Rural pregnancy care is in 'crisis.' Banner hopes telehealth can help
Pregnant mothers in many rural areas struggle to access adequate care. A lack of specialized doctors and maternity wards can increase the risk of labor complications and force patients to drive long distances. A new telehealth pilot program aims to connect rural physicians in Northeast Colorado with OB-GYN hospitalists at North Colorado Medical Center in Greeley.
Dr. Blake McLaughlin is a practicing OB-GYN with Banner Health who created the program. He spoke with KUNC’s Beau Baker about the pilot and the crisis in rural maternal care.
Transcript lightly edited for length and clarity.
Beau Baker: You split your time between Banner’s hospitals in Sterling and Greeley. What's that commute like for you?
Dr. Blake McLaughlin: Well, I live in the Fort Collins area and for the last year and a half or so, I primarily commuted to Sterling, where there's quite a need for OB-GYN care. So the commute there is about 100 miles round trip, about an hour and a half. It's interesting, the commute did make me think about what my patients that need to come to the front range to get medical care are having to go through. It's one thing for me to do that as a provider, but for patients to have to do that, especially patients that have high-risk pregnancies to do that multiple times a week, it's really invasive for their life and life-altering for them and their families.
Sterling MedCenter is a 25-bed facility, which is too small for a maternity ward. How many OB-GYNs are available there alongside yourself?
I'm the only OB-GYN there. I've been there for about a year and a half. Prior to me coming there, they had a couple of years without a full-time obstetrician-gynecologist. We had coverage from fantastic locums doctors (doctors who temporarily fill in at another practice) that came and helped out. And when I came there, what became very clear to me is the family medicine physicians that were there with additional training in obstetrics, frankly, can do probably about 90% of what we can do as OB-GYNs in terms of their (pregnancy) care. They're quite gifted in what they do and serve a huge need there. So I was able to augment and support what they were already doing.
But what also became clear is there was need for additional support from laborists and OB-GYN hospitalists. In addition to facilities that are beyond Sterling Regional MedCenter like Oglala, Nebraska, Torrington, Wyoming and Brush, Colorado where sometimes there will be very few physicians. But being able to think about the needs that they would have where they're located in terms of support and how to provide that virtually was something that was on the front of our minds.
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, partly because I am 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 family medicine physician in the rural setting. So that, 24/7, 365 they can either by telephone or a virtual platform, bring in to that labor room a specialist at North Colorado Medical Center and can get a consultation for care. And so that may look like a consultation on management of hypertension or preeclampsia for the patient. And what we really envision as this evolves is helping to address some high-risk emergency situations like shoulder dystocia, which is where the baby shoulder gets stuck as it comes through the birth canal. Or postpartum hemorrhage, when there's excessive bleeding after delivery, things like that.
I can imagine having virtual support from a full OB hospitalist in the room with the doctor and patient could be a huge boon to both, right?
Absolutely. And it really is invaluable to be able to ask a colleague, especially if it's a consultant who's a specialist in their field, 'Hey, what should I do in this situation?' And I think there can oftentimes be that hesitancy if there's not a relationship between the two providers because of geographical dislocation or if it's odd hours. This eliminates those barriers and those restrictions, it provides so much confidence and support. And really, that goes both ways, right? Because then the hospitalist that is often the receiving physician for patients that are being transported there, that they know that they're being able to support the patient real time when they're at a rural facility.
How much has the program been put to use 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 that means that there hasn't been a situation that's escalated to the level that it's needed to be used. But really, with this pilot program, we anticipate it being used probably a few times a month at this particular location.
How do you see this program expanding in the future?
Absolutely. We want to take this 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 that things work well, look for those places of success and opportunities to learn. And then we really want to scale that across the region. And ideally, that's going to extend beyond the borders of Colorado to Wyoming and Nebraska. But really, I do think this is going to be a national model for the way that we can address the crisis in obstetrics care in our rural communities. So, we're really excited about it. We really feel like it addresses one of the critical health inequities around geography here in our state, in our community.
University of Minnesota researcher Katy Kazhimannil recently published a national study on rural hospitals' obstetric care. 40% of hospitals she surveyed nationally reported losses on their obstetrics programs. She told KUNC’s Robyn Vincent:
"I think that maternal health and rural health are both public health crises in the United States, and the burdens of those crises fall disproportionately on the most vulnerable communities, the most remote, tribal and frontier rural communities, and on black and indigenous rural communities."
Dr. McLaughlin, how much are telehealth programs like these going to be able to help with that crisis?
I really see it as essential as we move forward. You know, there is a finite pipeline of obstetricians-gynecologists currently and many are staying in urban metro settings. And that's for a variety of reasons. And that's not a criticism, it's a fact. There's also this huge movement over the last decade to providing, appropriately so, inpatient 24/7 obstetrics care by an obstetrician-gynecologist at facilities where there are larger volumes of deliveries, like North Colorado Medical Center.
And so there is a desperate need to rethink how we deliver obstetric care to our rural communities, to our frontier communities, to our indigenous communities. And the way that I can see that happening is (through) well-trained, well-prepared family medicine physicians with OB privileges. Which, 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 out into these communities and to serve them well with the support, resources and expertise the virtual platforms can provide.
Banner hopes this program will reduce the need for medical interventions at the time of birth, such as a cesarean section, or transferring patients from the rural hospital to a larger hospital like NCMC in Greeley. Are there any limitations of using telehealth in maternal care that worry you?
One of the things that we really centrally wanted to integrate is real-time evaluation of the patient's electronic medical record of the patient's chart, of the fetal heart rate tracing, so we have a real-time sense of what's going on. And then to be able to bring in and literally wheel a telehealth cart into the room. It really does provide the closest to the 360-degree view or experience of the patient by the virtual consultant that's being experienced by the physician or provider there in the room. And so we're really trying to leverage all that 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?
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 on, nuances of facial expressions and comments. There's your peripheral information that can be gathered, that just can't always be relayed in a phone conversation or in a written form. But being able to virtually interact with the patient and get that more authentic interaction that most closely mimics the direct person-to-person interaction is critically invaluable. And there are so many health inequities that we're aware of right now. Geography is one of them. 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 causing any type of harms and have healthy moms, healthy babies as the outcome in their communities we're completely committed to making that happen.