How Visiting a Fetal Care Center Impacts Patient Employment and Education
More than 40% of pregnant women who travel to a large regionalized fetal center experience a disruptive impact on their employment or education, says new research from a Cincinnati Children’s Fetal Care Center clinician.
Kara Markham, MD, presented her oral abstract “The influence of care at a large regionalized fetal center on patient employment and education” at this year’s American College of Obstetricians and Gynecologists (ACOG) in San Diego May 6-8. Cincinnati Children’s was proud to be a major participant.
Providers should use a holistic care approach to minimize this effect, which can have significant financial implications for families who may already be contending with the costs of medical care for their child, as well as psychosocial impacts, Markham says.
“We need to be mindful and collaborative,” says Markham. “We can develop more supports for the patient herself and a more global and familial benefit.”
Barriers to Employment and Education
Study participants who received care at Cincinnati Children’s Fetal Care Center from 2015 to 2021 received an anonymous email survey. Questions asked about the patient’s:
- Demographic characteristics
- Fetal diagnoses
- Impact of referral center care on the patient or partner’s employment or education
- Non-medical expenses related to care at Cincinnati Children’s
Survey results found:
- 74% of women were employed while receiving pregnancy care at the Fetal Care Center.
- Among those, 50% worked full time.
- Half of these patients missed one to five days of work related to their care at the fetal center.
- One-third of patients missed more than 10 days of work.
- 8% of patients were pursuing an education during their pregnancy; 80% of them were unable to continue their education while receiving care.
Among the women’s partners, 90% worked full time. Partners missed a similar amount of work related to appointments at the fetal center.
The study illuminates the barriers to continued employment and education that care at a tertiary fetal center imposes on patients and their partners, Markham says.
“The Cincinnati Children’s Fetal Care Center supports women so they can come here to get the care they need,” Markham explains. “We can help with travel and a place to stay, but that only scratches the surface of the onus we place on them when we ask them to come here.”
Understanding the Financial and Social Impacts
The science shows fetal center care leads to better outcomes, and there are studies of the psychological implications, but “no one is diving into the social and financial background of it,” Markham shares.
A more holistic approach could include:
- Asking patients and their partners about how visiting the fetal center impacts their lives
- Minimizing length of stay and travel to the fetal center
- Requesting patients visit the fetal center when it’s the only place to get needed services
- Working closely with a patient’s hometown obstetrician for routine care and ultrasounds
- Having a dedicated social work team
“It’s a balancing act,” Markham says. “A lot of the burden comes at delivery, especially if the child is in the newborn intensive care unit. At that time, they need to be here.”
Ultimately, providers at tertiary fetal care centers should provide support and help patients understand that being away from family, home and work may be the best way to care for their fetus or newborn.
At Cincinnati Children’s, the fetal care team is committed to ensuring all women have access to the highest level of maternal-fetal medicine. Doing so means creating ways to support the entire family, including partners and siblings during what often is a stressful time.
Markham and her team are developing questions to ask patients and protocols to follow. This will:
- Ensure care is provided when and where it’s needed.
- Offer a full complement of support.
- Reveal patient and family needs.
“In the end, it will benefit the family as a whole,” Markham says. “They just need to get through this anxiety-provoking time.”
