Researchers find success in integrating lawyers into care teams to support pregnant and postpartum patients

Medical-legal partnerships (MLPs), which include a lawyer as part of a patient's care team, can help health systems address health-harming legal needs and better support pregnant and postpartum patients, according to a new research commentary published in Obstetrics & Gynecology.

The article offers insights and expert advice from Georgetown University Health Justice Alliance's Perinatal Legal Assistance and Well-being (LAW) Project at MedStar Washington Hospital Center, one of the first medical-legal partnerships in the country to focus specifically on the perinatal period and a key component of the D.C. Safe Babies Safe Moms (SBSM) initiative that aims to improve maternal and infant health in the nation's capital.

MLPs have long been used to improve health and well-being for historically marginalized communities and have been identified as potentially helpful in combating racism in health care. In the maternal health space, offering legal support to pregnant and postpartum patients facing unsafe housing, food insecurity, and challenges with navigating public benefits or insurance coverage can be a powerful tool.

To date, the Perinatal LAW Project has served over 164 patients/clients, helping to recover more than $200,000 in the form of income support, paid leave, back wages, health insurance coverage, debt relief, rent abatements, and security deposit refunds.

"Lawyers know that unmet legal needs in these areas are often at the root of daily life struggles that make achieving optimal health impossible," said Vicki Girard, JD, Co-Founder and Faculty Director of the Georgetown University Health Justice Alliance, professor at Georgetown Law, and one of the publication's authors.

"We are so grateful for the opportunity SBSM has provided to build a robust collaboration with health providers willing to work side-by-side with our academic MLP to treat patients' health-harming legal needs in this setting."

The Perinatal LAW Project helps patients tackle these issues head-on by creating a low-barrier path to access justice through early legal intervention: Doctors, nurses, and other clinical care team members are trained to identify where there may be an unmet legal need and provide a direct referral to one of the lawyers on the team. Patients can then meet with legal experts at the doctor's office as they continue with prenatal care.

"Learning from one of my patients that they don't have working appliances in the home they rent, or there are rats their landlord won't address, or their employer denied a reasonable medical accommodation and then not having the ability to offer tangible support is one of the most difficult parts of being a midwife. What happens inside the four walls of the hospital is only one piece of what determines their birth outcome," said Loral Patchen, Ph.D., CNM, scientific director and clinical lead for SBSM women and infants services, and co-author of the publication.

"Our partnership with the Perinatal LAW team has transformed our ability to tackle the social and environmental factors that impact health and well-being. And just as importantly, this approach has sparked hope in patients who in many cases, were not even aware of their rights or resources they were entitled to in the first place."

For health systems that are interested in implementing a similar program, study authors offer a few insights they credit for their success, including building the right legal team and referral processes, investing in training and capacity building among the health care team to help leverage and extend the legal team's expertise, and ensuring that a patient's legal needs are monitored throughout their perinatal journey.