In a groundbreaking update, the American College of Obstetricians and Gynecologists (ACOG) has released new clinical guidance calling for a complete transformation of how prenatal care is delivered in the United States. Centered on tailored, patient-centered care, the recommendations move away from a one-size-fits-all model and toward a system that adapts to individual risk profiles, preferences, and social determinants of health.

This shift presents a unique opportunity for OB/GYN practices, health systems, and maternal health innovators to redefine prenatal care delivery, improving outcomes while addressing systemic barriers to care.

A Legacy Model, Ripe for Change

For nearly 100 years, the U.S. prenatal care model has remained virtually unchanged: 12 to 14 in-person visits scheduled uniformly for all pregnant individuals, regardless of risk. While tradition held strong, research failed to link this structure to improved maternal or fetal outcomes. In fact, many patients do not even receive timely prenatal care under the current model:

  • 23% delay their first prenatal visit until after the first trimester
  • Nearly 50% do not receive all recommended services on time

This outdated model often ignores patient realities such as transportation barriers, inflexible jobs, lack of childcare, and more that make attendance difficult, especially for marginalized populations.

The Case for Tailored Prenatal Care

According to ACOG’s Clinical Consensus Committee report, Tailored Prenatal Care Delivery for Pregnant Individuals, average- and low-risk patients can safely receive fewer in-person visits when paired with modalities like telemedicine, home monitoring, and group care.

The guidance supports individualized care planning based on:

  • Medical history and current clinical risks
  • Structural and social drivers of health (e.g., housing, employment, education)
  • Patient values and preferences

As ACOG’s Dr. Christopher Zahn stated, “Advancements in technology and evidence-based assessments have warranted a change… we have to adjust the system and meet patients where they are.”

Building the New Care Model: PATH

To develop this updated framework, ACOG and the University of Michigan convened a diverse group of stakeholders – maternal health experts, equity advocates, pediatricians, and patients – to create the Plan for Appropriate Tailored Healthcare in Pregnancy (PATH).

PATH outlines recommendations for:

  • Frequency and structure of visits
  • Use of remote monitoring (e.g., BP, weight, BG)
  • Integration of telehealth and group visits
  • Addressing social determinants through “assistance and adjustment” strategies

Importantly, the model preserves intensive follow-up for high-risk pregnancies while freeing up resources by streamlining care for lower-risk individuals.

Addressing Equity Through Structural Change

Tailored care is more than a logistical adjustment – it’s a strategy to reduce maternal health disparities, particularly among Black, Indigenous, rural, and under-resourced populations.

By identifying and responding to social drivers of health like racism, lack of insurance, or housing instability, clinicians can modify care delivery through:

  • Assistance: Connecting patients to community resources, social services, and care navigation
  • Adjustment: Reducing barriers via telehealth, flexible scheduling, or group care

This approach reflects the growing understanding that health equity requires upstream intervention as much as clinical excellence.

RPM and Hybrid Models: COVID-19 as a Catalyst

The COVID-19 pandemic acted as an accelerant, forcing providers to quickly adopt hybrid models with:

  • Reduced visit schedules
  • Virtual prenatal consultations
  • Home monitoring of vital signs

These adaptations demonstrated that patient-centered, flexible prenatal care is not only feasible, it’s effective and preferred by many. ACOG’s new guidance seeks to formalize and standardize these innovations beyond the pandemic.

Challenges to Implementation

While promising, the tailored prenatal care model faces several barriers:

  • Infrastructure: Many clinics still lack robust telemedicine platforms or broadband access
  • Payment models: Existing billing systems aren’t designed to support hybrid or nontraditional care delivery
  • Workforce limitations: Staffing shortages make social needs screening and follow-up difficult in some settings
  • Policy resistance: Political and institutional barriers may inhibit structural change, especially around racial equity efforts

Nonetheless, ACOG emphasizes that these are solvable challenges and change is necessary to improve outcomes and eliminate disparities.

What This Means for Providers

For clinicians and health systems, ACOG’s guidance is a call to action. Tailored prenatal care means:

  • More flexibility in visit structure and modality
  • Greater attention to social determinants of health
  • Empowered, collaborative care planning with patients
  • New tools and technologies like RPM and EHR-integrated screening workflows to manage complexity
  • More time and resources directed toward higher-risk patients

As Dr. Alex Peahl explains, “Tailored care does not mean less care. It means delivering the right care, by the right professional, through the right modality.”

Looking Ahead: Policy, Research, and System Redesign

To scale this model nationwide, we’ll need:

  • Payment reform to support hybrid care
  • Ongoing evaluation to ensure equitable outcomes
  • Investments in technology and staff to expand access
  • Advocacy and leadership to challenge the status quo

Dr. Mark Turrentine, coauthor of the guidance, puts it plainly: “By streamlining the number of visits for average-risk patients, we can improve availability for higher-risk patients with more complex needs. But future research will be needed to assess the impact of this new approach in real-world settings to fully understand the effect on care delivery and pregnancy outcomes and ensure that there are no unintended consequences for marginalized groups.”

The Bottom Line

ACOG’s new tailored prenatal care guidance marks a historic turning point – an opportunity to rethink prenatal care delivery in a way that centers patients, reduces disparities, and improves outcomes.

The future of maternity care is flexible, tech-enabled, equity-driven, and grounded in shared decision-making. The work ahead is complex, but the mission is clear: to build a system that works for every patient, every pregnancy, everywhere.