About the programs of Maternl©

Introduction

Maternl© strives to improve maternal and fetal health, experiences and outcomes, in a milieu of empathy, compassion, advocacy and trust by addressing gaps, disparities and unmet needs in care by promoting the universal adoption of one standard of maternal care for all.

Maternl© is founded on the premise that the use of new technologies that abet science and innovation in maternal and child healthcare can also address age-old human values and lessons necessary for healing and well-being. The programs of Maternl© provide a platform to inform, educate and monitor the progress of the user's pregnancy through its Personal Prenatal Health Record while embracing language, communication and the vital tenets of 'humanism' to offer unique resources to improve the dimension of caring for all mothers. Maternl© provides original content and applications, authored, designed and monitored by the founder, an Obstetrician with a career-long committment to and practice in obstetrics, maternal and women's health and a Maternl© advisory board selected for their life's work, expertise and values inherent in our mission.

Mission of Maternl©

To Address pregnancy care and well-being with empathy, trust, and social justice by addressing disparities and unmet needs in care for vulnerable and underserved families and communities including the:
  • need for universal adoption of one standard of maternal care
  • need for immediate and continuous access to personal prenatal health record information
  • disparities and barriers to access to maternal (pre-natal) healthcare services
  • disparities in the quality of provider-patient relationships through a compelling need for omnipresent, patient-centered, humanistic care
  • access to resources for pregnancy loss, stillbirth, or neonatal death: imperative and essential bereavement care for healing and well-being for all parents who have experienced such losses
  • availability of a moderated, public space and a private and personal space to reflect and share thoughts, feelings and questions during pregnancy and beyond

Personal Statement of the Founder
I am first a physician, a distant disciple of Aesculapius and Hippocrates1; a clinician, a teacher, and a student. I am an Obstetrician. I stand before my patients2 and facilitate their births. I share their joys; I feel their pains. Yet, caring for the well-being and the illnesses of patients and their families is to accept that medical science in all its depth and possibilities is not precise and that the human mind and flesh are perishable. We are today steeped in myriad medical technologies that in themselves bring hope to previously hopeless conditions and pathologies. Yet there remains inexorable suffering which accompanies failures and tribulations not only of these new medical technologies but of pervasive disparities which exist to deny access to one standard of maternal care for all, disparities defined by the social determinants of health : the paradox of our societies to both cure and cause pain which is real and evident.

I believe that we as practitioners and guardians of humanity's health, have been granted by oath and by ethic the privilege to examine and treat, to counsel and advise our fellow human beings and we must never abandon the souls of all patients seeking our care. It is my hope that Maternl© will propagate and preserve these tenets.

Prociedo
Going forward (l)

Today are times of much despair
Yet times of great hope
To affirm our oath
As unfiltered reason and purpose
Rush in our blood
Every pulse a wave
Approaching distant shores

To leave our prejudice behind
To fade into vapors
As common as fog
And guide us to plant Roots to bond our humanhood and
Vines to grow our brotherhood
As we go forth into tomorrow.

Copyright @2020 Michael R Berman, MD, All rights reserved

Maternl©, a division of Hygeia Health Systems LLC, provides unique software programs developed specifically to offer opportunities and advantages to improve gaps and disparities in prenatal health care for women and their families, world-wide. Maternl© addresses access to maternal and child healthcare and is particularly focused on disparities to early entry into prenatal healthcare services, in an effort to reduce associated prematurity, neonatal and infant mortality. Maternl© provides important tools to monitor each pregnancy's progress, better understand the providers' care, and offers assistance to access maternal and child healthcare services and resources. Maternl© comforts and supports all pregnancy and newborn related concerns, particularly should one have a miscarriage or very complicated pregnancy that might end with a pregnancy loss, stillbirth or neonatal death. Unique to Maternl© is the opportunity to re-dedicate an original poem to honor their child (or for someone else's child ) and download this personalized, signed poem. One may select a poem written and rededicated for the loss of a pregnancy or newborn or a poem for other occasions to honor, eulogize or celebrate occassions that might be appropriate for the user or for their friends, family or colleagues. This is a free service of Maternl© but contributions can be made through GoFundMe to help sustain the mission of Maternl©.

