How New Prenatal Care Guidance From ACOG Might Affect Parents-to-Be

Since its formal rollout in the 1930s, prenatal care has saved lives and improved outcomes for parents and babies alike. Over time, experts have developed better ways to monitor health, prepare the body for birth and catch complications early. Still, many parents-to-be—especially those in marginalized groups—face hurdles accessing timely, affordable and personalized care. Studies show that a significant number of pregnant people skip out on prenatal visits due to work or financial concerns.

That’s why the American College of Obstetricians and Gynecologists (ACOG) recently released new guidance calling for a “transformation” of prenatal care. The recommendations, built around four key changes, aim to make care more tailored, equitable and accessible. Here’s what the updates are, what they could mean for expecting parents and where the gaps remain.

1. Early Comprehensive Assessments, Ideally Before 10 Weeks

ACOG recommends a full medical and social needs assessment before 10 weeks gestation to identify risk factors early and tailor care accordingly. This recommendation comes in response to data showing that nearly one in four pregnant individuals don’t receive prenatal care until after the first trimester, and almost half do not receive all recommended services on time.

What it means for parents: This early evaluation could help flag complications sooner and connect patients to critical resources. But it likely won’t feel new to many. As Jocelyn Fitzgerald, MD, a double board-certified urogynecologist and ob-gyn, points out, “A 10 week visit is already part of standard prenatal care. So I don’t really know what about that is transformational.” While the recommendation reinforces existing best practices, it doesn’t address the real barriers that prevent people from accessing care in the first place.

2. Shared Decision-Making and Tailored Care Plans

Studies show that shared decision-making can improve trust, satisfaction and adherence to care. It also allows the system to be more efficient by not overburdening lower-risk patients with unnecessary appointments. The new guidance encourages personalized care plans developed in collaboration with patients, moving away from a one-size-fits-all schedule to accommodate individual risk levels.

What it means for parents: This approach could give you more say in your prenatal experience, potentially involving fewer in-person visits if you’re low-risk or more specialized monitoring if you’re high-risk.

Still, Fitzgerald notes that shared decision-making should already be standard: “Some patients are going to be good candidates for midwifery care, some are going to be lower risk, some are going to be higher risk…you have to meet patients where they are.” She supports the intent but questions its billing as a breakthrough. And for those—particularly Black mothers—who often report feeling dismissed or unheard in clinical settings, “collaborative care” may feel more combative than reassuring if trust hasn’t been built.

3. Stronger Referral Systems for Social Support

Research shows that social determinants like income, education and environment play a major role in maternal health outcomes. ACOG’s recommendation encourages providers to help connect patients to community resources for needs like food, housing, and mental healthcare early in pregnancy.

What it means for parents: If implemented well, this could help ensure that more people—especially those with limited resources—aren’t left to navigate complex social challenges alone. Your provider could play a larger role in connecting you with wraparound services.

For those looking outside of traditional ob-gyn care, the new guidance represents the organization’s growing willingness to collaborate and not sideline other care providers like midwives and doulas who often prove integral to Black maternal and other marginalized group’s care.

But Fitzgerald cautions that without added support, this simply shifts more responsibility onto already overextended clinicians. “That’s a job unto itself,” she says. “They don’t really say how OB-GYNs are supposed to do that without extra resources and time.” In other words, the idea is sound—but the infrastructure to make it happen is still missing.

4. More Flexible Care Delivery with Telemedicine, Self-Monitoring and Group Prenatal Care

ACOG recommends broadening how prenatal care is delivered—through virtual appointments, at-home blood pressure checks and group prenatal care models that bring moms-to-be together. The goal: reduce barriers to care while still ensuring that patients receive necessary screenings and education.

What it means for parents: Greater flexibility could be a game-changer for those juggling work, childcare or transportation hurdles. But it also introduces questions about consistency, insurance coverage, and access to technology. Fitzgerald supports the spirit of the change—“anything that can make pregnancy a better experience is a good thing”—but stresses the reality is more complicated. “There’s a lot of legislation and billing that goes into telemedicine that is constantly shifting,” she says. And for some, being asked to self-monitor at home or attend fewer in-person appointments might raise concerns about whether care is being just scaled back rather than improved.

The Bottom Line

ACOG’s new guidance aims to modernize and humanize prenatal care. For parents-to-be, that could mean more personalized visits, expanded care options like telehealth, and earlier support for social challenges. But as Fitzgerald points out, the guidance largely asks providers to do more without addressing the foundational issues—like insurance reimbursement, workforce shortages, and resource constraints.

That disconnect is a recurring theme among health professionals. “The primary reason many OB-GYNs are resistant to these proposed changes lies in the current reimbursement structure for obstetrical care,” explains board-certified ob-gyn Christie Porter, DO, FACOG. “We are reimbursed under a global payment model, which means we receive a single bundled payment regardless of the number of appointments, the duration of labor, or the mode of delivery.”

“I am concerned that OB-GYNs working in private practice or under RVU-based compensation models will be slow to adopt these changes until insurance companies provide adequate reimbursement for the care we deliver,” she adds. “We genuinely care about pregnancy outcomes, but need insurance reimbursement to reflect the amount of care we provide.”

Fitzgerald agrees that the direction ACOG is headed in is positive—but insists the follow-through matters. “If these really said prenatal care is a valuable investment…and here are the social structures and revenue flows that we need to make this happen, I would’ve been thrilled,” she says. “But that’s unfortunately just not what happens.”