By Dr. Alana McGolrick
If you live anywhere in the United States, now is an unfamiliar time to be an expectant mother.
First, you have the high maternal morbidity rate (MMR) which affects all mothers in the U.S. That alone is cause for concern. But then there is an additional disadvantage for mothers in the 54% of rural counties that lack hospital OB units and areas where 120 rural hospitals have shut down completely over the last decade. All of which creates more pressure on the hospitals that are left while increasing inconvenience and risk for mothers and babies.
For those hospitals, implementing advanced technology that monitors mothers and babies throughout the stages of childbirth could provide support for OB nurses and physicians who are already stretched thin. The costs, however, may be beyond the budgets of small rural or critical access hospitals.
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Even if they had that technology, their OB staff may be smaller than that of their more urban counterparts. And while their clinicians may be excellent, they may have less experience managing difficult labors and deliveries (L&D). As a result, rural hospital executives may elect to close their OB units rather than chance the clinical and financial risks in an increasingly litigious society.
Right now, an added complication is the COVID-19 pandemic and the complexities, emotional stress and outright fear it generates. Under normal circumstances preparing for L&D can be difficult in even the most sophisticated, well-equipped OB departments. The logistics of preparing for and maintaining a healthy pregnancy and delivery has become even more challenging when pandemic precautions are factored in. Still, the American Academy of Pediatrics (AAP) continues to emphasize that the safest place to have a baby is a hospital or accredited birthing center. The challenge is ensuring that statement is just as true for mothers and babies in rural America as it is in the largest cities.
Sharing expertise through perinatal telemonitoring
Given the unpredictability of L&D, the goal should be to ensure that quality care during childbirth is available locally. It is neither practical nor safe to expect a mother in labor to travel 100 miles (or more) to reach an OB department.
One solution that has shown early success is perinatal telemonitoring. This arrangement gives experienced OB nurses in larger urban hospitals the ability to use a central command center to monitor labor progress for mothers and babies across multiple rural settings using sophisticated, artificial intelligence (AI)-driven technologies that compare current readings to known outcomes.