Rural pregnancy care is in “crisis”. Banner hopes telehealth can help
Dr. Blake McLaughlin is a practicing OB-GYN at Banner Health who created the program. He spoke with KUNC’s Beau Baker about the pilot project and the rural maternity care crisis.
Transcription lightly edited for length and clarity.
Handsome Baker: You split your time between Banner’s hospitals in Sterling and Greeley. What does this journey look like to you?
Dr. Blake McLaughlin: Well, I live in the Fort Collins area and for about a year and a half I have mainly traveled to Sterling where there is a significant need for OB-GYN care. So the trip is about 100 miles round trip, about an hour and a half. It’s interesting, the ride made me think about what my patients who have to come to the front line for medical care have to endure. It’s one thing for me to do it as a provider, but for patients who have to do it, especially patients with high-risk pregnancies to do it several times a week, it’s really invasive for their lives and it changes their lives and their families.
Sterling MedCenter is a 25-bed facility, which is too small for a maternity hospital. How many OB-GYNs are there next to you?
I’m the only OB-GYN there. I’ve been there for about a year and a half. Before I got there, they had had a few years without a full-time obstetrician-gynecologist. We had the coverage of fantastic locum doctors (doctors who temporarily fill in at another practice) who came to help us. And when I got there, what became very clear to me is that the family physicians who were there with additional training in obstetrics, frankly, can do probably about 90% of what we can do as an OB-GYN in terms of (pregnancy) caring. They are pretty good at what they do and fill a huge need there. So I was able to complement and support what they were already doing.
But what also became clear was that there was a need for additional support from OB-GYN workers and hospitalists. In addition to facilities that are beyond Sterling Regional MedCenter such as Oglala, Nebraska, Torrington, Wyoming and Brush, Colorado where there will sometimes be very few physicians. But being able to think about the needs they would have where they are in terms of support and how to provide that virtually was something that concerned us.
How does this telehealth pilot program work?
So with this pilot program, we chose Sterling Regional Medical Center to partner here with North Colorado Medical Center, in part because I go back and forth between the two facilities and can help with that process. But at North Colorado Medical Center, we have a really special team of OB-GYN hospitalists. And we really wanted to create the virtual presence of the specialist to be there in the room with the rural family doctor. So, 24 hours a day, 7 days a week, 365 they can, either by telephone or via a virtual platform, bring a specialist from the North Colorado Medical Center into this work room and obtain a consultation for care. And so it may look like a consultation on the management of hypertension or preeclampsia for the patient. And what we’re really looking at as that evolves is to help with some high-risk emergencies like shoulder dystocia, where the baby’s shoulder gets stuck when it passes through the birth canal. Or postpartum hemorrhage, when there’s excessive bleeding after childbirth, things like that.
I can imagine the virtual support of a full OB hospitalist in the room with doctor and patient could be a huge boon for both, right?
Absolutely. And it’s really invaluable to be able to ask a colleague, especially if it’s a consultant who specializes in their field: “Hey, what should I do in this situation? And I think there can often be this hesitation if there is no relationship between the two providers due to geographic dislocation or odd hours. It removes those barriers and restrictions, it brings so much confidence and support. And really, it goes both ways, right? Because then, the hospitalist, who is often the doctor in charge of the patients who are transported there, knows that he is able to take charge of the patient in real time when he is in a rural establishment.
To what extent has the program been used so far?
Well, we just launched it a little over two weeks ago. And so far we haven’t needed to use it, which is great, right? Because it means that there has not been a situation that has reached the level necessary to use it. But really, with this pilot program, we anticipate that it will probably be used a few times a month in this particular location.
How do you see this program developing in the future?
Absolutely. We want to use these first six months or so to pilot the program here between North Colorado Medical Center and Sterling Regional MedCenter and make sure that all the processes are in place and everything is working well, looking for those places of success and opportunities for ‘to learn . And then we really want to expand that to the whole region. And ideally, this is going to extend beyond the borders of Colorado to Wyoming and Nebraska. But really, I think this is going to be a national model for how we can solve the maternity care crisis in our rural communities. So we’re really excited about that. We really feel like this solves one of the major health inequities around geography here in our state, in our community.
University of Minnesota researcher Katy Kazhimannil recently published a nationwide study of midwifery care in rural hospitals. 40% of the hospitals she surveyed nationwide reported losses in their obstetrics programs. She told Robyn Vincent of KUNC:
“I believe that maternal health and rural health are both public health crises in the United States, and the burden of these crises falls disproportionately on the most vulnerable communities, the most remote rural, tribal and borders, and on rural black and indigenous communities.
Dr. McLaughlin, how can telehealth programs like these help address this crisis?
I really see it as essential as we move forward. You know, there is currently a limited pool of obstetrician-gynecologists and many of them stay in metropolitan urban areas. And this is for various reasons. And that’s not a criticism, it’s a fact. There is also this huge movement over the past decade to provide, appropriately, 24/7 in-patient obstetric care by an obstetrician-gynecologist in facilities where the volumes of deliveries are higher. important ones, such as the North Colorado Medical Center.
And so there is a desperate need to rethink the way we provide obstetric care to our rural communities, to our border communities, to our indigenous communities. And the way I can see that happening is (by) well-trained, well-prepared family physicians with OB privileges. By the way, at North Colorado Medical Center, we have a residency program that does just that. And then also training advanced practice providers like midwives and things like that to go into those communities and serve them well with the support and resources and expertise that virtual platforms can provide.
Banner hopes this program will reduce the need for medical interventions at the time of birth, such as a caesarean section, or the transfer of patients from the rural hospital to a larger hospital like NCMC in Greeley. Are there any limitations to the use of telehealth in maternal care that concern you?
One of the things that we really wanted to integrate centrally is the real-time evaluation of the patient’s electronic medical record, the patient’s chart, the fetal heart rate tracing, so that we have a real-time idea of what is happening. And then being able to walk in and literally roll a telehealth cart around the room. It truly offers the virtual consultant’s 360 degree view or experience of the patient that is experienced by the physician or provider in the room. And so we’re really trying to leverage all of this technology to do that because we don’t want there to be areas where we’re missing information.
How important is face-to-face access to an OB-GYN?
The face-to-face interaction with the patient, even if it’s in a virtual setting, is actually quite important. There are micro-gestures that are picked up, nuances of facial expressions and comments. There is your peripheral information that can be collected, which cannot always be relayed in a telephone conversation or in written form. But being able to virtually interact with the patient and get that more authentic interaction that most closely mimics face-to-face person-to-person interaction is invaluable. And there are so many health inequities that we are aware of right now. Geography is one. If we can reduce the number of unnecessary C-sections, if we can prevent unnecessary interventions while not tipping the scales in the process to cause any kind of harm and have healthy mothers, healthy babies as a result in their communities, we are fully committed to making this happen.