, the landmark studies we published in 2009 and 2010 found that elective deliveries before 39 weeks significantly increased the risk of complications for both mothers and babies, including higher rates of neonatal intensive care unit (NICU) admissions. These findings helped drive a nationwide shift in clinical practice and helped establish today’s industry standard, informing how health systems approach safe delivery timing today.

HCA Healthcare continues to analyze hospital data at scale to identify opportunities to safely reduce unnecessary C-section deliveries, particularly among low-risk, first-time mothers, also known as NTSV (nulliparous, term, singleton, vertex) births, and apply this same research-driven approach to other leading causes of maternal complications like preeclampsia. 

“While interventions like low-dose aspirin can reduce the risk of preeclampsia by up to 25%, we have to ask ourselves about the other 75%,” Dr. Aagaard explained. “By studying outcomes at scale, we’re working to better understand, identify and prevent complications, helping to close that gap through earlier detection, more personalized care and system-wide improvements.”

For Dr. Aagaard, the impact of this work is clear: “Every healthy delivery isn’t just a great clinical outcome – it’s a family living their best life and starting their next chapter together without a complication we work hard each day to prevent. We work hand in hand with our care teams and our patients to not only apply the evidence-based care they deserve, but to gather the data and conduct the studies that will change care tomorrow. We deliver not only compassionate-based care in the community today, but bring advancements that are the foundation of the miracles in the future.”

Advancing care during delivery and recovery

During labor and delivery, timely, coordinated care is critical. Across HCA Healthcare, teams are equipped with the tools, protocols and expertise needed to respond quickly, support moms through complex situations and ensure the safest possible experience during and immediately after birth.

Coordinated care with the Obstetrics (OB) Safety Model 

HCA Healthcare’s OB Safety Model’s goal is to improve patient safety for all obstetric patients through the implementation of a standard model for rapid clinical response during emergencies. By incorporating multidisciplinary rounds and safety huddles, the safety model standardizes communication and escalation pathways and incorporates rapid response when needed by the OB hospitalist to facilitate timely, coordinated responses during emergent situations.

This safety model is adopted locally by Medical Executive Committees (MECs) across HCA Healthcare and is designed to support collaboration among OB hospitalists, nurses, residents and attending obstetricians, and to prompt consistent and rapid responses to urgent conditions — such as severe hypertension, eclampsia or significant obstetric hemorrhage.

“This model builds on the strong care teams already in place by enhancing coordination and communication, especially in critical moments,” said Dr. Cindy Celnik, chief medical officer for HCA Healthcare Women’s Services. “By aligning teams and standardizing how we respond, we’re able to support moms with timely, well-coordinated care throughout delivery.”

By standardizing how teams communicate and respond in high-risk situations, this model reflects a need to move toward system-wide reliability in maternal care — ensuring that best practices are consistently applied across diverse care settings.

Enhancing surgical recovery after cesarean birth   

While reducing unnecessary cesarean sections is a priority, HCA Healthcare is equally focused on improving outcomes for patients who do require them. One of the most impactful advancements has been the adoption of Enhanced Surgical Recovery (ESR) protocols for C-section deliveries, a patient-centered, multidisciplinary approach that helps moms take a more active role in their recovery.

“These were initially developed for colorectal surgeries in Europe many years ago, but these protocols have been adopted for various other surgeries, including C-sections, to enhance the patient recovery and to reduce the risks,” Dr. Celnik told the American Medical Association.

Originally piloted in 2019 and adapted from evidence-based surgical recovery models, HCA Healthcare’s ESR program focuses on a set of key practices shown to have the greatest impact on outcomes, based on clinical research, peer‑reviewed literature and internal data. One of the most important is multimodal pain management, which prioritizes non-opioid medications and personalized pain control strategies.

“This approach allows us to tailor care to each patient while helping patients recover faster, leave the hospital sooner and have fewer complications or return visits,” Dr. Celnik said.

HCA Healthcare was an early adopter of ESR protocols for C-sections, first implementing them at The Woman’s Hospital of Texas in 2020. The results included shorter hospital stays, reduced opioid use and fewer complications. “Recognizing the benefits, we’ve expanded these protocols across our organization,” Dr. Celnik said. “It’s a meaningful way we’re improving the experience and recovery for moms who deliver by C-section.”

Supporting moms through the “fourth trimester”

The journey doesn’t end after delivery. The hours, days, weeks and months following birth, often called the “fourth trimester,” remains one of the most critical phases of maternal care. At HCA Healthcare, care teams remain closely connected to moms during this stage, providing guidance, clinical expertise and personalized support to help both mom and baby thrive.

Preventing and responding to postpartum complications

HCA Healthcare is also focused on identifying and preventing serious postpartum complications, including hemorrhage — one of the leading causes of maternal morbidity.