1 Hygeia Health Systems, LLC, symbolic of the Greek mythological goddess of health and healing for which it is named, represents a concern for the human dimension of healthcare and medicine, the use of new technologies to share age-old lessons, the development of software programs to improve quality, safety, empathy, compassion and physician-patient engagement and a concern to address disparities in access to and outcomes of care, domestically and internationally. ________________________________________

Programs

Personal Prenatal Health Record (PPHR)

A key tool and application of Maternl© is a web-based, cross platform Personal Prenatal Health Record (PPHR). The PPHR is a portable, secure and interactive electronic personal health record, designed specifically for pregnant women in underserved, urban and rural communities, nationally and internationally. Many women in urban, underserved communities do not have readily accessible and continuous access to pre-natal care, may get fragmented care at multiple facilities ("unregistered" patients) and may lack a primary pre-natal healthcare provider who is familiar with the patient, her health history and family history, her prior physical / prenatal examinations and her laboratory/ultrasound findings. Providers of care to pregnant women in urban settings often see patients in an emergency setting such as the labor floor or emergency room without access to their prenatal visit information such as their pregnancy / medical history, prior examinations and laboratory and imaging findings. These render the emergency visit suboptimal and oftentimes unsafe. Thus, there is a need for a reliable and immediately available prenatal health record in order to provide improved quality of the prenatal visit.

The Maternl© PPHR is easily useable and always accessible as a mobile, Internet-based application, intended for a specific target population of urban underserved pregnant women. The Maternl© PPHR is designed to collect, store and permit access to personal prenatal healthcare information in an effort to improve the quality of the point-of-service encounter for all pregnant women but in particular, "unregistered" patients arriving for pregnancy related care. Maternl© is designed to be culturally and health-literacy appropriate, and designed to be more effective than current attempts for target population to arrive at a healthcare facility with their pre-natal information; i.e. paper card. The Maternl© PPHR addresses:

a. Higher rates of perinatal morbidity, mortality and prematurity in urban, underserved, minority communities
b. Coincident disparities in access to prenatal healthcare services and access to and use of available health information technologies. (This division becomes particularly concerning as health information technologies play a greater role in the personal health of the patient / consumer in the general population.)
c. An outdated currently utilized "paper chart format" for maintaining prenatal care information ("Pregnancy Passport")
d. A compelling need to improve compliance with accepted prenatal care standards and procedures and patient education needs via the use of innovative, multiple platforms and approaches

The maternal PPHR uses decision support algorithms to notify the user of abnormal values / conditions when data is entered and both directs the user to educational resources to learn more about the condition and also a reminder to call their health-care provider.

Comfort and Support for families who have endured the loss of a pregnancy or newborn child providing:

a. A singularly unique program of personalized, original poetry for mothers, fathers and families of babies that have died, which I have written for my patients and now available to be rededicated to other's
b. An extensive database to register your pregnancy loss and share your stories with other families who have endured a pregnancy loss from a similar or other cause ranging from the current to up to 25 years ago.
c. A place to reflect, keeping it private or public, experiences, thoughts, poems etc. of the loss of one's pregnancy or the death of a newborn child.
d. Personal thoughts, eulogies and essays. I have designed and developed the foundations of these programs over a long span of my career. As an Obstetrician, my personal and professional mission has involved a striving to bring comfort and healing to children, born and yet to born, and to mothers through their years of childbearing and beyond. I have been uplifted by the triumphs of birth and healing and depressed by the failures. Yet I have always tried to look beyond the failures in search of the triumphs. I have counseled patients at the darkest times of their lives, when their children have died, and I have turned to the comfort of personal reflection, poetry and self-expression to better help me help my patients. Here at Maternl©, along with my companion book, Parenthood Lost , I am sharing these personal poems, essays and thoughts to help comfort those who have endured the tragedy of a Pregnancy Loss and / or Neonatal Death. Maternl© provides an opportunity for a family to re-dedicate an original poem to honor their child (or for someone else's child) and download this personalized, signed poem.

