“I didn’t know what was going on,” said Merlyn. “I was a first-time mother and I had never gone through [pregnancy and labor], but I had someone who was advocating for me…There’s this level of trust that you don’t experience anywhere else.”

Merlyn Hammer, MS, RN is the Senior Director of Public Health at Neighborhood Health Center. She also is a Neighborhood obstetrics (OB) patient, both her children being delivered by a Neighborhood provider. She explains how, with the OB care at Neighborhood, there is a relationship of trust developed between the patient and the care team that she has not experienced elsewhere. 

From a public health standpoint, Merlyn acknowledges the importance of Black maternal health. There is a disparity with Black birthing individuals where they experience an increase in postpartum complications such as preeclampsia and eclampsia, hypertensive disorders, and adverse pregnancies. 

“There is also a lack of hearing and understanding what a person’s experience is that happens especially to patients of color,” said Merlyn, about the healthcare system at-large. “That often impacts the patient’s pregnancy experience and decision-making.”

In Merlyn’s second birth, she shares that she had a postpartum complication. 

“I called the office and said ‘I don’t know, something isn’t right’,” explained Merlyn. “They said ‘come right in’. To be able to have that connection with my providers, them knowing what my normal was and realizing that something was not right…that was key.”

As the Senior Director of Public Health, Merlyn leads the community health team at Neighborhood. Community health workers (CHWs) help patients get connected with necessary social supports, such as housing, transportation, insurance, and more. These are best referred to as the social drivers of health (SDOH), which are external or environmental barriers to patient care. When it comes to OB patients, oftentimes CHW social supports will look like helping to coordinate insurance coverage and enrollment, insurance-covered transportation during and after pregnancy, and housing supports. 

“Then you add on the challenge of whether the patient speaks English, are they familiar with our healthcare system, what are the cultural practices and values that play into their pregnancy experience,” said Merlyn. “It’s really about being okay with not being the person who knows everything, but the person that sees the patient as a whole person, and incorporates that into their care experience.”

Whether a patient is already established at Neighborhood, or they come into care following a free in-office pregnancy test with a positive result, in-depth familial and social histories are taken. This is to help anticipate what needs the birthing individual will have throughout their pregnancy, and how the team can prepare and support them through that. This could be in the form of social supports from a CHW or medical support from the care team. From that first appointment, patients are connected with an OBGYN care coordinator. Care coordinators support patients in filling in healthcare gaps, such as helping to coordinate outside referrals to specialists, following up with any patients that miss visits, and more. OBGYN care coordinators also assist with social supports like helping the patient to get connected with where they can get necessary items for their newborn, such as a car seat, diapers, etc. 

“About 75% of our patients qualify as high risk patients,” said Rachel Muroff, MSN, CNM, WHNP-BC, a certified nurse midwife at Neighborhood. “They all go on a list that is reviewed at our monthly ‘high risk meeting’.”

High risk could mean a number of things, depending on each patient. It could be related to a previous complication during pregnancy, comorbidities such as hypertension and diabetes, and preeclampsia. High risk can also mean having two or more SDOH barriers to care. In order to prevent complications that result in things like postpartum hemorrhages, stillbirths, and low birth weights, patients are walked through an initial risk assessment in the initial appointment to determine if their pregnancy is high risk. 

Rachel has been a part of Neighborhood Health Center for nearly 2 years. As a midwife at Neighborhood, Rachel provides a lot of labor support and hours in the middle of the night laboring with patients. She works with patients on relaxation techniques through birth and on getting the baby in the right position. Depending on the practice, midwives are able to perform circumcisions, bedside ultrasounds for pregnancy dating, and IUD insertions. 

“I feel very grateful that, as a midwife, here I am still able to provide that midwifery care to high risk patients as I have the support of our OBGYN team,” said Rachel.

Once a month, the OB providers team meets with the OB medical assistants, nurses, CHWs, and care coordinators to discuss high risk patients. The discussion focuses on the current high risk patients, any healthcare gaps that need to be addressed, things to look out for with each patient, and any coordination in care needed. 

“It’s like a team collaboration to really highlight how we are all part of the system that cares for the patient and their unborn child,” said Merlyn. 

“So many patients can get lost to care in the general healthcare system,” said Rachel. “At Neighborhood, and especially with the OBGYN team, everyone works together to make sure no one slips through the cracks.”

When a patient is determined to be high risk, they will be scheduled for a weekly or bi-weekly visit with the OB team for the duration of their pregnancy, which is a lot more often than most practices. Another unique aspect of Neighborhood’s OB care is that the team does not wait to see patients until 6 weeks postpartum, and instead try to see them between one to two weeks following birth, depending on the patient. 

Merlyn explains how, at Neighborhood, a distinctive aspect of the health center is that, when the patient completes the pregnancy, they can get instantly connected with other services at Neighborhood, such as pediatrics for their newborn, behavioral health support, primary care and nutrition care.

“I’ve never worked anywhere else where we had all these services right here for patients,” said Rachel. “Other places you refer someone out, and they are left to figure it out on their own. Whereas here, anything we are referring them to do, the care coordinators can help them coordinate that.”

Rachel explains that postpartum is a time when people need a lot of help with mental health support, support with breastfeeding, nutrition, and more. 

“Having [behavioral health and nutrition] here is so nice because we really can coordinate care so well, and get patients to continue succeeding past their OB pregnancy experience,” said Rachel. 

Another service that has greatly impacted patient and provider experience at Neighborhood is maternal fetal medicine (MFM). With the addition of Dr. Margaret McDonnell, who joined the OBGYN team in 2023, Neighborhood is now offers in-office imaging to OBGYN patients. 

MFM includes the evaluation, diagnosis, and treatment of pregnant patients with complex medical conditions, as well as prenatal diagnosis and management of adverse pregnancies. MFM also involves the medical management of high risk patients. MFM at Neighborhood allows the OB team to coordinate the best timing, method, and location of delivery for patients and their babies, as well as help the team avoid having to send a patient to an outside imaging specialist. 

“Bringing in MFM internally allows us to keep the patient’s care at Neighborhood,” explained Merlyn. “This way we can continue to help them navigate their pregnancy under the same healthcare system, and regardless of ability to pay.”

“We really do care,” said Rachel. “We really want to see our patients succeed in getting these health-related milestones done.”