The American College of Obstetrics and Gynecology’s new guidelines on virtual care
The Current State of Maternal Health
The current state of maternal health in the US is dire. After years of research showing maternal comorbidities on the rise such as the rates of preeclampsia nearly doubling in recent years, many institutions have called for significant action.
The latest call to action from the American College of Obstetrics and Gynecology (ACOG), could be the most significant one yet. The first major update to their guidelines since 1930, ACOG is calling for a more tailored care approach that focuses on each person's individual needs–and much of that means offering telemedicine support.
Virtual care companies like SimpliFed have said many times that timely and consistent maternal care during pregnancy is essential, yet it's offered disproportionately due to access barriers outside of a patient’s control. Virtual care and monitoring bridges this gap and ensures families receive the care they need, preventing more serious complications. And all of this is true. In the latest release regarding these new outlines, ACOG agrees stating “the goal of this new guidance is to promote equitable care by focusing on upstream drivers that often contribute to the disproportionate maternal morbidity and mortality rates seen among marginalized populations.”
But it doesn’t stop there, offering virtual care to low-risk populations opens up access to those who benefit from more in-person care. It creates more flexibility when families need it the most, and can even increase care compliance for populations who think “they just don’t need to go”-- nearly 23% of patients don’t go to their first prenatal care appointment until more later than recommended and nearly half do not receive all the recommendation prenatal care at all.
Maternal Health Desert Challenges
The significance of these new guidelines has so many layers. And one of them is that it directly addresses a major concern in maternal health deserts. Over the last decade, over 500 hospitals have closed their obstetric care units, leaving women and families with few options when it comes to pre and postnatal care. One study took that even further, realizing that 30% of urban hospitals and nearly 50% of rural hospitals are without birthing units entirely. This massive shift in equitable access not only causes a lack of timely care, but also further enforces the significant care disparity among minorities and lower income families.
The Role of Virtual Care in Addressing Care Gaps
Telehealth and virtual care for new parents, especially in these maternal health deserts is essential. It nearly removes access barriers like transportation, and women are more likely to find times that work for them. We don’t further divide patients by those who can take off work or have access to childcare. There are so many different parts of the pregnancy and postpartum care pathway that benefit from virtual options.
However, virtual options don’t just lend themselves to maternal health deserts, and can be easily layered into any care pathway depending on each patient's individual needs.
This chart from ACOG’s guidelines depicts the typical prenatal care pathway and how to integrate virtual options at certain touchpoints. This is all dependent on each patient's risk factors, including both clinical and societal.
This concept means virtual care is beneficial in closing care gaps but also opening access, reducing provider burden, improving health outcomes and so much more. It Here are some more examples of virtual care that can be easily layered in during the prenatal and postpartum care pathway.
Breastfeeding and baby feeding support
Breastfeeding and baby feeding is one of the most stressful times for new parents. But what can compound that stress even further is the lack of access to support. With families having to travel farther distances for delivery or in-person care, it is even more difficult to find consistent lactation support. Virtual lactation is a great option for families who cannot travel and need support when it is most convenient to them. Virtual support does not wait for an issue to arrive; it acts preventatively, with easily accessible touch points. Most significantly if started during pregnancy, patients are prepared and have quick support at their fingertips.
High-risk monitoring
High-risk monitoring is similar to babyfeeding as it can act preventively, and can be easily done from home. We know preeclampsia is on the rise and occurs in 5 to 7% of all pregnancies in the United States. In fact, the CDC states that preeclampsia is responsible for over 70,000 maternal and 500,000 fetal deaths worldwide. But those numbers are likely underreported as preeclampsia can go undetected with zero symptoms. Even more so, preeclampsia affects underserved populations at a much higher rate. While our current healthcare climate makes it more difficult for patients in need to receive care, the rate of maternal morbidities keeps growing. Adding in virtual monitoring to better detect a rising risk could help connect patients with their providers faster and more efficiently than waiting until that next appointment.
Maternal mental health screenings
Studies show that if ALL pregnant and postpartum individuals were consistently screened that nearly 20% or 1 in 5 would be diagnosed with some form of maternal mental health disorder. Most care pathways screen women a few times during pregnancy, perhaps once at their 6 week postpartum visit, or even a few times during a pediatric visit. But the main issue isn’t necessarily that we aren’t screening, it’s that we’re just not screening enough. Consistent check-ins means providers can detect small changes and identify any risks before it’s too late. Undiagnosed and untreated mental health disorders can lead to a myriad of health issues for families, affecting parental bonding, the ability to breastfeed, infant developmental delays and so much more.
Virtual care works with in-house care
Layering in virtual care doesn’t mean we aren’t still concerned about patients and families attending their scheduled appointments. It’s actually the direct opposite. If virtual care is done right, then it compliments in-person care, encourages compliance, and aids in better health outcomes. As Alex Peahl, MD, MSc, FACOG, says in this latest ACOG release, “Tailored care doesn’t mean less care.” It’s actually the opposite. Layering in virtual care means each patient can and will receive the RIGHT care, at the right time.
Lower-risk patients may benefit from less in-person care, but more frequent virtual check-ins. Or a higher-risk patient’s in-person appointments are more beneficial because of virtual readings and monitoring done consistently to determine a care plan. It works in harmony to offer flexibility and remove barriers.
Conclusion
Virtual care is essential to combating maternal healthcare deserts and helping to stop the maternal health crisis we’re currently in. By offering care that supports in-person visits, we not only get families the care they need, we also prevent adverse outcomes. A lactation consultant can detect failure to thrive, a provider receiving blood pressure numbers can quickly refer out if if a reading is too high, and maternal mental health specialists can detect patterns and talk to a patient before it’s too late.
As our current political climate creates barriers for systems to address disproportionate care, and as the lack of funding or infrastructure in more rural hospitals makes telemedicine more difficult, clinicians and hospital systems must look into telemedicine companies and other community resources. If hospitals continue to close and units shut down, we have to support innovative ways to get the right care, to the right person, at the right time. And that’s where SimpliFed steps in.
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