When the outcomes of pregnancies end in miscarriage, stillbirth or infant death, we as healthcare professionals, families and friends struggle to find the right approach to break the news to them, treat them medically and/or surgically, help them recover physically and emotionally, and console them in their grief. Most healthcare professionals have not been taught to provide this bereavement care. Although the stillborn baby which might have been born viable represents the greatest emotional and management challenges, we must recognize any loss in pregnancy as a life-altering event for our patients. The care of the patient experiencing a pregnancy loss is a paradigm for what we do as physicians. It tests not only our clinical skills and judgments but stretches the fibers of the human aspect of caring very thin. Although we might ask, "how can we heal when our patients' children are incurable, when they are suffering or when they die or what do we do when the advanced technology that has become a part of our black bag fails", we must understand that we can heal by providing comfort , empathy and hope. As bad as this experience is for our patients, healthcare professionals, friends and families can make it better.

There is art as well as science to caring for the parents of a child who has died, either before birth or afterwards. Countless mothers and fathers and those close to them silently grieve with little resolution over the loss of their pregnancies, newborns and children. Seeking reprieve from their sorrow, they cry and yearn for solace and hope, many times for years following their loss; cries that are but a muted weeping of despair as a child so longed for is not born, or is not born alive, or dies during childhood. Pained by these losses, their lives seem devoid of hope. The joys expected from normal childbirth and child-rearing turn to sorrow. We as physicians share with them in this tragedy as now the balance between caring for the well-being of the child shifts to caring for the tolling physical well-being of the mother and father, the agony of their emotional well-being and that of their immediate family. The shadow of their grief will be indelibly imprinted in their minds and souls. Death may strengthen or threaten to tear apart the bonds of their relationships with friends, family and themselves. We, their physicians must recognize the impact of these losses, be the first responder in this time of need, and abet the healing process, no matter how long and difficult. The loss of a child brings to us pain that is primal and endures forever. Poetry enables us to ask why even when we already understand how. It permits us as healthcare providers, witness to the frailties of our humanity, to abet healing through the very core of what makes us human, our language and our personal emotions. It has been my platform to tell to honor my patients, my friends, my family and indeed, the essence of humanity, the "family of man".

The impact of words and thoughts at these difficult times are universal. Sometime ago, I received a note from a father who just had lost his prematurely born daughter to the condition called twin-to-twin transfusion syndrome. One twin died in utero and the remaining twin was born at 25 weeks, gravely ill and on life support systems in the Newborn Intensive Care Unit. After a brave but futile struggle, she, too, died. Her father contacted me from England, asking if I could suggest some words to read at the memorial service for his children. I sent a few lines to him and his bereaved wife. In their reply I learned that they placed these words upon the headstone of their twins' grave:

“Let us not succumb to this portent,
The solstice of our darkest hour.
For it is but a finite point
Upon an infinite journey
Which began with all creation and
Upon whose path walk
The souls of our children;
Pure as the silence of the virgin winter,
Alive with winds of indomitable hope”


Get the Healthcare You Deserve© ( GetCare© )

Through this portal, "GetCare©" provides the user with easy access to a database of geographic-specific Federally Funded Clinics and Maternal and Child Health Services linked through HHS.gov, where prenatal and delivery care can be given. "GetCare©" provides a personalized letter of introduction for the user to the health care facility they select as one who needs help with their care, much like patients have a letters of referral to a doctor from another doctor.

