Telehealth Offers Relief for Prenatal Care and Newborn Health

Putting Families First With Virtual Care

For babies who are born prematurely or who need special care, one of the first questions parents ask is, “When do I get to take the baby home?”

In the neonatal intensive care unit at UVA Children’s Hospital in Charlottesville, Va., Dr. Brooke Vergales noticed that many babies who were nearly recovered had to overcome one more hurdle: feeding. These babies were often fitted with a nasogastric (NG) tube to help them take in nutrients as they are bottle-fed around-the-clock to ultimately move them off the tube.

Vergales, an associate professor of pediatrics and neonatology at the University of Virginia, suspected that babies would do better at home, where their parents could care for them. There was already a similar pediatric cardiology home monitoring program in place, so she piggybacked off its success.

Parents brought their babies home from the hospital with an Apple iPad device, the NG tube, a scale and any other necessary equipment. They weighed their babies every day and recorded the results in an app created by the remote monitoring platform Locus Health, which stores the data in UVA Children’s Epic electronic health record system. The medical team at the NICU would then review the data.

Soon after starting the program, it became clear that Vergales’s hypothesis had been correct.

“What we found is that babies do better in a home environment,” she says. “The program gave parents the ability to see that they could do this and were making the right decisions.”

Initial research presented at the American Academy of Pediatrics reveals that the at-home infant monitoring program can save up to eight days per hospital patient, a benefit that cuts costs for both patients and hospitals, allows parents to be with their children earlier and frees up space in the NICU for more urgent cases.

Since its inception in 2018, the program’s technology has evolved. Parents now use the Locus Health app on their smartphones, although families who need them are still provided iPad devices by the hospital.

The program has expanded to include infants who need complex care or who have blood pressure issues, and postpartum care for parents. “Next, the program will be moving to patients undergoing transplants or dealing with cystic fibrosis,” Vergales says.

Telehealth's Benefits for Patients and Providers

Mayo Clinic’s OB Nest, one of the earliest telehealth programs for obstetrical care, started in 2011, says Dr. Jennifer Bantz, medical director of inpatient obstetrics and gynecology in northwest Wisconsin. The program has since expanded to the entire Mayo Clinic Health System, including in Bantz’s home base of Eau Claire, Wis.

“Typically, we have 110 to 115 active OB Nest patients in Eau Claire enrolled at a time,” Bantz says. “This is a great ­program for low-risk obstetrical patients.”

Bantz says she has found high patient satisfaction with the program. Not only can patients skip a long commute, but they can also involve their entire families in their appointments if they choose, and older siblings love to help find the baby’s heartbeat, she adds.

“I have had virtual visits while our patients are at home folding the laundry, doing dishes, at their lake house, while on vacation or while at work,” Bantz says.

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Dr. Nathaniel DeNicola, the chair of the ACOG’s committee on telehealth for nearly five years, has seen how telehealth has improved prenatal care as a practitioner and a researcher.

“Several well-regarded studies show that after their first appointment, at least half of patients would consider telehealth appointments on a regular basis. For physicians, the reaction is the same,” DeNicola says.

Providers appreciate telehealth because the modality helps them both increase their interaction with patients and better manage their time.

“Frankly, patients get more time for a follow-up phone call when it’s a structured telehealth visit, whether it’s with video or audio only,” DeNicola says. “The doctor can spend more time with the patient and get more questions answered.”

Prenatal Care Goes Virtual With Telehealth

Prenatal telehealth programs have mostly similar structures, involving take-home equipment such as blood pressure cuffs and fetal heart rate monitors along with a secure portal to conduct remote visits.

Mayo Clinic’s OB Nest program employs experienced nursing staff ­members to oversee telehealth appointments. Patients receive a blood pressure cuff and a fetal Doppler to monitor the baby’s heart rate at home. Appointments are set up through the patient portal, where they can also communicate with the program’s nurses.

For virtual appointments, “patients are asked to send in their vital signs: blood pressure, heart rate, fetal heart rate and weight,” Bantz says. “The nurses record this information and send educational information through the portal.”

Remote monitoring of pregnant patients increased drastically when the pandemic began. All pregnant patients used the Mayo Clinic’s patient portal for visits. Clinicians then had secure virtual visits over Zoom.

“The traditional prenatal face-to-face model hadn’t changed in the last 50 years,” Bantz says. “Technology has allowed us to update this model and bring individualized prenatal care to our patients’ homes.”

MultiCare Health System’s Virtual OB Visits program in Washington state also offers nursing staff involvement with similar technology.

“At first, patients can struggle to find the baby’s heartbeat, but the nurse provides patient education during the visit,” says Maureen Faccia, the administrator for the Women’s Careline at MultiCare. “Patients get used to finding the heartbeat easily.”

MultiCare’s Virtual OB Visits began around 2013, when administrators and clinicians strategized on how to better provide care for expecting parents, who were generally young and technology-savvy. MultiCare initially used videoconferencing services from Lifesize but has since shifted patients and health professionals to use the videoconferencing tool within the MyChart app. Most patients access visits from their smartphones, Faccia says, and it’s not uncommon for patients to take their visits during a lunch break.

“MyChart has become a lot better than when we first started the program,” she says. “But what’s really improved is the patients’ own comfort with video visits.”

During the pandemic, the program enrolled 10 times the number of patients than in previous years, scaling dramatically, Faccia says. It has since dropped off, but is still three to five times the typical pre-pandemic monthly enrollment. “Early on, we had dozens of patients in the program, which grew to hundreds,” Faccia says. “Eventually we added on services for patients who are very high-risk, who tend to be far away and have transportation or social challenges. If some appointments are virtual, they are more likely to come.”