When updated guidelines for prenatal care were released for the first time in nearly a century earlier this year, they arose from more than the consensus committee sifting through the most current evidence and comparing it to existing guidelines. The American College of Obstetricians and Gynecologists (ACOG) also incorporated findings from a national listening tour of qualitative focus groups conducted from March 2022 to June 2023, according to a document summarizing those findings in the September issue of Obstetrics & Gynecology. 

That means the new guidelines not only bring the standard of care in line with the realities of the present day but also reflect how many ob/gyns are already practicing.

“The first thing I thought was, what took them so long?” said Barbi Phelps-Sandall, MD, an ob/gyn and founder of Renaissance Healthcare for Women in Mountain View, California, shortly after the guidelines first came out. “I think we’ve been doing a lot of these things, so I’m glad I can be confirmed in what I’ve been doing right.”

At the same time, Phelps-Sandall told Medscape Medical News that some doctors have continued to follow the same practices they have for decades. “I think this is going to allow some doctors to rethink their approach and know that more options are out there.”

According to those responding to queries from Medscape Medical News, the guidance has not posed a significant challenge for many practices because so many were already individualizing care and paying attention to social determinants of health. 

One of the three guidance committee leads and the senior author of the listening tour publication is Alex Friedman Peahl, MD, assistant professor of Obstetrics and Gynecology at the University of Michigan Health, Ann Arbor, Michigan. Neel Shah, MD, chief medical officer of Maven Clinic and a visiting scientist at Harvard Medical School, Boston, said that Peahl’s “research and leadership helped shape a modern framework for prenatal care that better aligns with how people live today and reflects the holistic, wraparound approach Maven has championed from the beginning.”

The Three Main Focus Points

The three main focus points of the updated guidance are individualization of care through dynamic approaches to prenatal visits and monitoring, addressing unmet social needs of patients, and incorporation of telemedicine and alternative care modalities. Together, this triumvirate forms the foundation of the prenatal model of care developed during the pandemic that the updated guidelines have now formalized as the Plan for Appropriate Tailored Healthcare in Pregnancy standard of care.

“Tailored care acknowledges that no two pregnancies are the same. When visit schedules and care modalities reflect a patient’s actual needs — rather than a rigid template — we see improved trust, better engagement, and more efficient detection of complications,” Shah said. “Importantly, it also reduces unnecessary visits and burden for low-risk patients while enabling more frequent touchpoints for those who need it most.”

The listening tour involved nine focus groups with a total of 102 obstetric stakeholders from 10 obstetric care organizations, seven patient advocacy and equity organizations, nine policy and public health organizations, and four payer groups.

“Participants broadly supported the idea of care tailoring and raised important concerns about unintended inequities and negative health outcomes that could arise with inappropriate application of the model,” Peahl and her colleagues wrote. “Participants affirmed that addressing social needs is crucial to improving prenatal care access and pregnancy outcomes but identified barriers including insufficient resources and support for interprofessional collaboration.”

Addressing Social Determinants of Health

The ACOG guidelines state that nearly a quarter of pregnant individuals do not establish prenatal care until after their first trimester, and almost half do not receive all the recommended services on time. Reasons for these delays include social and structural drivers of health, such as institutionalized racism, socioeconomic status, and geography, which, in turn, contribute to maternal and neonatal outcomes, including adverse outcomes due to gaps in prenatal care, as noted in the guidance notes.

“Improving access to and the experience of prenatal care services is an important part of addressing inequities,” the guidance states. “Prenatal care tailored to the needs and preferences of each individual has the potential to improve maternal satisfaction and outcomes and improve health system functioning, especially if implemented with attention to equity.”

Hence, the first consensus recommendation of the document, that maternity care professionals conduct a comprehensive prenatal needs assessment that considers not only medical concerns but also social and structural drivers of health, is detailed in a related ACOG committee statement. That assessment ideally should occur before 10 weeks of gestation or when a pregnant person otherwise first presents for care.

The second recommendation, to engage pregnant patients in developing their own care plan through shared decision-making, enables patients to exercise more agency in addressing their needs, such as their employment situation, transportation options, and caregiving responsibilities.

“This process supports patient knowledge and autonomy, improving outcomes and satisfaction,” the guidance stated.

The incorporation of social drivers of health into a patient’s care plan leads logically to the third recommendation — that providers refer patients or help coordinate assistance through the health system for unmet social needs.

While the listening tour revealed widespread agreement with the “need to embed social needs screening and management into routine practice,” it also revealed concerns about how blind spots or misapplied practice could exacerbate inequities.

