PHILADELPHIA _ The coronavirus crisis has had a special and profound impact on women who are pregnant or have recently given birth. Anxiety abounds that they'll contract the virus or that their newborn will. Some are fleeing hotspots like New York to seek care elsewhere. And most women in labor can have just one person with them, if that.
Much of the fear comes from the need to be in hospitals or doctors' offices for prenatal care _ checkups, ultrasounds, blood-pressure monitoring _ as well as for delivery and those critical first few days after the infant is born, while both baby and mother are typically confined to the hospital.
The science isn't yet certain on whether mothers who contract COVID-19 can pass it to a fetus. And hospitals are taking steps to keep COVID-19 patients isolated, especially from other at-risk patients like pregnant women, and expanding telemedicine and remote care capabilities.
But there's more to be done to help pregnant women maintain social distancing, and physicians at the Hospital of the University of Pennsylvania are now fast-tracking high-tech solutions that aim to keep them away from the hospital as much as possible before delivery, and to get them out of the hospital sooner after birth.
The new programs include the distribution of blood-pressure cuffs _ so pregnant women can monitor their own blood pressure and report it to their doctors via text, potentially eliminating a few check up appointments _ and a postpartum check-in system that uses a chatbot to answer questions women have about everything from umbilical cords to breastfeeding. And the programs will be used in the future, post-pandemic, to help Penn better tailor care to women who are pregnant.
All told, the prenatal blood-pressure cuff distribution could potentially eliminate three in-person appointments, and the postpartum program is aiming to get women out of the hospital a day earlier than usual.
Doesn't sound like much. But the physicians rolling out the programs say every minute in the hospital matters. Anna Graseck, who is overseeing the cuff distribution program, said Thursday that she saw three new pregnant patients, and all told her it was the first time they had left the house in more than a month.
"Pregnant patients are taking social distancing extremely seriously, as they should," said Graseck, an assistant professor of clinical obstetrics and gynecology. "When people are rationing their groceries over three weeks, that one trip matters."
In the prenatal phase, Penn obstetricians this week began distributing blood pressure monitoring cuffs to women who are pregnant. Doctors prompt patients via text to check their blood pressure at home, then the women read the monitor _ which interprets the reading, so no counting _ and then report it to the doctors for monitoring. The process is used in conjunction with counseling via phone.
Blood-pressure monitoring is a critical component of prenatal care, particularly in the third trimester, Graseck said, as elevated blood pressure among pregnant women, while "incredibly common," is also a leading cause of pregnancy-related death if left untreated.
Routine prenatal care is anywhere between nine to 12 visits over the course of a pregnancy, Graseck said, and lowest-risk patients who use the cuff at-home could require just six to nine trips, largely for lab testing and ultrasounds that can't be done remotely. The distribution of the cuffs could continue in the future
HUP delivers about 4,000 babies per year, so Penn could "easily" enroll 1,000 pregnant women in the cuff-distribution program over the next several months as the pandemic plays out, Graseck said. The equipment is covered by insurers, including some Medicaid payers that "have really stepped up," she added.
As for postpartum care, Penn has accelerated and expanded the rollout of its "Healing at Home" program, which was launched in 2017 with the goal of getting new mothers out of the hospital as soon as possible to promote bonding time in the earliest days.
The program, initially piloted last year, involves using augmented intelligence, whereby a new mother and her infant can be discharged from the hospital early, and mom is set up to communicate with a robot via text that can counsel her on frequently-asked questions, said Kirsten Leitner, an assistant professor of clinical obstetrics and gynecology who oversees the program.
It's not all communication with the chatbot (whose name is Penny, after Penn, of course). Leitner said the questions and answers are all monitored by providers, and any question that isn't answered with a programmatic response is answered by a clinician, who typically responds within 30 minutes to an hour, far sooner than the full business day it can often take to get a phone call back from a physician.
In addition to answering questions like "when should the umbilical cord fall off?" and "is this rash normal?" providers are also offering lactation counseling and postpartum depression screening, all via text.
The early-discharge program can reduce post-delivery time in the hospital from, on average, about two days to just over one day. It's available for mothers who delivered vaginally _ moms who have Caesarean sections have different questions that haven't been programmed in yet _ and had little to no complications.
Leitner said much of the value for the new mothers, especially during a pandemic, is just in knowing help is a text away.
"Call volumes to our office are up," she said. "To know there is something established they can be grounded in is a huge benefit to this program."
