TaShenma Mack thought her pregnancy had been going smoothly. Then again, she was expecting her first baby and had nothing to compare it to. After putting on a lot of weight in a short time, she had been getting winded easily. But she figured that was just what happens when you’re pregnant.

The 27-year-old, Lexington, N.C., resident was surprised to learn at her 24-week OB/GYN appointment that she had high blood pressure – called pre-eclampsia in pregnancy. She was even more surprised – and scared – when her doctor sent her immediately to Novant Health Forsyth Medical Center’s obstetrical emergency room.

She was admitted on April 18 with severe pre-eclampsia. In addition, doctors were concerned about the small size of the baby girl she was expecting.

“It was scary,” said Mack, a recent graduate of Winston-Salem State University and a health care patient advocate. “I was really worried about what might happen next. I was worried about my baby’s health and mine.”

She stayed in the hospital until she delivered, by C-section, at 25 weeks and 2 days. (A full-term pregnancy is 38 to 40 weeks, and doctors tried to keep Mack from delivering until her 28th week.) Baby Zalani came 15 weeks early and weighed just 1 pound, 2 ounces. She was in the NICU for 100 days.

Zalani was able to come home to her mom and dad on Aug. 10, weighing 5 pounds. Today, she’s up to 12 pounds, which is considered normal for her age.

Maternity 2024 High Performing emblem

Novant Health Forsyth Medical Center is among just 17 North Carolina hospitals to receive the coveted U.S. News and World Report High-Performing Hospitals designation for maternity care.

Melissa Tharpe
Melissa Tharpe

Melissa Tharpe, a nurse practitioner at Novant Health WomanCare in Winston-Salem, said Mack had no prior history of high blood pressure. It was the result of pregnancy, which is not uncommon. “With high blood pressure becoming more common in the female population, it is also occurring more often in pregnancies,” Tharpe said. “It’s present in 8% to 10% of pregnancies.”

A newfangled house call

Mack still had pre-eclampsia even after she delivered – also not uncommon – and her care team wanted to follow her closely once she was sent home. Tharpe thought she was a good candidate for remote patient monitoring (RPM) and asked if she was interested in the free program. It’s part of Novant Health’s commitment to innovation, smart use of technology and caring for patients in the most convenient way possible.

“Once they told me pre-eclampsia can stick around, even after you deliver the baby and the placenta, I knew I wanted to be part of the program,” Mack said. “It felt really important to take this step. Life is different now; I want to be here for my baby.”

Her RPM kit – mailed to her home – included an electronic blood pressure cuff and a scale. The program also includes an app for your phone. After RPM patients receive their kits, a nurse calls them to walk them through what’s in the kit and how to use it.

The data is automatically sent to the patient’s doctor’s office. Patients don’t have to record anything, make a phone call, send an email. It all happens with minimal effort.

The primary goal, Tharpe said, is helping maternity patients avoid health complications that could require an ER visit or hospital stay. With RPM, clinicians monitor patients daily and respond to potential trouble, as measured by patients’ reported vitals and symptoms. Nurses can contact patients by text message or phone if their numbers are concerning.

Remote patient monitoring can make a big difference.

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It’s also part of a new three-tiered strategy at Novant Health to address disparities in maternal and infant health that are rampant across the U.S. Increasing the ease of access to care through efforts like RPM, particularly to people of color who suffer disproportionately from those disparities, is just one of several steps Novant Health is taking.

Mack, who was on three blood pressure medications when she left the hospital, was a good candidate because “she wanted to stay on top of her condition,” Tharpe said. “Not everyone is as diligent as TaShenma. This is a seven-day-a-week commitment.”

But not an onerous one, according to Mack: “It takes three seconds to step on a scale and about 30 seconds to check your blood pressure. You don’t have to record anything. The app takes care of that. It was a comfort to know someone was checking on me and would notify me if there was a problem.”

Making accountability easy

The program is also a way to involve patients in their own care, Tharpe said of the RPM program WomanCare launched in July 2022.

“Outcomes are better when the patient is committed to doing the work. We love giving patients accountability. When the patient sees that number – on the blood pressure cuff or on the scale – it somehow means more than when they hear a nurse read the number. There’s something really powerful about visualization. It makes a difference.”

If, during RPM, a blood pressure reading is high, the app asks the patient questions: Do you have a headache? Do you feel dizzy or lightheaded? A nurse will contact the patient if their responses merit further discussion and perhaps an office visit.

Mack’s readings never raised any concerns.

While not every patient wants to be tracked this closely, Tharpe offers RPM to anyone she thinks could benefit, including “any patient with a history of elevated blood pressure or one who has one or more risk factors for pre-eclampsia or had pre-eclampsia with a prior pregnancy.”

The program represents technology at its best. It’s high-tech, but also high-touch.

Most patients say “yes” once they understand how they can benefit. “Patient education is very important with this program,” Tharpe added.

Novant Health now offers RPM for patients with high blood pressure, bariatric patients, heart patients and obstetric patients. Only some patients within those areas are eligible, depending on the care they need and other factors.

The initiative began with a program for heart failure and cardiac patients in the Charlotte area in 2022. These programs are part of a national trend that’s expected to increase by 11% between 2022 and 2028.

While she was on RPM, Mack’s blood pressure steadily improved, and she was able to come off her three medications, little by little. Over the two months she was monitored, her blood pressure stabilized and was regularly recorded at normal or close to normal.

Ultimately, she was able to pack up the scale and blood pressure monitor and mail them back.

Today, both she and Zalani are healthy. And having this health emergency – and being so closely cared for during it – has changed the way Mack approaches her job as a patient advocate. “I’m more empathetic now,” she said. “I knew Novant Health was on my side each step of the way, and I try to make my patients feel that way, too.”