Mississippians giving birth in hospitals this year will be part of a new statewide system aimed at lowering infant and maternal mortality, according to state officials. 

State Health Officer Dr. Daniel Edney said new regulations will change how hospitals operate, but pregnant patients will not have to do anything differently. It’s all in the hopes of streamlining and expediting transfers for high-risk mothers. 

The Mississippi Board of Health in January approved the use of what is referred to as the obstetric system of care, in which pregnant women will be triaged and sent to “the right place at the right time,” Edney told Mississippi Today. This new system of care will go into effect Feb. 13, though it could take years to be fully implemented, Edney said. 

Edney attributes the main problems facing obstetrics in the state to “a bad system.”

Mississippi has more preterm births and babies dying than anywhere else in the nation, as well as one of the highest rates of maternal mortality. A public health emergency was declared in August for the state’s rising infant mortality rate. The obstetric system of care has been branded by the Mississippi State Health Department as a solution to these problems. 

“When you’re 50th in something, I think it’s OK to do things other folks aren’t doing,” said Edney. 

The system will cost $1.5 million to build, which will come from money appropriated to the Health Department during the 2024 legislative session, Edney said. 

Birthing hospitals will be designated with the level of care they are equipped to handle – something done in 16 other states according to the level of care provided for pregnant and postpartum mothers, and  30 other states for types of services provided to newborn babies. 

Here is how the transportation component of the new system would work when an emergency happens, according to Edney. 

• A paramedic would relay the patient’s information to the region’s emergency medical director. 
• The emergency medical director would assess risk and decide the appropriate level of care needed, directing emergency medical services to the hospital. 
• The patient’s medical records would be entered into an online system accessible to all providers they encountered. 
• Paramedics would give the patient a geolocation wristband, allowing the system to track the patient, with the long-term goal of shortening transport times. 

Regardless of whether there are rooms available, hospitals are required to stabilize all emergency cases under the federal law known as Emergency Medical Treatment and Labor Act, or EMTALA, Edney added. 

The patient tracking component elevates hospital designations to being an obstetric system of care – the first of its kind in the nation, Edney said. 

Jamila Vernon, spokesperson with the American College of Obstetricians and Gynecologists, said the organization does not have a definition for an obstetric system of care, and so has no way of measuring whether other states have similar systems.

In states that have hospital designations, informal agreements around patient transfers between facilities tend to develop naturally, but can be disorganized. Establishing firm protocols can improve the likelihood of success, explained Honour McDaniel Hill, director of infant and maternal health initiatives for March of Dimes. 

“When you have a system where everyone is on board, hands all in, ‘This is what we do when this happens’ – and continuing to update that as things change – that’s all important,” McDaniel Hill said. “It’s the difference between (having) a personal relationship with this hospital, versus an ‘Everyone is on the same page’ plan.”

The Health Department expects to designate hospitals with levels of care by the end of this year, Edney told Mississippi Today. 

Divisions of care and disparities in outcomes

There are four maternal levels of care, according to ACOG. Facilities designated as Level I provide the most basic level of care, and Level IV offers the most advanced level of care. That’s the opposite of the trauma system of care, where Level I is the most advanced level of care. 

The Mississippi Hospital Association is still reviewing the regulations as they were approved by the Board of Health, said Leah Rupp Smith, vice president for policy and advocacy at the association. 

The Mississippi Healthcare Collaborative, a coalition of hospitals that splintered off from the Mississippi Hospital Association in 2024, did not respond to a request for comment about how its hospital members feel about the new regulations. 

Changes were made to the regulations after several stakeholders voiced concerns about language and scope of practice at a hearing in December. Edney said that since amendments were made to already-existing rules, and the Board of Health approved them, an additional period of public comment was not required. 

Those changes included taking out a provision that mentioned anesthesiologist assistants – a profession that doesn’t exist in Mississippi. Another change added nurse anesthetists with pediatric expertise to a list of providers allowed to do surgery and other procedures in the neonatal intensive care unit, in line with the way they currently practice. 

But it’s important to remember that the system will not fix all of Mississippi’s maternal health woes, said Kathryn Mitchell, the senior director of maternal and infant health and collective impact at March of Dimes. 

“One of the most interesting and challenging things about maternal health and child health is that it is not one thing that is ever going to fix the problem,” Mitchell said. “ … I definitely think this is a strong systems approach, but there are going to be other things that need to be looked at as far as what’s going on in the community and what are some of the other root causes.”

Adopting multiple strategies that better target shortfalls in the state’s reproductive health care system could help more families and boost maternal and infant health outcomes, some advocates say. March of Dimes has identified the state’s failures to expand Medicaid and to adopt paid parental leave and doula reimbursement policies as decisions directly contributing to the state’s preterm birth rate. Mitchell said she hopes the new system can be used to map out need and to promote solutions that can bolster communities with no neonatal intensive care units and more basic birthing hospitals. 

“It could be mobile, it could be pop-up clinics, it could be federally qualified health centers … They’re not typically doing births, but they may be providing other services,” Mitchell said. “Essentially, you would want to probably layer what other services are available and then continue to see if you have any spotlight zones.”