OB Nest: Reimagining Low-Risk Prenatal Care

Abstract

Using a human-centered design method, our team sought to envision a new model of care for women experiencing low-risk pregnancy. This model, called OB Nest, aimed to demedicalize the experience of pregnancy by providing a supportive and empowering experience that fits within patients' daily lives. To explore this topic, we invited women to use self-monitoring tools, a text-based smartphone application to communicate with their care team, and moderated online communities to connect with other pregnant women. Through observations of tool use and patient- and care team-provided feedback, we found that self-measurement and access to a fetal heart monitor provided women with confidence and joy in the progress of their pregnancies while shifting their position to being an active participant in their care. The smartphone application gave women direct access to their care team, provided continuity, and removed hurdles in establishing communication. The online community platform was a space where women in the same obstetric clinic could share nonmedical questions and advice with one another. This created a sense of community, leveraged the knowledge of women, and provided a venue beyond the clinic visit for information exchange. These findings were integrated into the design of the Mayo Clinic OB Nest model. This model redistributes care based on the individual needs of patients by providing self-measurement tools and continuous flexible access to their care team. By enabling women to meaningfully participate in their care, there is potential for cost savings and improved patient satisfaction.

Self-care and remote care during pregnancy: a new paradigm?

“…For example, obstetric facilities in Florida, Texas and New York reduced their in-person visits from 11 to 6, 13 to 9, and 11 to 6 respectively [ 9 – 11 ]. They developed their ANC schedules based on expert recommendations, established WHO and national guidelines, and the OB Nest model developed at Mayo Clinic for women experiencing low-risk pregnancies [ 12 ].…”

Telehealth for High-Risk Pregnancies in the Setting of the COVID-19 Pandemic

“…Prenatal care regimens were developed individualizing care to patient risk factors and incorporating telehealth formats from prior studies and expert recommendations, including resources from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. [6][7][8][9][10] Virtual visits were performed with Epic Haiku and Canto, with patients accessing appointments via the Epic Connect and MyChart application on their mobile phones or tablets. Providers were trained in this software 1 week prior to adoption via a short video tutorial course ($15 minutes in duration) and a user guide with additional support as needed.…”

Adaptation of prenatal care and ultrasound

“…Telehealth formats from prior studies and expert recommendations, including resources from the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM), were incorporated into our prenatal care regimens. 2 , 3 , 4 , 5 , 6 It has been our experience that a general telehealth approach for low-risk patients eliminates about one-half of in-person visits. 7 …”