In 2012, there were fewer than 1,400 maternal-fetal medicine specialists in the United States, and 98% resided in metropolitan areas.
This left pregnant patients in rural areas without the ability to access care, especially if travel was not an option.
Today, telehealth can be used to fill that gap – but providers still may face challenges in ensuring patients get the services they need.
As Dr. Craig Sable, associate division chief of cardiology at Children’s National Hospital in Washington, D.C., noted during a virtual ATA2020 session Tuesday, the COVID-19 pandemic has only clarified the potential usefulness of telehealth for expectant parents.
“We can connect primary obstetricians with maternal-fetal medicine experts, and we know this will improve outcomes,” he said. “The only way to improve access is to use telemedicine.”
Additionally, when those maternal-fetal medicine experts identify problems, they can contact specialists.
The importance of access is magnified for underserved populations, Sable pointed out. He drew special attention to the maternal mortality and morbidity crisis among Black women, who are three times as likely to die in childbirth as white women.
That disparity is even more severe among Black women with a college degree – who are five times as likely to die in childbirth as their white counterparts – and for those over the age of 30.
Sable also noted that maternal mortality and morbidity rates are higher in rural areas than in urban ones.
Though a number of steps can be taken to address that crisis, including working to eradicate systemic racism throughout the healthcare system, Sable indicated telehealth as one useful tool.
“No time in my lifetime more than today do we have an opportunity to use telemedicine to close that gap,” Sable said.
Drawing on resources published by the Kaiser Family Foundation, Sable proposed virtual prenatal and postnatal visits, mental health care, online provider-communication, lactation support, and at-home monitoring of blood sugar and other measurements as pregnancy-related services that can be delivered virtually.
Avera eCARE CEO Deanna Larson also highlighted the potential to train people how to take their own measurements, as providers have done during the COVID-19 crisis for pregnant patients.
“Our obstetrics department is very interested in providing that supportive service,” she said. “Women were trained to … support themselves in their home settings so they weren’t exposed” to any chance of infection through in-person clinical contact.
Of course, like other telehealth services, telemedicine for pregnancy faces barriers to permanent expansion, particularly around reimbursement and licensing.
The necessary infrastructure may be in place, but as ViTel Net executive vice president Mark Noble said about telemedicine in general, the challenges may be “more political than they are technical.”
Still, even before coronavirus rates swelled around the country, legislators eyed telehealth expansion as a viable way to promote maternal health, especially among rural women.
In January, Democratic senators introduced a bill to direct the Federal Communications Commission to include data on maternal health outcomes in its broadband health-mapping tool, with an eye toward boosting internet access in critical regions.
Last week, Sen. Tina Smith, D-Minn., told Healthcare IT News that she hoped telehealth expansion would result in improved maternal outcomes – again centering the crisis among Black women in particular.
“Think about the challenge of that rural mom who lives 60 miles from her provider, and she’s got two little ones and has to be able to work: the opportunity telehealth presents,” Smith said.
Sable, too, said reducing the cost of childcare and transportation is important to consider. And although telehealth screenings certainly benefit patients whose fetuses present abnormalities, Sable urged attendees to weigh the value of near-immediate information for parents with fetuses without apparent severe disease.
Rather than make parents wait two weeks to meet with their doctor in person, he said, “you can reassure the mom … on the spot.”