Pregnancy Risk Assessment Monitoring System (PRAMS)
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Stories and Impact
Listening matters
MN PRAMS captures experiences before, during, and shortly after pregnancy—and every journey is different. When participants share their story, it helps improve care for others.
In the US, the CDC’s Hear Her campaign shares powerful stories of those who have experienced serious pregnancy or postpartum complications. These stories remind us that listening to mothers and birthing people and taking their concerns seriously can save lives.
Hear Her stories—including those shared by Takayla in Minnesota, Sanari, and Kylie—highlight moments when something didn’t feel right, when warning signs were unclear, or when concerns were not addressed.
You can:
- Hear Takayla’s story
- Hear Sanari’s story
- Hear Kylie’s story
- Explore additional personal stories and learn more about maternal warning signs through the CDC’s Hear Her campaign
- Learn how the Minnesota Department of Health is promoting the CDC’s Hear Her campaign with resources that both raise awareness of urgent maternal warning signs and improve communication between patients and providers.
MN PRAMS builds on this same principle- sharing your experiences and stories so we can guide statewide improvements in care.
What birthing parents are saying
MN PRAMS includes an opportunity for mothers and birthing people to share comments in their own words. These experiences —both positive and negative —help us understand what care feels like from the patient’s perspective.
Here’s a selection of comments MN PRAMS participants have shared:
‘I almost died from preeclampsia because the doctors and nurses at the hospital did not listen to my concerns and complaints. I suffered in lots of pain and because of that, I had to be readmitted. They neglected to pay attention to the signs and symptoms I had.’ – MN PRAMS respondent
‘I wish there was more education pre-pregnancy, having conversations, encouraging education etc. I felt already behind the ball when I found out I was pregnant. During pregnancy, I live in a rural area, the only provider that was there made me feel small and dismissed me, my questions and concerns. I am fortunate that I was able to go to another hospital (but that hospital was over 2 hours away). I was glad I switched because I felt a lot more comfortable with the care I received at the new hospital. There needs to be more coordination across the system -- if people want doulas, then the hospitals should be educated on local resources and offer. Doctors should expect to educate more and have discussions. If I didn't do my own research and ask questions, I would not have received half the care, because I didn't ask for it. Insurance shouldn't be a barrier to care - the hospital I am more comfortable with - I just received notice that it is going to be more expensive to go there, deterring me from going due to cost, even though I liked my care there in my previous pregnancy. There also needs to be more inclusion around traditional practices in the hospital.’ – MN PRAMS respondent
‘I believe more information should be given to expecting mothers and their doctors about how to prevent a cesarean section. I believe the majority of cesareans are not totally necessary. More accurate information about VBACs and their success rates should also be provided. Thank you for the opportunity to do this survey.’ – MN PRAMS respondent
‘This was my 3rd pregnancy, and it wasn’t great. Unfortunately, the small rural town I am from stopped delivering babies. I was unable to see the same midwife I had seen with my 1st two & had to deliver in another town 1 hr. away from home. Because they no longer had a provider, mine only came to my town 2x a week, which made it more difficult to get an appointment. Thankfully this wasn’t my first & I felt comfortable not seeing a provider as often.’ – MN PRAMS respondent
‘Having a doula in the delivery room with me helped so much. I think without her I would’ve ended up needing a c-section because I was getting tired and she helped me consider my options to make the birth go faster.’ – MN PRAMS respondent
From data to action
The experiences Minnesota mothers and birthing people share through PRAMS inform decisions that affect care in clinics, hospitals, and communities across our state.
When common themes appear in responses, they help guide provider training, strengthen public health programs, and improve systems that serve Minnesota families. Here are two examples:
Improving lactation support in Minnesota
MN PRAMS data highlighted important differences in breastfeeding experiences and access to lactation support among families in Minnesota. While 93% of participants overall initiated breastfeeding, responses were lower for US born Black (89%) and American Indian (85%) participants. Additionally, breastfeeding over time dropped — at three months post-partum, 52% of US born Black and 56% of American Indian participants reported breastfeeding and at six months postpartum, rates were even lower. Only 38% of US born Black and 49% of American Indian participants reported breastfeeding at 6 months (MN PRAMS, 2023).
MN PRAMS data also pointed to differences in hospital experiences and support. US born Black (35%) and American Indian (28%) participants were more likely than White participants (25%) to report that the hospital gave them a gift pack with formula. US born Black and American Indian participants were also more likely to report experiencing racial discrimination in a healthcare setting (8% and 7% respectively) compared to 2% statewide.
These insights helped inform the development of The Roots of Racial Inequities in Lactation training in Minnesota. Designed to build capacity for culturally responsive lactation care, the training includes Minnesota PRAMS data to illustrate key differences in breastfeeding rates and healthcare experiences. It also includes important historical events that have shaped breastfeeding perceptions and norms within Black and American Indian communities, helping providers understand how past and present systems influence care today. In addition, the training highlights specific steps that healthcare providers can take to better support patients in meeting their breastfeeding goals. The overall purpose of the training is to increase the number of Black and American Indian women and birthing people receiving culturally responsive lactation care and ultimately increase breastfeeding rates within these two populations.
Strengthening support for hypertensive disorders of pregnancy in Minnesota
Minnesota PRAMS data from 2016-2021 highlighted the significant impact of hypertension during and shortly after pregnancy and the disparities experienced by some families across Minnesota. Among participants who self-reported hypertension during pregnancy, 17% had a preterm birth compared to 6% of participants without hypertension. The burden was even greater among U.S. born Black (24%) and American Indian (20%) participants who self-reported both hypertension during pregnancy and preterm birth. In addition, 13% of participants with hypertension during pregnancy delivered low-birthweight babies —more than three times the percentage among those without hypertension.
These findings highlight the seriousness of hypertensive disorders of pregnancy as well as the importance of early education, close monitoring, and postpartum support, particularly for communities experiencing higher risk.
MN PRAMS data have helped increase understanding of where disparities are and have informed ongoing efforts such as Heart-to-Heart, a public health nurse home visiting program. The program serves individuals who are experiencing hypertensive disorders of pregnancy or have a history of the condition, which affects blood pressure during pregnancy and the postpartum period. Through partnerships with local public health and clinical teams, the program provides education about blood pressure management, support with home monitoring, and connections to community and clinical resources during pregnancy and the postpartum period.
By using MN PRAMS data to better understand which communities are more likely to experience hypertensive disorders of pregnancy and its related complications, Minnesota can continue to strengthen programs like this that support families affected by hypertensive disorders of pregnancy. The use of data to inform community-based care helps ensure that resources are directed where they are most needed.