Care Plan

Case Study and Care Plan: High-risk Obstetrics for Women in Rural America.
Introduction
High-risk pregnancies are a risk to the health of both the mother and her fetus. A pregnancy turns to a high-risk if the mother is suffering from existing health conditions, for example, high blood pressure, being HIV-positive, or diabetes. Other factors that promote high-risk pregnancy include obesity and overweight, early or old maternal age, and multiple births (Lowery, 2018). The problem of high-risk pregnancies is exacerbated by the rurality of the region a woman lives. Americans in rural America often have worse health as compared to the general population. The reason for this disparity is because rural populations are geographically isolated, have low socioeconomic status, limited access to income-generating opportunities, and the majority are older. These problems are even more pronounced to high-risk pregnant women living in rural America. This paper, therefore, explores the case of high-risk pregnancies in rural America and proposes a care plan that is driven by telehealth solutions.
The case for high-risk pregnancies in rural America
According to the National Institutes of Health, high-risk pregnancies should receive care from a special team of health care providers so as to ensure that the best possible health outcome is ensured for both the mother and the infant (National Institutes of Health, 2017). Despite the clear needs for the “special team,” there is a threat as the representation of such a professional resource is rapidly declining. According to the American College of Obstetricians and Gynecologists, it is projected that the United States will lack on average, 7,000 obstetricians by 2020, with the projections indicating a shortage of about 22,000 by 2050 (American College of Obstetricians and Gynecologists, 2015).
Despite the decline in the professional resource, the problem of care for high-risk pregnancies is exacerbated by the fact that, in rural America, the population has trouble accessing care. Particularly, pregnant women are further isolated from care. According to a report published in the New York Times (Healy, 2018), since 2010, 85 hospitals in rural America have closed since 2010, which means that fewer than half of American rural counties have a hospital that is equipped to offer obstetric care. The health result for fewer obstetric hospitals is that fewer women in rural America go for doctor’s prenatal care appointments as a result, there are more premature births, women increasingly deliver outside the safety of a hospital, and in case a woman ends up into the emergency room during labor, the likelihood of not receiving obstetric care his very high.
In the typical childbirth education class un urban areas, educators recommend that the expectant woman should go to the hospital when contractions are five minutes apart. While this is the medically recommended safe timing to ensure the health of the mother and the infant, in the rural areas, it is physically untenable, because, for the majority of expecting mothers, they have to go to hospitals very far from their homes (Gallardo & Martin, 2017). Even though at the time of planning this can be planned adequately, for high-risk pregnancies, the challenge begins at the prenatal care stage, and it is further complicated in case of a medical emergency. For mothers in rural America, the subject around prenatal care and childbirth revolves around transport and logistics (Hung et al., 2017). As a result, the issues expectant mothers in rural America have to grapple with in case of high-risk pregnancy are; whether they will get to their prenatal appointment, whether they have access to a car, whether the car is reliable, whether there is money for the gas, whether there is an alternative option in case the car doesn’t start, and whether there is someone available in the case of an emergency (Gallardo & Martin, 2017).
Summary of the problem
The problems expectant mothers with high-risk pregnancies living in rural America are facing are access to prenatal care, transport and logistics challenges during delivery or in case of emergency, and postnatal care. These challenges are exacerbated by the fact that, for a high-risk pregnancy, a special team of professionals is required. For example, an expecting mother with a high-risk pregnancy as a result of high blood pressure should consult with a gynecologist, a nutritionist, a physician, and a primary care doctor for management of hypertension. These professionals are all located in different places and an expectant mother has to travel to see each professional, which adds on the logistics and transport burden, and the financial costs and time available for working mothers in rural areas. Based on this, it is recommended that a telehealth solution will be appropriate to solve this challenge.
PICO definition for the issue
P – the focus population for this healthcare issue is mothers with high-risk pregnancies living in rural America.
I – the intervention for this paper is a telehealth solution that helps to breach the challenge of access to healthcare professionals
C – the “comparison” for this intervention will be the expectant women with high-risk pregnancies living in rural America and who do not have access to any telehealthcare solution to fill the gap of declining hospitals and professionals (while this is not a standard experiment and thus comparisons is not is the astute terms within).
O – the outcome will be measured in the increased access to care through, the number of prenatal care appointments honored, improved prenatal and postnatal care through remotely available interventions, and the safe deliveries and infant health status at birth.
