As covid-19 took over the United States, medical providers searched for a possible way to keep people at home and out of hospitals without compromising care. We are only now understanding the unintended consequences of changes intended to slow the spread of the coronavirus and provide relief to the medical system.
One of the most important is that millions of women and babies have hastily become subjects experience. The hypothesis: would it be better if more prenatal and postpartum care were provided at home?
Pregnancy, including childbirth and subsequent care, is the number one reason for hospital visits in the United States, and on average a typical pregnancy will involve between 12 and 14 medical appointments. Appropriate antenatal visits can prevent life-threatening complications. But limiting in-person care during the pandemic is vital, especially for pregnant women, who are more likely to develop severe and even fatal Covid infections.
As a result, unprecedented numbers of women are turning to virtual care or telehealth services such as video appointments, SMS support, and phone calls.
“It didn’t take long for telehealth visits to explode,” says Melissa Simon, professor and obstetrician-gynecologist at Northwestern Medicine in Chicago, who mainly sees patients on Medicaid or without health insurance.
This expansion may be a beacon of hope for the pandemic. Access to prenatal and postpartum care is incredibly uneven in the United States, and experts have long argued that telehealth can help fill the gap. This solution, of course, is only available to women who have access to a connected device.
“Covid has definitely exacerbated everything”
The use of virtual care, often referred to as telehealth, has grown steadily in many areas of medicine over the past decade. It can be as simple as a phone call or text message, or as complex as a system where patients use monitoring devices to send their vital signs to the cloud.
Obstetrics, however, had remained largely an in-person practice until the current confluence of pandemic-related funding, policy changes and technological developments began to change things.
For example, pregnant women have traditionally seen a doctor for regular blood pressure checks that could reveal warning signs of preeclampsia, a complication responsible for 70,000 maternal deaths and half a million miscarriages every year in the world. Now, some companies are providing blood pressure cuffs equipped with remote monitoring technology so women can be checked at home instead.
“Covid has definitely exacerbated everything,” says Juan Pablo Segura, president and co-founder of Babyscripts, a company providing such services. “Our number of registrations has multiplied by 10.”
Telehealth is also providing additional support in womens hospital rooms at a time when medical facilities have limited the number of people women can have at their bedside during labor, meaning some doulas have been excluded. Studies show that having independent representation and assistance during childbirth can be difference between life and death. This is especially true for black, Native American and Alaskan women, who face unprecedented maternal mortality rates elsewhere in the developed world; more than half of these deaths are preventable.
Tennis player Serena Williams, who almost died when clinicians first dismissed his concerns on postpartum pulmonary embolism, subsequently invested in the Mahmee telehealth platform, which coordinates care for patients who see providers in different systems. It also employs nurses, lactation consultants and others who respond to messages and offer women advice or health check-ups when problems arise.
Although it was not designed for the pandemic, it has been a lifeline for many women and their advocates in recent months.
Ashanti rivera, a doula in Connecticut, used the service to visit women practically in the delivery room. “If people were nervous about giving birth before, they’re even more nervous about going to the hospital now,” she says. “We used video calls during work to get a better sense of connection, as close to being there as possible.”
“You will detect serious problems faster”
However, it is not only as childbirth approaches that the technology is used. The services are also used to provide postpartum support, which is especially important as women’s hospital stays are shorter during the pandemic. New mothers are usually sent home with their babies in 24 hours or less, unlike the usual two days before.
“Lactation education and support, how to heal yourself, how to feed your body to feed your baby – these conversations are delayed to get people out of the hospital faster,” says Melissa Hanna, co-founder and CEO of Mahmee .
The company also offers home screening for depression which, before the pandemic, affected between 15% and 20% of pregnant or postpartum women. Recent evidence suggests that up to a third of women may now suffer from depression during or after pregnancy.
Hanna points out that a pandemic pregnancy is stressful enough – but for black women, the confluence of isolation, a pandemic that has disproportionately impacted racial minorities, and a months-long account of racist police violence has created conditions conducive to anxiety. and depression. There has been a significant increase in the number of women reported at risk for depression after undergoing Mahmee screenings, although Hanna says they have yet to properly analyze these trends.
She recalls an incident in the fall when a woman who had recently given birth texted Mahmee’s team for help, fearing her three-week-old baby would not recognize her.
“I’m just a nervous wreck right now,” she told one of the nurses at the company, according to Hanna. “I have an older black son who is going through this chapter in American history and seeing how black men are treated in this country. I just had a baby. I just don’t feel like myself right now. The healthcare team called her doctor, who Hanna said responded, “Come to think of it, she had a really traumatic childbirth experience. I probably should have checked it out. The woman – who had contacted the doctor a few days earlier and had received no response – was able to join a support group and receive breastfeeding advice through the platform.
“By actively listening to women and the needs of women, you’ll be there faster, to spot really serious issues before they become life-threatening and incredibly costly,” Hanna says.