Using Self-Measured Blood Pressure Monitoring with OB Patients 

The risk of serious illness to mothers and babies associated with hypertension in pregnancy are well-established. One strategy health centers are employing with pregnant patients, especially those who are high risk for hypertensive disorders, such as preeclampsia, is the use of a self-measured blood pressure (SMBP) device.

Two barriers making it difficult for pregnant women to their get to their prenatal appointments are transportation and lack of childcare. SMBP devices allow at-risk patients and care teams to regularly monitor for blood pressure fluctuations, and manage care and treatment without scheduling additional appointments or if the patient is unable to come in for their scheduled appointments.

“Having the ability to more frequently monitor our pregnant patients’ blood pressure has enabled us to identify issues sooner,” says Pat Young, OB-GYN Clinical Care Coordinator, Hometown Health, Schenectady, NY, who shared how a recent pregnant patient with borderline high blood pressure, called the health center with a significantly elevated reading. Care team staff were able to help get her to a hospital immediately where she safely delivered without complications. 

Hometown Health has been growing and refining their maternal health SMBP program since 2017. Over the years, they have worked through several challenges including: 
  • Limited supplies
  • Initial time constraints for “loaning” SMBP devices to maternal health patients
  • Lack of insurance coverage for patients without a hypertension diagnosis

With a grant from an insurance provider, all high-risk OB patients can own a digital blood pressure device and self-monitor through postpartum.

Champions and Education are Critical to Implementation

In February 2020, Lisa Green, DO, MPH, CEO and Co-Founder, Family Christian Health Center, Harvey, IL, along with a group of Black women OB-GYN physicians and nonprofit leaders held a Facebook Live event addressing health disparities and unique challenges of the birthing population on the South Side of Chicago and South Suburban Cook County; amid an alarming trend of hospitals discontinuing inpatient obstetric services and an unprecedented global pandemic. Dr. Green explained the urgent need to have blood pressure devices for each OB patient and gained the attention of the state's Department of Health & Human Services. Now, all OB patients on Medicaid are given a blood pressure device to take home.

“About 70% of our OB patients are at high risk for hypertension and preeclampsia, so giving our patients the ability to monitor at home and call us to help them manage their blood pressure has been tremendous,” says Dr. Green. The health center launched its SMBP cuff program for pregnant patients in 2020.

Incorporating the SMBP program into routine patient care requires educating both staff and patients to get their buy-in. “Your staff becomes your champions,” says Dr. Green. “Your nurses and MAs are the ones who take the patient’s blood pressure, not the physician, so getting them on board is key.” 

To preserve time for nurses and MAs, the health center first allowed nursing students and then community health workers to implement the program to teach patients how to use the SMBP devices. They spend time helping patients become advocates for themselves and gain a voice in their health care.