Proposed telehealth solution
The solution proposed for this problem is in the form of an App as well as other gadgets that a mother with a high-risk pregnancy and living in a rural area can use to keep in touch with a healthcare professional and to test the vitals.
The App will be a program in the form of software compatible with mobile devices, in particular, mobile phones running on both android and iPhone. It estimated that, every home whether in the rural or in the urban areas, there is a person with a smartphone. Once the application is developed, it will be available through the app store for download by expectant mothers. Once an expectant mother visits the hospital for prenatal care for the first time, she will be advised to download the app and log in to the app using the identification details provided at the first hospital visit.
For high-risk obstetrics, the app will be used as a medium to bring together the various health care professionals required to keep the health of the mother as well as the neonate and ensure a safe outcome for both. Telehealth, in this case, will be used to provide support, ancillary services, and diagnostic. Ancillary services will include nonstress testing, counseling for existing conditions e.g. hypertension or diabetes, fetal echocardiograms, and monitoring ().
To test for nonstress, an additional gadget will be required. First, it is important to note that, nonstress testing is vital in ensuring the fetus is in good health as it ensures there is no stress placed on the fetus. To test, it will be done by placing a belt with sensors on the mother’s abdomen and to take a reading of the fetal heart rate through response to movements of the fetus (Lowery, 2018). The belt will then be connected with the app so that readings are uploaded on the app for all are available to all the stakeholders. In case of any health issues detected from the nonstress testing, the relevant health care professional is to act accordingly, i.e. advise the mother on the corrective measure to take or require her to visit a hospital.
Fetal echocardiograms involve the use of ultrasound for the evaluation of the heart of the fetus to assess for any cardiac abnormalities before birth. For mothers who cannot assess a physical hospital for an ultrasound, the tests will be performed remotely through the use of real-time teleultrasound and video technology. Fetal echocardiogram test is common during the second trimester and it shows blood flow, heart rhythm, and structure. The details of the fetal echocardiogram will be available on the app for all the health professionals to access it. For women who can’t access a teleultrasound, the program will have the devices placed in offices near the women so as to alleviate the need to travel a long distance to the nearest hospitals offering ultrasound services.
The app will also provide services for the monitoring of complications in high-risk pregnancies e.g. hypertension, diabetes, obesity. In addition to a tool to manage these complications, there will also be wearable devices for use as educations and/or counseling tools. The app will provide a notification system where women can be reminded on time for their upcoming mandatory prenatal care sessions, as well as practices needed to manage health complications for high-risk pregnancies.
Conclusion
High-risk pregnancies are a risk to the health of both the mother and her fetus. The problem of high-risk pregnancies is higher for women living in rural America. High-risk pregnancies for women living in rural America are faced with problems which include; access to prenatal care, transport and logistics challenges during delivery or in case of emergency, and postnatal care. These challenges are exacerbated by the fact that, for a high-risk pregnancy, a special team of professionals is required, which adds to the problems. A telehealth solution is proposed to address this problem. The solution proposed will be in the form of an App as well as other gadgets that a mother with a high-risk pregnancy and living in a rural area can use to keep in touch with a healthcare professional and to test the vitals. The advantages of a telehealth solution are that it will be a platform where all the required health professionals are available under one roof and thus, will help to cut on the costs involved in transport.
References
American College of Obstetricians and Gynecologists. (2015). ACOG Practice Bulletin No. 156: Obesity in pregnancy. Obstetrics and Gynecology, 126(6), e112–126.
Gallardo, A. & Martin, N. (2017, Sept. 5). Another Thing Disappearing From Rural America: Maternal Care. ProPublica. Retrieved from https://www.propublica.org/article/another-thing-disappearing-from-rural-america-maternal-care
Healy, J. (2018, July 17). It’s 4 A.M. The Baby’s Coming. But the Hospital Is 100 Miles Away. The New York Times. Retrieved from https://www.nytimes.com/2018/07/17/us/hospital-closing-missouri-pregnant.html
Hung, P., Henning-Smith, C. E., Casey, M. M., & Kozhimannil, K. B. (2017). Access to obstetric services in rural counties still declining, with 9 percent losing services, 2004–14. Health Affairs, 36(9), 1663-1671.
Lowery, C. (2018). “Chapter 6: High-Risk Obstetrics and Telehealth,” in Rheuban, K.S. & Krupinski, E.A., Understanding Telehealth. McGraw-Hill Education. 
National Institutes of Health, (2017). What is a high-risk pregnancy? Retrieved from https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/high-risk