On the morning of her doctor appointment, Andrea Pedersen had stopped at the gym to check her weight and blood pressure. She noted her measurements on her iPhone, and at the appointed time, she headed to a computer for a video chat with her physician.
Altogether, she admits, it wasn’t the typical prenatal visit.
But it may be by the time her 7-month-old daughter, Anna, grows up.
Pedersen, who lives in Rochester, was taking part in an experiment at the Mayo Clinic to test a new do-it-yourself model of prenatal care.
And while it’s not yet ready for prime time, experts say it’s one more sign of how the pressure to reform health care, and rein in costs, is starting to transform modern medicine. The experiment is one of several taking place at Mayo’s Center for Innovation, a breeding ground for new ideas.
Maternity care seemed particularly ripe for change, according to Mayo’s own surveys, said Marnie Meylor, one of the project leaders. “This is a very tech-savvy population,” she said. Young women, armed with smartphones, are used to getting information fast and at their convenience.
Yet the current model of prenatal care — which revolves around a fixed schedule of office visits — “was developed about the same time the telephone was invented,” said Dr. Roger Harms, a Mayo obstetrician. “It hasn’t changed much since.” And he thinks it’s overdue. For the most part, Harms said, prenatal care is about two things: monitoring the baby’s progress and making sure the mother is healthy.
So he and his colleagues started wondering: If women could do more of the monitoring themselves, would they be able to reduce costs and possibly improve care?
A series of experiments, known as OB Nest project, was born.
Harms and his team started enrolling pregnant volunteers, giving them special phone apps and other equipment to track their vital signs at home. They even installed fetal monitors at kiosks around the Mayo Clinic campus, where participants — many of them Mayo employees — could listen to their babies’ heartbeats on the way to lunch.
The expectant mothers were told they could contact the clinic, night or day, any way they preferred: phone, e-mail, text.
Jewel Wang, 27, jumped at the chance. At the time, she was pregnant with her second child and heading to Shanghai to join her husband for several months.
“I would have had doubts if it was my first pregnancy,” she admitted. But in this case, she said, “it worked out fantastically.”
Once a week, she took her own vital signs, measured her abdomen and used an iPhone app to snap pictures of her growing belly.
All in all, she said, it was “hard to mess up.” She sent in her results electronically to the Mayo team and followed up with e-mails and the occasional “face to face” doctor visit on Skype.
Ordinarily, Wang would have visited her obstetrician once a month during her second trimester. But remembering her first pregnancy, she didn’t feel she was missing much. “It was just hand-holding and making sure I was OK,” she said.
‘It was just reassurance’
The idea of patients doing some of their own prenatal care isn’t entirely new. It’s a common practice at group prenatal visits, also known as “centering groups,” where women chart their own vital signs with a medical professional in the room.
But Katy Kozhimannil, a maternity-care researcher at the University of Minnesota, said the Mayo experiment is breaking new ground. “It seems like this is taking it into the 21st century,” she said.
Andrea Pedersen, who works at the Mayo Clinic finance department, had her own reasons for volunteering. After two miscarriages, she and her husband were in a state of “high anxiety” about her most recent pregnancy, she said. When she learned she could take home a fetal monitor if she joined the OB Nest project, “I was like, ‘Heck, yeah.’ ”
She checked the monitor daily to hear the baby’s heartbeat. “It was just reassurance,” said Pedersen, 31. Harms, who is Pedersen’s doctor and the lead obstetrician on the project, says he was worried that patients might panic if they ran into trouble with the equipment, such as the fetal monitor. “We thought, ‘Oh my goodness, the telephones are going to ring off the wall,’ ” he said. “They’re not going to be able to find the kiddo because it’s in an odd position.” To his surprise, “it didn’t happen.”
Of course, the biggest fear is that the women — or their doctors — might miss something important, such as signs of premature labor. But Harms said that’s a concern even with traditional prenatal care. In theory, he said, if a woman is monitoring herself at home, she may spot trouble signs sooner rather than later.
For this project, Mayo made a point of screening out high-risk patients, such as women with diabetes or expecting twins.
One potential downside is that expectant mothers may be unduly alarmed by what they find, said Kozhimannil, of the university. “There’s a wide range of normal in pregnancy,” she said, and most people “are not statisticians.” With do-it-yourself monitoring, patients may need extra reassurance, she said, especially when it involves the health of a baby. “It needs to be both physically safe and psychologically safe,” she said.
Fewer in-person visits also could take a toll on the doctor-patient relationship, said Dr. Charles Lais, the chair of obstetrics at HealthPartners. But overall, he said, the Mayo experiment could make prenatal care much more accessible.
“We have a lot of patients that don’t get all their prenatal care,” he said, but “almost every one of them has a smartphone.” If they could check in electronically, he said, they “might actually be more compliant.”
In fact, he added, the change already is happening. Many of his patients are renting fetal monitors and using prenatal apps, on their own.
The Mayo Clinic, however, is not ready to abandon its traditional prenatal care program. At this point, Harms said he’s planning to launch a formal study to compare the old and new models. But any significant changes may be years off.
One reason is money.
As long as doctors are paid for face-to-face visits, the incentive is to keep things as they are, said Harms. “At the moment it’s still an impediment,” he said. In addition, doctors are naturally cautious about making changes in a system that has worked for decades.
But Meylor, the project designer, is hoping to expand the OB Nest experiment. She thinks it could benefit women with high-risk pregnancies, who were excluded from the first round.
“Some of them are coming in twice a week throughout their pregnancy,” she said. “You just know there has to be a better way.”