By having this introduction to prenatal care services "GetCare©" addresses the lack of an advocate / provider, the lack of awareness of local healthcare facilities offering maternal and child health care services including prenatal care, a lack of understanding of the need for pre-natal care, albeit early care, the late diagnosis, recognition and acceptance of ones pregnancy, embarrassment and denial, and perhaps, shame, diminished self worth and dignity and a feeling of isolation without a place or professional to turn to for immediate care, counseling and accompanying advocacy. The letter itself is not a referral but an introduction. This service can be easily linked to local and regional social services so families in need can have their support as well. At this time, this program is only available in the United States but will be expanded internationally in the near future.

Request a Personalized Poem
The impact of words and thoughts at difficult times of loss are universal. Upon other occasions, poetry can equally bridge the chasm of what to say and what is felt at significant times in our lives. Through metaphor and allusion, rhyming and meter; for eulogy and celebration; for love, understanding and hope, poetry does "matter". Poetry, a central foundation to the Maternl© organization, enables me to ask why even when we already understand how. It permits me as a Doctor of Medicine, witness to the frailties of our humanity, to abet healing through the very core of what makes us human, our language and our personal emotions. It has been my platform to tell my 'stories', to honor my patients, my friends, my family and indeed, the essence of humanity, the "family of man". It is my hope that offering these very personal poems to the visitors at Maternl© for their own purpose or to be shared with friends and familywill bring solace, comfort, joy, meaning and hope at difficult as well as joyous times.

As an Obstetrician, my professional mission has involved a striving to bring comfort and healing to children, born and yet to born, and to mothers through their years of childbearing and beyond. I have been uplifted by the triumphs of birth and healing and depressed by the failures. Yet I have always tried to look beyond the failures in search of the triumphs. I have counseled patients at the darkest times of their lives, when their children have died, and I have turned to the comfort of personal reflection, poetry and self-expression to better help me help my patients. Maternl©, along with the companion book, Parenthood Lost, I am sharing these personal poems, essays and thoughts; my personal approach to my patients that I can now extend to many others to help comfort those who have endured the tragedy of a Pregnancy Loss and / or Neonatal Death. Unique to Maternl© website is the opportunity to re-dedicate an original poem to honor their child (or for someone else's child ) and download this personalized, signed poem.

For those who would like to contribute to and help sustain the mission of Maternl©, you may select a poem written and rededicated for the loss of a pregnancy or newborn or a poem for other occasions to honor, eulogize or celebrate; occassions that might be appropriate for you or for your friends, family or colleagues.

Thoughts, Reflections and Humanism in Medicine
Here, you will find a space to document personal reflections, essays, stories and commentaries that reflect perspectives on maternal and child healthcare, humanism, caring and medicine and the importance of trust: the hallmark of the doctor-patient relationship as well as thoughts and teachings about our patients when they die or are incurable: the ultimate challenge to the bond of patient with doctor.

It is also a space to share any thoughts the user would like to document regarding their pregnancy, their prenatal care, questions about where to find resources, etc. and for the user to keep a private, anonymous personal diary, visible only to the user. This platform is accessed only by the registered user's email address and Maternl© username's credentials. The Maternl© leadership and professional advisory team comprised of multicultural, international, experienced professionals from the disciplines of health sciences, specifically obstetrics, 'mother-baby' nursing, patient safety, midwifery, ethics, medical education (faculty, medical students, House Staff) and health informatics may also participate in contributions to this space.



The programs and applications of Maternl© are free of cost to use, but please consider a voluntary contribution through our GoFundMe campaign to help further develop, support and sustain the programs and mission of Maternl©.

