Pregnant During COVID-19: An Experiment in Forced Healthcare Consumerism and Telehealth

Out of an abundance of caution in the presence of a novel virus that is not yet well understood, COVID-19 has rapidly transformed prenatal, labor and delivery care. This transformation places added responsibility and stress on pregnant women and their care providers, and raises some interesting questions about the future of care for women and their unborn babies in a post-COVID-19 world.

Patient Realities: Lack of Information, Upended Plans, Fear of the Unknown

Given the recency and novelty of COVID-19, research into potential pregnancy impacts is limited in both timeframe and sample size. Looking at past coronavirus epidemics (e.g., SARS, MERS), data show increased mortality among pregnant women. And an early message from The American College of Obstetricians and Gynecologists (ACOG) offers only that “COVID-19 might affect a fetus” and that “some pregnant women with COVID-19 have had preterm births.”

In an early response to these factors, some NYC hospitals temporarily barred support persons and visitors from being with laboring mothers in the delivery room to reduce the spread of the virus and promote safety for women and their newborn babies.

While these policies have now been overturned by the governor, the temporary action caused many mothers to rethink their birth plans:

• What does it look like if I have to deliver alone?
• Is the hospital still a safe space to give birth?
• What happens if I or my partner contracts COVID-19 prior to delivery?

The situation creates an increased need for patient support and provides an opportunity for physician practices and hospital systems to help educate patients and ensure them that processes are in place to help keep them safe.

Beyond Telehealth, Expectant Mothers are Actively Self-Monitoring Health Markers

Similar to caution around labor and delivery, non-essential maternity appointments have been moved to telehealth visits. At one of my own telehealth appointments, my doctor told me to purchase a blood pressure cuff, thermometer and bathroom scale to track my vitals between in-person appointments. Other women are also purchasing fetal heartrate monitors, protein test strips, and blood glucose meters to capture additional diagnostics at home.

With much of prenatal care thrust suddenly upon pregnant mothers, it raises important questions for health systems:

• What does a long-term shift toward patient ownership of health monitoring look like for health systems?
• Do patients develop different expectations of their providers or carry more weight in decision making after self-monitoring?
• What is HCP sentiment about the quality of home device measurements, benefits and risks?

Virtual Hospital Tours and Patient Education

In addition to appointments, important patient education resources such as hospital tours, childbirth classes and lactation consultations have also moved online.

Research has shown that the hospital and doctor that a woman chooses for her labor and delivery experience has a significant impact on the birth outcome for both woman and baby, so choosing the right birthing staff is very important. As women begin to shop their birthing experience almost exclusively online, curating an engaging and thorough virtual presence will be important for not only expectant mothers, but their caregivers and family members, who are being excluded from care visits at this time as well.

This offers a key opportunity for health systems to engage in new, differentiating ways with patients. For example, the hospital that my doctor delivers at created a virtual maternity center tour and set-up a web platform where patients schedule follow-up Zoom appointments to answer lingering or specific questions after watching the video.

Limitations on Caregivers

Caregivers play an important role after birth, acting as support system and advocate for the new mother as she heals, as well as caring for the newborn between visits from a labor and delivery nurse. While birth is a highly visible example of where the absence of caregivers is felt, it is not unique during this pandemic. There are many diseases and conditions where the involvement of caregivers is very important. As COVID-19 continues to change the landscape of healthcare, there are some key considerations that health systems need to address in relation to caregivers:

• As hospitals and practices limit visitors and expedite patient releases, how will this affect patients and providers?
• Social distancing limits or eliminates the usual help women receive from friends and family during the early days of their infant’s lives. What should physicians and hospitals do to help close that gap and protect against parental burnout?
• Patient/caregiver education needs to be optimized—or compliance could suffer since caregivers are known to play a role in implementing physician recommendations. Providing user-friendly, clear patient education materials is now more important than ever.
• Caregivers often play a role in treatment selection or discontinuation decision making. It will be important for doctors and health systems to account for this with patients.

A Catalyst for Increased Patient Agency and Consumerism

While this time of uncertainty is scary, it can also be empowering with regard to patient agency over their health. The circumstances surrounding COVID-19 will change the way some patients consume healthcare for years to come.

After taking on such an active role in our care during this time period, I believe patients will want to maintain some semblance of increased involvement in their care. Patients will demand increased health education and information, and it will be up to the physicians and health systems to fulfill this new need.

The Escalent Health team is committed to keeping you updated with the lastest developments. We encourage you to read our most recent COVID-19 Healthcare Market Research Newsletter. It presents articles addressing tension and conveying hope to help you navigate the pandemic as a whole person, inclusive of your personal and market researcher self. Stay Safe and Be Well.