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Researchers considered the act of reporting itself a success: Patients were monitoring their health and taking the next step to call in. Still, the team expanded the health-screening tool, adding more information for midwives and other staff who were in the position of educating patients at the outset, helping them learn more about their own normal blood pressure levels, knowledge that can be lifesaving.
Nurse midwifery student Miriam Chengo visits with mother-to-be Fatma, who is enrolled in Heart, Soul and Joy. he mother-to-be was glad to get her own blood pressure cuff so she can take daily readings at home.
But researchers want clinics to change too. And that means adapting their health-care culture and boosting resources. During a typical 15-minute appointment, a pregnant person might relay any concerns since the last visit and be evaluated. If a translator is present, which allows for vital information to be communicated back and forth, patient to provider, provider to patient, then that allotted time essentially shrinks by half.
“They’re the people who are doing the hardest work with the fewest resources for the most vulnerable communities,” Chapman says of community clinics such as Neighborcare. “And yet they are partnering with us to find out how to do things better.”
Neighborcare Health, which primarily serves low-income and uninsured patients in the Seattle area, was a clinic partner in the Heart, Soul and Joy pilot during the pandemic and continues to enroll participants in the study at five locations. “The tool allowed for us to have a reminder to always screen for safety and well-being when, in the busy visits and the limited time we have, other needs can take priority,” says Nicola Solvay, co-director of Neighborcare Health’s midwifery program and practicing midwife at the Columbia City clinic.
The home-use blood pressure cuffs were a huge perk, Solvay says, recalling a patient whose blood-pressure readings at a clinic visit were normal, but were higher at home. So clinic staff ran some tests and learned that the woman had preeclampsia. “This diagnosis would not have been realized so early had we not had this program,” Solvay says.
She tells of another patient who disclosed thoughts of harming herself, something the woman came ready to discuss, thanks to the emotional health materials she’d been given as part of Heart, Soul and Joy. The appointment “turned into safety planning, and we were able to connect her, at that moment, with our behavioral health specialist down the hall,” Solvay recalls.
Two positive outcomes, in that patients identified and reported a problem, and clinic staff were able to respond immediately. But what of countless other pregnant people, and clinics, without even these tools? “My fear around the world of health care is that we mainly screen, and we don’t have the resources to do more,” Solvay says.
One tangible step, the researchers agree, could be increasing funding for public health clinics across the state so that medical staff have more time with each patient. Another, even more pointed step: Apple Health (Medicaid in Washington state) could cover blood pressure cuffs for every pregnant person enrolled.
“This project isn’t about further pathologizing people,” Harris says. “We’re saying to the systems, what can you do? What can you take away? What can you add to make sure people are healthy when they leave?”
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