Dissuaded from visiting clinics but armed with blood pressure cuffs, fetal heart rate Doppler monitors and smartphones, many pregnant women are being taught to self-monitor. For many parents-to-be, it’s the first time we have been involved in collecting our own data or had direct communication with our care teams outside of face-to-face appointments. For some, collecting information about their pregnancy symptoms, blood pressure, weight and fetal heart rates can be oddly empowering at this uncertain time – but only if a person has the resources to do it properly.
Niha Zubair, a data scientist, signed up for a TeleOB program through the University of Washington School of Medicine that provides a blood pressure cuff and fetal monitor, along with instructions, to participating expectant mothers. Even before the Seattle area was hit hard by the coronavirus, these women regularly met their doctors and midwives on video-conferencing calls between their in-person appointments. “It’s a huge time saver. I have a full-time job and two small children, and it means not having to drag kids to an appointment if I don’t have child care,” Zubair said. And now, she also has the benefit of avoiding medical facilities where she could be exposed to the coronavirus, she said.
But TaNefer Camara, a lactation consultant based in Oakland, Calif., said she was disappointed to have one of her prenatal appointments moved to Zoom recently and to learn that her midwife would limit most in-person meetings to one per trimester. “Regular prenatal care in this country already feels like it lacks connection. Already it feels so impersonal,” said Camara, adding that as a health care provider herself, she understands the need to limit in-person visits. But other women may not have the level of access and information she has, she said.
The danger for people whose pregnancies were already risky
Dr. Peahl said that the country’s less advantaged institutions and patients would probably miss out on some opportunities that higher-income patients have. Many blood pressure cuffs start at $25, and fetal heart rate monitors are not covered by Medicaid.
Dr. Jennifer McLeland, M.D., an obstetrician with Vivi Women’s Health in Fort Worth, said that without opportunities to meet in person or access to tools to self-monitor, some conditions might be missed in financially vulnerable expectant mothers, particularly in their third trimesters. She said patients in this population already experience higher rates of preeclampsia, a potentially fatal condition that can be indicated by changes in blood pressure, protein in urine, swelling and other symptoms. Individualizing care for people in these higher-risk categories and with underlying medical conditions is crucial, Dr. McLeland said.
Monica McLemore, Ph.D., a family health care nursing professor at the University of California, San Francisco, said that “we have already seen things we never expected” because of the coronavirus. “Let’s maintain that orientation. We must work together to fix this system for people with the capacity for pregnancy,” she said. She suggested mental health check-ins and regular self-monitoring. Because successful telemedicine requires access to a device, internet connectivity and technical savviness that not all patients have, Dr. McLemore suggests that clinics or philanthropic foundations provide devices and data plans not just for providers but also for patients who need them.
This pandemic is, of course, highlighting myriad existing health care gaps, whose roots include systemic racism and classism.