A discussion on ACOG’s new clinical consensus on tailored prenatal care

In May 2025, the American College of Obstetricians and Gynecologists (ACOG) released a new Clinical Consensus that reimagines the traditional model of prenatal care. Titled "Tailored Prenatal Care Delivery for Pregnant Individuals," the guidance outlines a patient-centered framework that accounts for medical risk, social needs, and individual preferences. In the following Q&A, 3 authors behind the consensus—Mark Turrentine, MD; Alex Peahl, MD, MSc; and Julia Phillippi, PhD, CNM, FACNM, FAAN—discuss the motivation for the new framework, how telemedicine and shared decision-making can be effectively implemented, and the steps clinicians can take to ensure health equity and improve access for all pregnant individuals.

Contemporary OB/GYN: What motivated the development of this new tailored prenatal care framework, and how does it address the limitations of the traditional 1930s-era visit model?

Mark Turrentine, MD

Mark Turrentine, MD: There has been a lot of evidence-based changes in the antenatal services provided over time; however, the format for delivery of these services has remained largely unchanged for almost 100 years. The COVID-19 pandemic accelerated significant changes in prenatal care delivery, including adapting to targeted visit schedules, the use of telemedicine, and home monitoring. The major limitation of the traditional paradigm of prenatal care is the lack of flexibility. The traditional prenatal care model uses a ‘one-size-fits-all’ approach. This new framework allows a foundation for the delivery of tailored care to be developed between the patient and their healthcare practitioner. This approach can allow the care plan to be adapted to the patient’s needs. For example, an individual who is with her second pregnancy may not need to be seen every 2 or 4 weeks during the middle of the pregnancy. Whereas, those individuals who need additional time for their clinical situation can be scheduled for longer visits.

Contemporary OB/GYN: Telemedicine and alternative care modalities are emphasized in the guidance—how should clinicians balance remote care with ensuring the delivery of essential, evidence-based services?

Turrentine: All the same essential, evidence-based services are delivered. Just more efficiently. The targeted in-office visit times are structured to capture all of the evidence-based services. When in-person services are not needed or can be completed through alternative means, telemedicine is an effective means to continue contact with your patient. Hybrid models of prenatal care delivery (including both in-office and telemedicine contacts) have been demonstrated to provide cost savings for the patient (from less travel time, costs of travel, and time-off costs from work).

Contemporary OB/GYN: What strategies or tools do you recommend to effectively engage pregnant individuals in shared decision-making throughout their prenatal care?

Alex Peahl, MD, MSc

Alex Peahl, MD, MSc: Shared decision-making is a central part of the new tailored care recommendations, and can support patient knowledge, autonomy, satisfaction, and birth outcomes. Tailoring care should begin with a comprehensive assessment of individuals’ pregnancy risks, including preexisting conditions, pregnancy history, and unmet social needs. These risks can be assessed through interviews or standardized questionnaires by any trained member of the care team. Maternity care professionals should also ask about individuals’ preferences and priorities for their care. With this information, pregnant individuals and their maternity care professionals can discuss and review flexible, safe, individualized options for their prenatal care delivery. It is important that shared decision-making be an evolving process and that care delivery decisions be revisited over the course of pregnancy. Decision grids and prenatal road maps are helpful tools for visualizing and selecting options. These resources will be available on the ACOG Prenatal Care Website in the upcoming weeks as part of the implementation resources section.

Contemporary OB/GYN: The guidance stresses health equity. What practical steps can clinicians and institutions take to ensure that tailored prenatal care models reduce disparities rather than unintentionally widen them?

Peahl: In the United States, birthing people marginalized by racism, socioeconomic status, and geography experience suboptimal prenatal care, including barriers to access, discrimination and bias, and a negative care experience. Tailored prenatal care is designed to directly address these concerns: providing care more flexibly to improve access and elevating the patient voice through shared decision making to improve the care experience. To avoid widening existing inequities, clinicians and institutions should work to ensure all patients have access to the necessary tools for tailored care, such as broadband internet and devices for self-monitoring. “Standardizing choice,” creating processes for routinely offering available options to all pregnant individuals, can reduce bias in care delivery. Additionally, incorporating additional support people in shared decision-making discussions, such as family members or Community Health Workers, can help patients from marginalized groups overcome the inherent power differentials in clinical discussions.

Contemporary OB/GYN: Can you elaborate on how the recommended comprehensive prenatal needs assessment incorporates social and structural determinants of health, and why this is critical for care planning?

Julia Phillippi, PhD, CNM, FACNM, FNAP, FAAN

Julia Phillippi, PhD, CNM, FACNM, FAAN: This new prenatal care model encourages ob-gyns and other maternity care professionals to talk with patients about their day-to-day stressors and needs and encourages care providers to ask what assistance or adjustments might be helpful for them. The care provider can then work with the full healthcare team to adjust prenatal care and assist that person in getting the health care and social services they may need for a healthy pregnancy, birth, and baby.

Social and structural drivers of health are daily pressures on individuals. For many families, the day-to-day juggle of meeting work expectations and family needs is already a strain. Adding prenatal care to that full schedule can be difficult. Customizing their care schedule around their needs and offering help for overcoming barriers, such as transportation, can make prenatal care not only possible but something to look forward to during a busy phase of life.

Rigid, one-size-fits-all models have not been meeting the needs of families in the United States. This new approach helps people receive the medical care and the overall assistance they need during pregnancy to optimize their health, outcomes, and experience.

Disclosures:

Turrnentine: None

Peahl: Consultant; Self; Mirvie, University Grants/Research Support; Self; Pulsenmore.

Phillippi: Advisory Committee/Board Member; Self; Journal of Midwifery & Women's Health, Royalties; Self; Jones & Bartlett Learning (editor of Varney's Midwifery textbook), University Grants/Research Support; Self; Health Services & Research Administration, National Institute of Nursing Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Reference:

Tailored Prenatal Care Delivery for Pregnant Individuals: ACOG Clinical Consensus No. 8. Obstet Gynecol. 2025;145(5):565-577. doi:10.1097/AOG.0000000000005889