About the Founder and Author
I received my Doctor of Medicine Degree from New York Medical College and my Masters Degree in Biomedical Informatics from Oregon Health and Science University (OHSU) with an area of concentration on Personal Health Records. I spent two summer sessions at the Wesleyan Writers Workshop studying poetry under the mentorship of poets Dana Gioia and Henry Taylor. I completed my Post Graduate Residency Training in Obstetrics and Gynecology and one year fellowship in Maternal and Fetal Medicine at the Yale School of Medicine and Yale New Haven Hospital. I am currently Professor of Obstetrics, Gynecology and Reproductive Science and Associate Dean for Quality and Patient Safety for Graduate Medical Education at the Icahn School of Medicine at Mount Sinai, and Chief Quality Officer and Ombuds at the Mount Sinai Health System in New York, New York. Prior to joining the faculty at Mount Sinai, I was in Clinical Practice in Obstetrics and Gynecology and Clinical Professor of Obstetrics, Gynecology and Reproductive Sciences at the Yale School of Medicine. In 1996, I founded the Hygeia Foundation for Perinatal Loss and Bereavement, now Hope After Loss , and am the author of numerous poems and essays documenting the human condition. I am also author of the book, Parenthood Lost : Healing the Pain After Miscarriage, Stillbirth and Infant Death. I joined the faculty and attending staff of the Mount Sinai Beth Israel Medical Center in 2012 where, as the medical director of the Labor and Delivery Unit, I implemented the hospital's first full-time laborist program, which provided a structured, collaborative, patient-centric approach to improving the quality, safety, and patient experience on the labor floor. In 2017, I was appointed Chief Patient Safety Officer for Mount Sinai Beth Israel Medical Center and Associate Dean for Quality and Patient Safety in Graduate Medical Education. Major focus areas of mine at Mount Sinai were leading system-wide patient safety initiatives, developing customized information systems for labor and delivery, safety-event incident reporting, hospital security reporting programs, participation in perinatal bereavement and spiritual care initiatives, and teaching. However, throughout my entire career, none was more important to me than my role as Obstetrician and Physician to my patients. As of September, 2020, I have retired from my full-time positions at the Mount Sinai Health System but continue in my faculty and teaching roles as Clinical Professor of Obstetrics, Gynecology and Reproductive Sciences at the Icahn School of Medicine at Mount Sinai.

Inkind Organizations


I would like to recognize the following organizations whose work and missions are complementary to the mission of Maternl©.

                         

Funding
Maternl© is not a non-profit organization but does provide its full range of services pro bono in support of and in consideration to its intended user base. Although the Maternl© business plan is not included in this introduction, I anticipate sources for monetization will come from licensing of other software products which I have developed, grants, support, co-branding and sponsorship from in-kind organizations and from a GoFundMe campaign providing support in the following ways:

1. If a Maternl© user has experienced a pregnancy or newborn loss or knows someone who has, the user may go to the Maternl© pregnancy and newborn loss community and Request a Poem: A selection of original, signed poems that may be dedicated to a parent or child and then have an opportunity to make a voluntary contribution at GoFundMe.
2. A general visitor to Maternl© may request and receive an original signed poem with universal themes of Hope and Loss, Eulogy and Celebration, Love and Understanding and make a voluntary contribution at GoFundMe.
3. Through Social Media GoFundMe campaign notifications

Summary
Inherent in what defines a best practice in the physician-patient partnership and in turn, the health system / provider-patient partnership, is an unfaltering responsibility of the physician / provider and an unconditional trust of the provider by the patient. Together these bond the chasm between the vulnerable patient and the knowledge and experience of the physician / provider; a synergy of the need for care and the privilege of caring. This paradigm must apply to all mothers seeking pre-natal care ( albeit to all those seeking healthcare ) to play a role to reduce maternal and perinatal morbidity and mortality It is my hope Maternl© will contribute to the health and well-being of mothers and families, particularly those at-risk, vulnerable and disadvantaged families, world-wide, by providing an opportunity to improve access to care, shared-decision making for better understanding of maternal prenatal care through the interactive, Maternl© Personal Prenatal Health Record and provide solace and comfort when the unexpected, tragic loss of a pregnancy or newborn child occurs.