Lynn Handley
President, American Pregnancy Association
Recent studies show women in the United States have a high rate of maternal mortality (pregnancy-related death) because of complications from pregnancy or childbirth. We also have the highest rate of caesarean sections which significantly increase the potential of complications.
Why? Two of the three major reasons are limited access to healthcare and poverty. Poorer pregnancy and birth outcomes are pronounced among Black women, American Indian and Alaska Native women, and women living in rural areas. Ten million women in the United States live in rural counties where obstetricians are scarce and pregnant people often must travel significant distances to access care due to hospital closures. A recent study found that rural residents have a nine percent greater likelihood of severe maternal mortality than their urban counterparts because of workforce shortages, transportation barriers, the opioid epidemic, and limited access to specialty care.
The third reason is women are having their first babies later in life. First births among those age 40 to 44 increased 171 percent among Black Americans and 130 percent among whites. Women who are over age 35 are automatically considered a high-risk pregnancy because they are at greater risk of having complicating health issues such as diabetes, high blood pressure, or heart disease when they become pregnant. They also are at higher risk for developing pre-eclampsia, a pregnancy condition causing high blood pressure and protein in the urine.
Technology provides a significant way to tackle these issues, one of which is telemedicine.
In the virtual doctor’s office
The COVID-19 pandemic and social distancing has prompted Americans to turn to telehealth services at a greater rate. During the early months of the pandemic, the American Pregnancy Association’s pregnancy helpline received a four-fold increase in calls from pregnant women concerned about going to their doctors’ offices and hospitals.
Pregnant people, especially those considered high-risk, could greatly benefit from a telehealth service called “remote nurse monitoring.” This is a daily care service that uses personal devices to track key vital signs such as blood pressure, weight, oxygen and glucose levels.
The patient completes a health assessment questionnaire just like at the doctor’s office, and includes all her doctor’s directions for care. For example, someone with gestational diabetes and at risk for hypertension would take her blood pressure and glucose levels the prescribed number of times per day, and input the numbers into the tracking app.
The nurse reviews these daily metrics and if the readings are abnormal, the nurse proactively contacts the parent-to-be to discuss what’s going on, offer suggestions, and flag when the doctor’s intervention is needed.
Proactive pregnancy education
Remote nurse monitoring ensures communications is truly two-way. The pregnant person can ask all kinds of pregnancy-related questions via text, chat, or phone call.
It’s normal to forget to ask your doctor a question or not want to ask what could be a “silly question.” But when you’re talking with a nurse daily, you form a relationship that may make you feel more comfortable asking all kinds of “silly questions” that you otherwise might not think are important enough to ask the doctor.
Nurses also proactively offer suggestions on a wide range of topics including medication, nutrition, exercise, supplements, and discomfort remedies that will enhance the pregnancy journey.
More dynamic maternity care
During a typical prenatal checkup, the doctor sees metrics for that one point in time, and may answer only one or two pressing questions. With daily nurse monitoring, the doctor receives a complete status report containing all health concerns, daily metrics, and a trend line that shows the doctor a more thorough picture of overall health. This enables doctors to address issues before they become complications.
Technology and healthcare professionals willing to offer their services in new ways enable women of all ages, economic status, and geographical locations to access a higher level of care. This leads to a healthier pregnancy and birth, and maybe puts a dent in the maternal mortality rate.