For New Moms, Bridging the Breastfeeding Gap With Telehealth

The care delivery landscape during the pandemic has been dramatically altered, with practically every specialty being impacted in some way. Maternal and pediatric health are no exceptions, and like they have for many other patients, providers have turned to telehealth for new and expecting moms during the crisis.

To better understand new mothers’ concerns and perspectives during the pandemic, Pacify Health, a telehealth company geared towards prenatal and pediatric care, conducted a survey of 1,000 new and expecting moms across the country in May 2020. The survey was specifically aimed at understanding how COVID-19 has affected mothers’ perceptions of and plans around in-person care, the value of breastfeeding, need for lactation support, and the role of telehealth, according to Pacify officials. Key takeaways from the report include:

• The proportion of mothers who intend to breastfeed has increased during COVID-19. However, a majority of all moms anticipate challenges in continuing to breastfeed their babies because of COVID-19.
• Anticipated difficulty of breastfeeding is particularly high among mothers covered by Medicaid, Black and Hispanic mothers, and mothers of NICU babies.
• COVID-19 puts vaccination and breastfeeding rates increasingly at risk, as 70 percent of new and expecting moms are concerned about in-person visits post-delivery.
• Just a 5 percent drop in breastfeeding rates could cost the U.S. healthcare system  more than $320 million in medical spending annually and increase maternal mortality by more than 30 percent.
• Telehealth may offer a remedy, with nearly 60 percent of new moms expressing a strong preference to receive virtual lactation support as opposed to an in-person lactation consultation.

At Heartland Women’s Healthcare, a provider group with several locations throughout Southern Illinois and Missouri providing OBGYN care for women of all ages and stages of life, there was a desire amongst its leaders to take the pressure off breastfeeding moms, says Gina Lyons, the chief operating officer at Heartland. “Society puts a lot of pressure on women, whether they realize it not. If you can breastfeed your kids, that’s great and it’s what you want, but sometimes it doesn’t work that well and there’s a lot of pressure that moms put on themselves. And when things don’t work quite right, you start to think, ‘what’s the matter with me?’” says Lyons.

To that point, a 2019 commentary in the journal Nursing for Women's Health noted that that "psychological pressure to exclusively breastfeed has the potential to contribute to postpartum depression symptoms in new mothers who are unable to achieve their breastfeeding intentions." 

Enter Pacify, a company founded on the idea that more can be done to use mobile technology to help families access quality prenatal and pediatric care. Pacify’s mobile platform provides immediate, 24/7 support to new mothers who download the app and connect via video-visit with clinicians including nurses and lactation consultants. There are no appointments or scheduling, and calls are answered in an average of less than 30 seconds, according to the company’s officials.

Heartland turned to Pacify to “take that stress out of the scenario for women,” notes Lyons. “We educate our women about this offering during their pregnancy, and we also talk to our postpartum patients about it, as well as patients thinking about getting pregnant. It’s really important to educate  people who are planning on having a family, and putting [options] out to there to let them know what’s available to them. It gives some women ease that there are lots of resources that an organization could provide, and it doesn’t become quite as scary to them as things come up. So we’re educating women at all stages,” says Lyons.

In terms of patient usage with Pacify so far, officials point out the following data points:

• The ratio of patient enrollments to calls made: 85 percent

• 80 percent of those who signed up for Pacify did so before they had given birth. Pregnant moms called in with concerns about COVID-19; they had questions about the safety of taking medications, as well as general anxiety.

• More than 70 percent of Heartland patient calls came in after hours (nights, early mornings, and weekends, when other sites of care are not available) so these moms would have been without care had Pacify not been an option.

• For calls placed, the average answer time was 19 seconds

• Average call rating was 5/5

Heartland specifically has not seen a big resistance to new moms coming to the clinic in person, as most new mothers have been comfortable with a blend of face-to-face and telehealth visits, depending on the need, says Lyons. More broadly from a general telehealth perspective, Lyons points out that many of Heartland’s locations are located in rural areas, and that can create a challenges to deploy virtual care since “you have a demographic that wants to access some of those services, but not having that type of access or Internet support can sometimes be [problematic],” Lyons says.

One way Heartland has been overcoming this is again, through education. For example, one of Heartland’s clinics is in Poplar Bluff, Mo., a very rural area where the nearest hospital for some patients might be an hour away. “So we know how important it is to be able to tell [folks] in these areas that they can get to somebody sooner if needed. Of course it’s a different story when trying to deliver a baby, but we have at least gotten that message out,” says Lyons.

In the Midwest, Lyons notes the culture there is that patients prefer face-to-face interactions with their providers to telehealth. In Illinois specifically, prior to the pandemic, the state laws in regard to telehealth were very restrictive, she adds. The patient would have to show up at a distant site from the provider in order to have a telehealth visit, meaning there was still a need to have a healthcare worker on that site, in a distant location, while also requiring that the patient travels to an office location. 

During the crisis, those restrictions have been lifted,  and in the meantime, Heartland has had to ramp-up its messaging and education to let individuals know that the quality and experience of the visit can essentially be the same as if they were going in person. “We have had to work on getting people comfortable with the fact that virtual can be just as good as face-to-face. Once they started to understand and get more comfortable with virtual, and realize that in many [cases], telehealth works just as well as in-person visits, we quickly saw more of them signing up for it,” she says.