“At the individual level, clinicians, patients, and advocates were concerned that biases against individuals with unmet social needs could negatively influence care delivery,” such as making assumptions about a patient’s compliance based on their material needs. But “relationship-building with patients, often over multiple visits,” can help promote trust and disclosure of needs, noted the results of the listening tour. Another approach is to share available resources with patients before screening them.

At the same time, on the listening tour, “groups shared concerns that screening, particularly in the absence of resources, could cause retraumatization.” One way to help prevent that is to collaborate with community health workers, doulas, care navigators, and social service professionals.

Visit Schedules, Monitoring, and Delivery Models

Until the new guidelines, formalized models of prenatal care delivery had not changed much since the first guidance was published in 1930. Those models recommended monthly in-person visits until gestational month 7, visits every 2 weeks until month 8, and weekly visits after that until delivery.

But the pandemic forced many practices to tailor their prenatal care schedules to individual patients’ needs, including remote monitoring of vital signs such as weight and blood pressure.

The final four consensus statements of the updated guidance bring together a recognition of the value of telemedicine and an acknowledgement of the way different medical needs and personal and social realities necessitate different models of care for different patients. This is where the individualization of care that so many practices have already adopted comes into play.

These last four consensus statements say that providers may offer telemedicine, may individualize monitoring options for most routine prenatal parameters, may adjust prenatal care delivery to be more accessible, and may tailor both the visit frequency and monitoring schedule according to the patients’ needs.

For example, a low-risk multiparous patient with caregiving responsibilities and unreliable transportation would likely benefit from more telemedicine visits and fewer overall visits. Meanwhile, a nulliparous patient with multiple risk factors may benefit from visits more than once a month before the seventh month. And a patient with a history of preeclampsia may follow a traditional visit schedule but may want to opt for more frequent remote blood pressure monitoring.

Telehealth: An Integral Part of Tailored Care

Shah suggests that “virtual care is essential” to making the model of tailored care work.

“It creates timely access to a multidisciplinary care team — including ob/gyns, mental health providers, nutritionists, doulas, and care advocates — especially for those in underserved areas,” Shah said.

Well over half, perhaps as many as two thirds of practices, already offer telehealth visits, largely as a result of continuing what was necessary during the COVID pandemic. The updated guidance offers its blessing, in a sense, to the value and legitimacy of telehealth as an important option in standard care.

“They’re finally recognizing the benefits of telehealth, and that’s becoming more obvious with rural hospitals and smaller hospitals being shut down,” Phelps-Sandall said. “Where it’s going to be harder to get to a place for prenatal care, telehealth can be very convenient for patients and their doctors.”

According to an ACOG policy statement on telehealth published in October, only 9%-12% of surveyed ob/gyns used telehealth for patient visits prior to the pandemic. But the realities of COVID rapidly changed that status quo, with 84% of providers reporting the use of telehealth 3 months after the pandemic began.

While it’s difficult to find updated numbers on how many ob/gyn practices continue to offer telehealth visits in 2025, data since the early days of the pandemic suggest it has become a permanent fixture at more than half the nation’s practices. A 2023 American Medical Association report found that just over half of ob/gyn providers were offering videoconferencing visits in 2022, at an average of 5.5 videoconference visits per week. Even more (61.5%) had offered audio-only visits in the previous week.

Phelps-Sandall said she believes as many doctors as possible should be offering telehealth options, but she also acknowledged the potential barriers, including payers that may not reimburse much — or at all — for telehealth visits. Another challenge is simply setting up a practice in terms of Health Insurance Portability and Accountability Act-compliant platforms and other digital infrastructure.

For example, Phelps-Sandall said she had the advantage of a university community network that helped her set up her practice. Without that, “you are stepping into unknown territory, and you’ve got to make sure all your connections are secure and that privacy [protection] is up to date.”

Shah agreed that “realizing the promise of individualized prenatal care” means buy-in and action from stakeholders across the healthcare ecosystem, including health plans with “payment models to support virtual care, care coordination, and nonclinical services that address social drivers of health” as well as policymakers doing their part to make these services “reimbursable, interstate, and accessible.”

Shah reported being the chief medical officer of Maven Clinic. Phelps-Sandall reported being the founder of Renaissance Healthcare for Women. The authors of the listening tour document reported having no conflicts of interest. Any potential conflicts of interest from authors of the prenatal care guidelines “have been considered and managed in accordance with ACOG’s Conflict of Interest Disclosure Policy,” the document states. 

Tara Haelle is a science/health journalist based in Dallas.