Pregnancy brings changes galore — including frequent visits with a health care provider.
Until the coronavirus pandemic, those prenatal visits typically happened in a clinic for Sanford Health patients.
That was the case for Michele and Kyle Sorenson of Bemidji, Minnesota, who found out in mid-December 2019 they were expecting their first baby.
Nausea and vomiting marked Michele’s first trimester. “But now it’s good, and I guess I’m praising God for a healthy pregnancy so far,” she said.
Michele and Kyle were grateful to find an OB/GYN they could trust when they were referred by Kyle’s friend to Dr. Johnna Nynas with Sanford Health.
“It ended up being a great fit,” Kyle said. “It was probably the most perfect thing that could have happened as far as a doctor situation for us.”
Michele describes their first visit with Dr. Nynas at the clinic: “I thought she was really great and so friendly, always smiling and knowledgeable. The way she explains, it’s thorough and it’s easy to understand.”
Soon, though, the pandemic changed the way patients and providers viewed those prenatal visits — and even, in the process, each other.
‘You can call me an early adopter’
Dr. Nynas’ department had done quite a bit of research into prenatal video visits before the pandemic. The desire to find a better way to provide health care to patients in the large remote region that Bemidji serves drove this effort.
“We were in the process of trying to launch it, but we hadn’t quite gotten there yet, so I hadn’t done any video visits prior to COVID,” Dr. Nynas said.
Suddenly, though, they became a priority during a time of adaptation that put into place measures to help keep patients and staff safe.
“The second I was able to do video visits, I did video visits,” to keep moms and their babies safe, Dr. Nynas said. “You can call me an early adopter.”
Of course, not all prenatal visits can be video visits. Some require lab work or ultrasounds that have to be performed in person, and clinics are still safe to visit. But following guidance from the Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists, certain appointments can accomplish just as much through a screen as they can in an exam room — with possibly even more benefits.
Dr. Nynas’ office identified patients who would be eligible for video visits during their next scheduled exam and offered them that option. “A surprising number of patients were on board with it right away,” Dr. Nynas said.
‘I actually felt like it was a lot more personal’
The Sorensons became homebodies when the coronavirus came along. Kyle already worked from home for an audio-visual technology company. Because of her pregnancy, Michele took a leave of absence from her work in an accounting firm to minimize her exposure to the public. They also canceled a planned trip to the Philippines. Now, they choose carefully when and where to shop. They still visit parks, but with a strict observance of social distancing.
And after their first prenatal video visit with Dr. Nynas, they’re sold on that option.
“I expected it to be harder than I thought, checking in and stuff like that, but it went smooth,” Michele said. “We figured it out so quickly.”
Kyle appreciated the fact that it saved transportation time, as well as waiting time in the clinic.
“I actually felt like it was a lot more personal,” Kyle said. “You didn’t feel like she was at work, and almost like you brought her home with you.”
When their appointments allow it, the Sorensons plan to continue with video visits.
The video visit omits any staff involvement except the provider. So Dr. Nynas’ appointments begin and end with her face, and she said patients have been surprised that she’s the one verifying information such as date of birth and allergies.
“Literally all the time is me focused on the patient. So it does get really personal, and we can talk about life stuff. We can talk about what they’re concerned about,” Dr. Nynas said. “I find that I have more time to ask questions about, ‘Have you guys thought about picking a pediatrician?’ ‘Have you guys thought about breastfeeding?’”
Dads can get involved again
Whereas COVID-19 restricted exams to her pregnant patients only, their partners can again be part of the conversation on camera. “This has been a nice way to get dads back in the thick of things,” Dr. Nynas said. “… It’s just like any other time, and they get to ask questions, and we talk through things.”
One concern Michele had during her appointment was to follow up on an accidental rib injury that had happened a couple of months before. The growing baby had begun pressing on her rib cage, giving Michele more pain.
“Even by having a video chat,” Kyle said, “(Dr. Nynas) was actually pointing out things on herself, like with Michele’s ribs … and she was actually using her own body to portray what was happening.”
“I still have the benefit, where if they have a question about an incision or if they want to show me a rash, I can see it in real time,” Dr. Nynas agreed.
And of course, Dr. Nynas can continue the visit in person if something concerns her.
“If a patient describes anything that is at all not 100% completely normal, we talk with them and say, ‘Hey, you need to come in for a visit.’ And we just bring them right into the office.”
Other benefits of prenatal video visits
Dr. Nynas likes the fact that a video visit can provide her with new insights.
“Seeing the patient in their own home gives you a lot of additional information about how they’re doing and where they are,” she said. “For example, it’s interesting to see moms who have three little kids who are busy running around in the background, and you can hear them. And when they come in and say that perhaps they’re anxious or stressed about something, yeah, I understand, a little bit, why you’re feeling that way.”
And even a simple chat about the plants visible in the Sorensons’ home during their video visit made an impression on Kyle.
Dr. Nynas believes video visits will continue to play a significant role in how she cares for her patients. Some patients may simply consider it a convenience — they don’t have to leave the comfort of their home. For others, though, it could have a much greater impact.
Those might include people with transportation issues, or with medical conditions that require remote monitoring. “I can still provide them really great care without the strain of having to get them into the office,” Dr. Nynas said.
She sees it being helpful for consultations as well. “For example, if a patient is seeing a provider at Indian Health Service and develops a complication with their pregnancy and they just need a consult with high-risk obstetrics, we can have a visit with them where they are, which I think will really improve our coordination of care.”
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