How Tele-health Can Prevent Maternity Care Deserts

Currently, fewer than half of the rural hospitals in the nation have maternal units. More than 2.2 million women of childbearing age across 1,119 US counties live in maternity care deserts without hospitals offering obstetric care or birth centers.[1] The rapid closure of rural hospital maternity wards in 2023 is exacerbating the issue with mothers having to choose between traveling a longer distance for maternal care or face giving birth in emergency rooms – both choices presenting life-threatening risks for mother and child.[2] Remote towns in rural counties in states with less generous Medicaid programs are most likely to be affected, and rural Georgia counties are a prime example. 

63% of 68 rural Georgia hospitals do not provide OB services.[3] In Georgia, 34.6% of counties are defined as maternal care deserts.[Ibid] This not only poses a direct barrier in receiving prenatal care, high-risk OB services, and postpartum care, but it prevents the establishment of a continuity of care and echoes health disparities across rural counties.[4] The problem escalates, considering that Black and Hispanic mothers are more likely to face maternal care disparities. According to 2021 CDC data, Black women are two to three times more likely to die from pregnancy-related complications than white women, and most of the deaths are preventable.[5] These compounding characteristics of identity deny healthcare rights to many minority groups. Georgia. policymakers have the power to reduce maternal mortality through the expansion of health coverage for perinatal services received from midwives or through telemedicine, higher reimbursements for rural hospitals, and increased accessibility of tele-health services. 

The Georgia Rural Health Innovation Center, housed in the Mercer School of Medicine and established in 2018 with HB 279, should further leverage their maternal health pilot project launched in 2021 and the growth of telemedicine to provide more support to rural mothers.[6] They should partner with the Georgia Health Information Network, a state-designated nonprofit organization dedicated to creating a healthier Georgia using the exchange of electronic health information, to invest in a pilot maternity telemedicine program in rural Georgia maternity care deserts. The Georgia Health Information Network recently received a $1 million grant to promote rural healthcare services. They are partnering with a regional health information exchange, which improves the speed, quality, safety, and cost of patient care by allowing doctors, nurses, pharmacists, and health care providers and patients to assess and securely share vital medical information electronically.[7] The Rural Health Innovation Center can work with the Georgia Health Information Network to establish a strong tele-health network in rural Georgia. They can also apply for the $2,00,000 grant through the Rural Maternity and Obstetrics Management Strategies (RMOMS) program for funding to establish a tele-health system.[8] 

The Georgia Rural Health Center should have maternal-fetal medicine specialists from Mercer Medical School provide video consultations, genetic counseling, and interactive ultrasounds at Burke Health, a community hospital in Waynesboro, GA.[9,10] This would be funded by the state applying for the $2,000,000 federal Rural Maternity and Obstetrics Management Strategies (RMOMS) program. It is a four-year program aimed at improving rural hospital obstetric services.[11]

Second, using money from the RMOMS grant, the center can design, and OBs can prescribe, a tele-health kit for people who have higher-risk conditions, such as diabetes or hypertension to improve services for higher-risk perinatal care. New Mexico implemented a similar technology in which the tele-health kit includes a tablet with embedded devices that monitors and reports blood pressure, weight, oxygen level saturation, glucose level, and fetal heart rate tracings.10 High-risk pregnancies require frequent consultations and careful monitoring, which is difficult for patients in rural areas. Thus, they are more likely to suffer from life-threatening consequences for the mother and fetus.[12] 

Opponents may argue that tele-health maternal services are costly and not preferred by rural residents. However, in a national tele-health survey from 2021, 25% of 700,000 respondents used tele-health services.[13] Telehealth also results in lower short and mid-term costs and reduces more costly urgent and emergency department care and overused services like imaging.[14,15] There have been successes in the associated states who participated in rural obstetric tele-health programs or are a part of RMOMS, such as Arizona, Utah, and Missouri. [Ibid]

Overall, the solution to the exacerbating health consequences caused by the lack of obstetric services in rural Georgia is to use grant funding provided to states through the RMOMS program and existing organizations in the state to bridge the gap. Telehealth services can be used to address the shortage of OB providers and to improve the access to perinatal care to rural areas. With the growth of broadband services and the dedication of the Georgia Rural Health Innovation Center to improving rural healthcare services, there is existing infrastructure that can be built upon.