While some bleeding after delivery is normal, excessive blood loss can quickly become dangerous if not recognized and treated early. That’s why our care teams are trained to closely monitor for warning signs in the hours and days following birth.

Through standardized protocols, early warning systems and coordinated care teams, clinicians are equipped to respond quickly when concerns arise. This includes clear guidelines for recognizing abnormal blood loss and team-based approaches to ensure timely intervention.

These efforts build on the same safety-focused approach used during delivery, helping ensure moms receive the right care at the right time, both in the hospital and during the critical postpartum period.

Nurse navigators guide moms through complex journeys

For moms facing higher-risk pregnancies or fetal anomalies, support often extends well beyond delivery. HCA Healthcare offers nurse navigation programs that connect families with dedicated clinical experts who help guide them through each step of their journey.

These nurse navigators provide education, coordinate appointments across specialties and serve as a consistent point of contact, helping reduce uncertainty and ensuring moms and families feel informed and supported throughout their care.

By bringing together maternal-fetal medicine specialists, obstetricians, pediatric experts and care coordinators, HCA Healthcare helps ensure that moms with complex needs receive personalized, well-coordinated care from pregnancy through delivery and beyond.

Providing specialized NICU care for our smallest patients

When newborns need additional support after birth, care teams across HCA Healthcare’s more than 90 neonatal intensive care units (NICUs) provide specialized care to newborns born prematurely or sick.

These NICUs span multiple levels of care, from Level I nurseries for healthy newborns to Level IV NICUs equipped to care for the most critically ill infants, ensuring babies receive the appropriate level of care based on their needs.

Care teams include neonatologists, pediatric surgeons, neonatal nurses, respiratory therapists, physical and occupational therapists, case managers, social workers and lactation consultants — all working together to support each baby’s unique and complex needs.

This multidisciplinary approach allows for seamless coordination between maternal and neonatal care teams, helping ensure the best possible outcomes for both moms and babies during this critical stage.

Partnering with March of Dimes on postpartum education to encourage follow-up care

Education remains a critical part of supporting moms after they leave the hospital. Through our work with March of Dimes, HCA Healthcare is working to improve maternal outcomes by increasing awareness of postpartum health and the importance of follow-up care.

According to the American College of Obstetricians and Gynecologists (ACOG), as many as 40% of women do not attend a postpartum visit after giving birth. To help address this gap, HCA Healthcare helped develop educational resources for both providers and patients focused on recognizing warning signs of potential complications, including high blood pressure, hemorrhage and perinatal depression.

These efforts include tools such as educational videos that encourage new moms to schedule their postpartum visit before leaving the hospital and better understand what symptoms to watch for in the days and weeks after delivery.

Postpartum care plays a vital role in helping identify and address complications early, ensuring moms have the support and care they need during recovery.

Expanding access to breast milk in the NICU

In addition to highly skilled medical care during risky deliveries, HCA Healthcare facilities ensure that, once babies come into the world, they have the nourishment they need to thrive. Because breast milk provides the utmost nutrition for infants — the American Academy of Pediatrics recommends that babies younger than six months exclusively drink breast milk — HCA Healthcare hospitals make breast milk accessible for mothers and babies who need it.

“Here at Memorial, we have a dedicated milk prep room with big refrigerators where we store donor breast milk or moms’ milk,” said Dr. Brad Buckler, medical director of HCA Healthcare Memorial Health’s Level IV neonatal intensive care unit.

While some mothers may experience challenges with milk supply, others may produce more than their baby needs and can choose to store or donate it to support other families. “To become a donor, you have to go through a screening process,” Buckler adds.

In the dedicated milk prep room, two to three trained milk prep techs and RNs work to sterilize the milk, and then prepare it in syringes or bottles to feed newborns bedside

“Mom may bring in 100 milliliters of breast milk [about 1/3 cup], for example, but her baby is only getting 5 milliliters at each feed,” Buckler explains. “The prep techs would put that 5 milliliters in the appropriate syringe to send out to nurses, and we can keep the remainder frozen so we know it’s being utilized in the appropriate period of time.”

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HCA Healthcare also supports moms with access to lactation consultants who provide education, encouragement and hands-on guidance starting in the hospital and continuing after discharge.

“It’s not as easy as everybody thinks,” said Theresa Bryan, a lactation consultant at affiliate Methodist Hospital Stone Oak in San Antonio, Texas. “Get all the information you can.”

Early education and support can make a meaningful difference. Lactation consultants work closely with moms to answer questions, address concerns and help navigate common challenges, from latching difficulties to milk supply.

While breastfeeding offers many benefits, Theresa emphasizes that feeding decisions are personal. “It’s a relationship; it’s a choice,” she said. “It’s not for everybody, but if you can give it a good three months, you are a champion.”

For moms who experience challenges, support is key. “I can’t stress early intervention enough,” Theresa said. “You can get help to overcome anything that you’re going through.”