Monitoring for High Blood Pressure Improves Maternal Health

Despite advances in healthcare, 700 women in the U.S. die during pregnancy or from complications of childbirth within a year. Black women are three times more likely to die from a pregnancy-related cause than white women. But according to the Centers for Disease Control and Prevention (CDC), more than 80 percent of these deaths are preventable.

That’s why Memorial Primary Care began an obstetrics hypertension navigator program last year. Nurses help at-risk moms with high blood pressure by:

• Coordinating prenatal and postnatal care
• Connecting patients to additional services like social work
• Monitoring blood pressure readings
• Providing education

“While the program shows signs of success, we still have work to do,” says Tammy Scott Reese, director of Care Management and Population Health at Memorial Primary Care. “We must continue to advocate, to get the word out and to educate our communities so we can effect change,” Reese says.

Maternal Health Disparities

Hypertension or high blood pressure is a common cause of complications during pregnancy. Preeclampsia is another serious blood pressure condition that can develop during pregnancy. It accounts for up to 15 percent of maternal deaths worldwide.

Deaths from these conditions impact Black women at a disproportionate rate compared with white women. Black Maternal Health Week, from April 11 to 17, provides opportunities to share information about the causes of this disparity — such as access to care, chronic conditions, implicit bias and structural racism. It also allows us to share information about what Memorial Healthcare is doing to address them.

A Personal Connection

Reese knows first-hand how scary preeclampsia can be. At age 30, she was pregnant with her third child. At 37 weeks, her blood pressure rose. Doctors delivered her baby right away and treated her hypertension.

Once home, she developed “an agonizing cough. I thought I caught a cold from the hospital,” Reese says. But the cough lingered. Reese couldn’t breathe when lying down. She was losing weight. Five weeks after giving birth, a nurse friend convinced her to go to the ER.

She’s lucky she did. When a doctor told her she needed to be admitted, Reese protested.

“He told me, ‘If you leave this hospital, you may not make it back alive,’” she says.

Reese didn’t have a cold. She was in chronic heart failure. The condition is a postpartum effect of preeclampsia.

How the OB Hypertension Navigator Program Works

Funded in part by a $700k grant from the Essential Hospitals Institute, the hypertension navigator program promotes healthcare access and equity. Our team aims to prevent women from developing serious, even life-threatening complications.

The program operates at Memorial’s three Family Birthplaces and in all emergency departments:

• If a pregnant person comes to the ER with a blood pressure of 140 over 90 or higher, a doctor notifies a navigator.
• The navigator contacts the patient and explains the program.
• Mothers in the program report their blood pressure daily.
• A nurse or case manager contacts the mom every three days and monitors their results.
• The navigator schedules follow-up appointments as needed.
• The navigator also coordinates any additional patient care.

“So many times, we think if we take our meds, we will be well, and we don’t have to worry about what we eat or all the other things,” Reese says. “But we must follow the whole recipe. Take the meds. Eat right. Follow up with our doctor.”

Navigators partner with women throughout their pregnancy and for up to a year after giving birth. If patients need a cuff to monitor their blood pressure, the navigator provides one.

“If we see a spike in their readings, we notify the doctor,” Reese says.

This close monitoring allows patients to get care quickly.

Educating Patients and the Community

The program also provides important education. The hypertension navigator teaches patients about high blood pressure warning signs, including:

• Abdominal pain
• Blurry vision
• Swelling in the legs
• Throbbing headache

The navigator explains when to call a doctor, how to control their blood pressure and signs of postpartum depression.

“At each interaction with a mom, we review the warning signs and remind them not to lay down or go to sleep but to call their doctor right away,” Reese says.

The navigator also helps patients with any social needs — offering resources to help with access to food and transportation, paying monthly bills or taking care of themselves. The navigator follows up with patients for one year.

Reese says any patient who uses Memorial Healthcare can access the hypertension navigator program. Community physicians can also refer patients along with Memorial Healthcare doctors.

The navigator and a Memorial Healthcare community educator share information about the program at events in North Broward and South Broward, including at the YMCA.

Positive Outcomes

The hypertension navigator helps many patients keep their high blood pressure in check. It has also helped others get the care they need when they need it.

“We’ve definitely had cases where we’ve been able to intervene and get a mom back to the hospital in time,” Reese says.

When the navigator notices blood pressure readings trending up, they take note. Reese recalls a patient who had elevated blood pressure with swollen legs. The navigator called a doctor for guidance but didn’t hear back right away. Reese had concerns, so she reached out to Timothy De Santis, MD, chief of obstetrics and gynecology at Memorial Healthcare.

After reviewing the case, Dr. De Santis directed the patient to the ER, where she was admitted to the hospital. The mom received treatment to stabilize her blood pressure and was able to go home within a week, Reese says.

To date, we have received 2,890 referrals and 1,294 pregnant people have been enrolled in the program.

A Comprehensive Approach

The early success of the hypertension navigator program is one example of Memorial Healthcare’s efforts to improve maternal health.

Reese says a $500k grant from the Florida Department of Health created the Severe Maternal Morbidity through Telehealth (SMMT) program, further increasing access to care.

The SMMT program offers services to moms with high blood pressure and other chronic conditions using telehealth and at-home devices. The grant funds blood pressure cuffs, diabetic accu-check machines and technology to complete a telehealth visit, such as a tablet or internet-connected phone.

Reese works with community partners and Medicaid to help patients access technology. These efforts help patients get care no matter where they live.

“We can use telehealth to visit with a mom with a chronic condition and get her the services she needs,” Reese says. “This immediate help improves the outcomes for moms of color in our community.”

Care for a Healthy Pregnancy

If you have concerns about your blood pressure, talk to your doctor right away. If you don’t have a doctor, let us help you find a Memorial Healthcare System physician.

If you have questions about your pregnancy, contact a nearby Memorial Family Birthplace.