Telehealth enhances home fetal monitoring for at-risk pregnancies

The out-of-office pediatrician gets the call no one wants to hear: a mother has gone into labor and the baby’s heart rate is decelerating – a life threatening condition.

The pediatrician reaches out to a colleague, Jason H. Collins, M.D., MSCR, based in New Orleans, and asks him to look at the online data and meet him at the hospital. “I was looking at it as I was driving to the hospital, and the child was having significant decelerations where the heart beat was going down to about 60 beats per minute,” he says. Dr. Collins called the delivery team onsite and told them to put the patient in the waiting room, call anesthesia, and get the mother ready for C-section delivery.

Five minutes later, Dr. Collins arrived, followed closely by his colleague. “She was already in the operating room (OR),” he recalls. “She already had the monitor that you use in the OR, she was clearly having decelerations, I started her procedure and my friend was right behind me by a few minutes, and we came in and delivered the baby.” Collins credits, in part, telehealth applications synchronized with home fetal monitoring (HMF) for the happy ending to a story that might easily have turned tragic.

“Now, contrast that to the usual way of doing things, which is, [the other physician] would have to get there, I would have to get there, we would have to sit there and figure out what was going on and then to have a time delay to tell everybody to go to the operating room,” Dr. Collins says. “So, you're looking at a 30-minute advantage by using the telemedicine versus the usual way things were done.”

Clearly, telehealth is already playing a significant role in protecting the lives of children. However, broader adoption of HMF has been slow, according to Dr. Collins, founder of the Pregnancy Institute, a nonprofit research organization dedicated to exploring umbilical cord accidents. Among other issues, there’s a fear factor among physicians and other healthcare practitioners, he says.

“They're afraid that if they're not interpreting it, that they're going to be blamed for a bad event,” he explains, “and what I'm trying to tell them is you can't get blamed because [multiple studies have shown] the baby's not going to die in the middle of the night anyway. You can train the mother to recognize these patterns.”

While he’s a little frustrated by the slow pace of adoption, he’s heartened by the U.S. Health Resources and Services Administration (HRSA) recently unveiling a Remote Pregnancy Monitoring Challenge (RPMC). It will award $375,000 in prizes to help spur the creation of “innovative solutions to help prenatal care providers remotely monitor the health and well being of pregnant women, as well as place health data into the hands of pregnant women themselves as a tool to monitor their own health and make informed decision about care.”

“It’s amazing they are looking at it,” he says.

With Dr. Collins’ own home state of Louisiana reporting some of the worst outcome numbers in the nation, many women who are low-income in both rural and urban communities face barriers in accessing prenatal care – barriers that continue into the postpartum period (i.e., up to three months post-birth), according to HRSA. Personal barriers (e.g., work, childcare, transportation, education, culture, and language), health system barriers (e.g., hours of operation, and lack of services), and environmental barriers (e.g., location, and connectivity or cell phone coverage) make it difficult to attend prenatal and postpartum care appointments.

For Dr. Collins, one component of the solution is hiding in plain sight. “Home fetal monitoring is here,” he says. “It's already been tested. We're just doing it at home in a different environment, and we're letting the mother be the first responder.”

“This story needs to be told,” he stresses. “This is one of the best applications of telemedicine you'll ever see."

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