Kaitlyn Thomas is director of maternal special projects with the Missouri Perinatal Quality Collaborative, also known as PQC, attached to the Missouri Hospital Association. She said, when experts look at maternal mortality in Missouri, the largest portion of deaths occurs in the postpartum period. Knowing what is happening in Missouri is the first step to addressing the root problems. Thomas explained how PQC is leading the effort in the state to put that knowledge to use.
"At MHA, we were identified as a neutral convener of maternal and infant stakeholders in our state. This happened around 2018, and really, there was an opportunity for us to align stakeholders around a lot of energy to improve maternal and infant health outcomes in our state. And that started with something called the Maternal Child Learning and Action Network, and it's a group of about 100 stakeholders now that are just really engaged and invested in improving the health and lives of Missouri moms and babies. If you fast forward a few years, in 2022, the PQC was formally established. And that really allowed us the opportunity to engage with Missouri hospitals and help them implement evidence-based practices within their birthing units to hopefully drive improvements and address some of the key issues around maternal mortality," she said.
"When we think of postpartum, traditionally we think of 6 or 12 weeks after delivery, but the majority, about 43% of those deaths actually occur between six weeks and 12 months postpartum, which is pretty unexpected and surprising for most people.”
Thomas said professionals talk about a postpartum cliff; it's one area of maternal healthcare where leaders see an excess of negative outcomes that they think could be prevented. The state is working to help improve access to postpartum care.
“In 2023, Missouri actually expanded Medicaid coverage through 12 months postpartum. Previously, it was only through 60 days, and so that really signaled an opportunity to hopefully address some of those drivers of maternal mortality for some of our most vulnerable populations," she said. "Medicaid, I believe, covers about 40% of the births in our state.”
Thomas said the postpartum time can be hard on any mom.
“Some of the key drivers, unfortunately, of maternal death during the postpartum period are mental health and cardiovascular disease, and you know, that affects anyone and everyone. It doesn't discriminate based on race or income, and so when we talk about these recommendations, Medicaid extension started the conversation, but it really applies to everyone," she said.
"We identified that there was an opportunity with support and funding from the Department of Health and Senior Services to bring together people who are really engaged in postpartum care delivery to have a conversation about what recommendations we could make for Missouri providers, both clinical and non-clinical, to support a postpartum pathway through 12 months. And recently in December of 2025, we released those recommendations.”
Those recommendations are part of PQC’s comprehensive 12-month postpartum care guide. The organization has also produced a more user-friendly version to reach as many Missourians as they can.
“This has grown into the ‘Ask Me 5’ campaign, which really provides some simple guidance and resources to support anyone providing care or care touch points during pregnancy through that one year postpartum. It really sets them up for success in having those heart-to-heart conversations. There's already really great screening tools that are validated and that are highly recommended for clinical settings, but this is more about starting those conversations in a very empathetic and supportive way," she said.
"The topics include high blood pressure, emotional and mental health, access to care, recognizing substance use and trauma, abuse and safety. And really, the goal here is to build trust and facilitate openness with your patients around these topics so that you can help connect them to resources. You can help them feel supported and make sure we're addressing these things, because these are often what we're missing for Missouri moms that often lead to those preventable poor outcomes and maternal health.”
PQC has been spreading these resources. They have also been hosting a symposium each year on the topic of maternal health and hosting dinners and conversations with stakeholders across the state, taking advantage of their unique position to connect with those working in healthcare, help lead coordination and lead the conversation.
“We often think about the baby as the candy and the mom as the wrapper. And sometimes after delivery, we kind of discard the wrapper, discard mom, and don't give her as much attention. And that really is unfortunately reflected, I think, in our maternal and mortality results. And that's something we really hope to change," said Thomas.
"And we're always looking at bringing in people we haven't reached yet into this conversation, because it is broader than just the four walls of the hospital, and it is broader than just OB units. And we need to make sure we're reaching all the people that really impact that continuum of care.”
In the months ahead, Thomas said PQC will be publicizing its “Ask Me 5” campaign and resources introducing the key concepts to the public. They’ll also look to continue the conversation, including on some of the other big challenges they see facing Missouri moms, like deserts of care, fragmented systems of care and persistent inequities.
Nick Burasco and Dax Bedell provided production support for this story.
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