There are many challenges for new moms after giving birth, especially after they arrive home.
Recovery can be difficult and exhausting while juggling round-the-clock care for the newest member of the family. Leaving the house in those first weeks can often feel like a chore.
However, for women who suffer from a condition known as preeclampsia – which affects as much as eight percent of the population – connecting with a doctor for blood-pressure monitoring can mean the difference between life and death.
Women who suffer from preeclampsia experience issues with high blood pressure caused by their pregnancy leading up to delivery. While delivery starts the process of resolution of the condition, blood pressures can worsen after giving birth. It’s difficult to know whether the pain and fatigue felt after birth is normal or something more serious, which is why most doctors recommend that women diagnosed with this condition come back for a follow-up visit within a week after discharge.
“The first ten days are the highest risk and most women leave the hospital on day two or three,” said Adi Hirshberg, MD, Assistant Professor of Clinical Obstetrics and Gynecology at Penn Medicine.
“So, they go home with their baby at a time when they can get really sick.”
A More Convenient Way
In 2014, maternal fetal medicine specialists Dr. Hirshberg and Sindhu K. Srinivas, MD, MSCE, realized that about 70 percent of women opt out of attending their first follow-up appointment shortly after delivery. In order to reach women with high blood pressure-related conditions, the pair developed Heart Safe Motherhood, a first-of-its-kind text message-based program for tracking hypertension in new moms.
“We recognized that women were not coming to follow-up appointments because a lot of them actually felt fine until they didn't feel fine,” said Dr. Srinivas, Professor of Obstetrics and Gynecology at Penn Medicine and Director of Obstetrical Services at the Hospital of the University of Pennsylvania. “And then they would come back and get readmitted to the hospital after they were already very sick. This seemed preventable.”
Heart Safe Motherhood allows Penn’s doctors to more easily monitor new moms – even after they leave the hospital – by offering a blood-pressure cuff and one-on-one training on its use before leaving the hospital. After discharge, each patient receives a reminder to check her blood pressure twice a day for two weeks. Those with higher blood pressures are asked to take additional readings and send them to their doctors. Doctors are notified of the elevated values and then contact the patient to discuss next steps. It ensures women in need get immediate medical attention.
“Since there's still a potential in the first one to two weeks postpartum for women to get sick, we wanted a program that met women in their own homes,” Dr. Srinivas said. “We're acknowledging care doesn't have to be the way it is traditionally thought of, which is in-person. And patients really seem to prefer this.”
By the Numbers
Number of innovation-focused awards Heart Safe Motherhood won in 2018. The program earned a Clinical Innovation Award from Vizient, as well as placed second in the American Hospital Association’s 2018 Innovation Challenge. Both awards recognize inventive solutions that improve patient experience. The team also was recognized for their leadership with a first prize award in the American Heart Association's Philadelphia Heart Science Forum Innovation Challenge, Digital Health Category, and first place in the Council on Patient Safety in Women’s Health National Improvement Challenge on Hypertension in Pregnancy. Philadelphia Business Journal named Dr. Hirshberg a Health Care Innovator for her role in the development of Heart Safe Motherhood.
Of the thousands of new moms who are readmitted to the hospital within six weeks after delivery, more than 20 percent have a hypertensive disease, including preeclampsia, according to data published in the Journal of the American Medical Association in 2017.
Reducing Hospital Readmissions for New Moms
About 15 percent of the patients enrolled in the program end up sending a blood pressure reading that requires intervention, Dr. Srinivas said. However, that patient population is very difficult to predict at the time they leave the hospital.
Drs. Hirshberg and Srinivas set out to make it more convenient for patients to have their blood pressure checked.
“It really started as a simple idea,” Dr. Hirshberg said. “A lot of our patients in the office and ultrasound unit are on their cell phones and we're all on our cell phones all the time texting. So we thought that since they're all busy with their babies after delivery, we’d send them home with a blood pressure cuff and have them check their blood pressures at home, and see if we could manage it that way.”
Now, Penn’s doctors can intervene and treat women with high blood pressure remotely, by prescribing medications and allowing moms to stay at home with their newborns. It also enables physicians to give feedback to their patients more quickly and efficiently.
In 2018-19, 1,400 women were enrolled in Heart Safe Motherhood at the Hospital of the University of Pennsylvania. Over 85 percent of the women reported their blood pressure at least twice within the first seven to 14 days.
Setting the Standard
Heart Safe Motherhood is now the standard of care for obstetric patients across Penn Medicine. Drs. Hirshberg and Srinivas, along with their team, are partnering with other health systems, payors, and vendors to evaluate if the program can be rolled out nationally.
The success of Heart Safe Motherhood also has prompted us to think of other ways to translate this approach to meet a variety of other needs, such as depression screening or breastfeeding support.
“Other people have really caught on to the fact that women are busy after delivery but they still need help, and text messaging is an easy and effective way get in touch with them,” Dr. Hirshberg said. “They can't get to the office or they have so many other things going on. Why not see if it helps address other concerns and problems that women have after having a baby?”