Mayo Clinic tests self-help prenatal care as a solution

Doctors discouraged the use of take-home fetal monitoring kits when they first hit the market, because they worried that user error would cause expecting mothers to panic if they couldn't find their babies' heartbeats.

But now the monitors are key to a Mayo Clinic effort to streamline prenatal care.

Called "OB Nest," the program cuts the number of prenatal visits for women with uncomplicated pregnancies from around 12 to eight, and trains them to monitor their blood pressure and babies' heartbeats.

The approach proved popular in a trial run last year — especially among expecting mothers with jobs who struggled to attend numerous checkups. And reducing unnecessary visits gave obstetricians more time with women who have high-risk pregnancies, said Dr. Yvonne Butler Tobah, who co-authored a paper released earlier this month about the trial.

"We showed we could reduce … prenatal visits and still maintain the quality of care," she said.

Women also had easy access to nurse advisers by phone or e-mail, and to an online site to interact with other expecting mothers.

Mayo nurse Sally Rude participated in the OB Nest trial during her pregnancy last year. Driving from Zumbrota to work 12-hour shifts, Rude said it was a struggle to make prenatal appointments. So fewer was better.

At least once a week, she would place the fetal monitor on her belly and search — paring through static noise to find her baby's heartbeat — and count the beats for a minute.

"Kind of depended on where the baby had moved to each week," she said. "If it had moved, I would have to look in a different spot."

Fetal monitoring proved in the trial to be a family matter, Butler Tobah said. Husbands and children often gathered to listen.

"It allows them to get involved in the care," she said.

Mayo will soon add OB Nest as a routine obstetric service.

Rude felt her first contractions around 3 a.m. on March 14, 2015. Her baby girl, Bristol, was born later that evening.

Rude liked the reduced checkup schedule and home monitoring so much that she said she doesn't want to go back to standard prenatal care if she has another baby.

Maybe that's just because the Rude women aren't slaves to convention. Bristol didn't exactly go along with the first-birthday tradition of gleefully eating cake earlier this year.

"She stuck her hands in and just kind of looked at her hands and cried," her mother said. "She didn't want to be messy."