Can we answer this question as we look to the future of healthcare technology and maternity care?
“When will my baby be born?” A question that as a Midwife, I have been asked time and time again. It is also a question that I have never been able to (confidently) answer and I often reply with answers such as, “oh it’s difficult to predict, or the baby decides when he/she will make an appearance.” Now, there is truth within this response, but as I start to understand the potential of AI and digital technology, I am beginning to question the answer I have provided to so many mothers and their families.
As a Midwife and Co-Founder of a digital health start up – Lister, I am interested in exploring how AI and digital health can be applied to the Women’s Health Strategy that was recently released by the government, but particularly, labour and pregnancy care.
Turning gut instincts into a digital approach
There are so many variables that determine time of birth and mode of delivery that to an extent, are out of our control, such as foetal distress. But, as I became more experienced, I started to develop and instinct, a gut feeling: ‘I think this baby will be born soon’ or ‘I think this may be prolonged and we may end up in theatre.’ Ask and Senior Midwife or Obstetrician to look at a labour ward board, I am sure they could give a rough indication of likely outcomes…but what if we could turn these instincts into a formal digital approach? A thought-provoking question that I am interested in exploring.
Is this necessary?
You may be wondering why this is needed. Labour is a natural process, why do we need to predict it? This may be true in many circumstances, for example, spontaneous labour, where all is going well and mother and baby are supported within a low risk, low intervention environment. However, there are certain scenarios which I can immediately think of where such a digital tool could contribute to better clinical outcomes, such as: reducing long labours where the chances of a vaginal delivery are ‘considered low’, c-sections at full dilatation which present further risks to mother and baby than if performed at an earlier stage, or, on the contrary, reducing the numbers of babies who were born unintentionally before hospital arrival.
We also don’t always get it right. As a Midwife, I can put my hand up to not always making the right decision. Not only is this extremely difficult for patients, but it is also difficult for us as clinicians, as human beings. The ‘mental beating’ is a familiar thought process for many healthcare professionals and with staffing levels in crisis, this only exasperates decision-fatigue.
I don’t envision a black and white approach. I want women to be supported statistically in their decision-making process and I want women to feel empowered within their care. I want them to have a choice, to understand, in real-time, what the data is and what it means for the situation they are in.
Developments within women’s health digital space
There are encouraging developments in this space and I know I am not the first to connect AI with labour care. One particular clinical decision-making tool that I admire was developed by Tommy’s research centre in St Thomas’ Hospital in London. I hope this example will be an opportunity to leverage AI and digital technology into maternity services to further improve identification of risk, reduce health inequalities and promote safer, more personalised care. There is also recent research around AI and foetal monitoring. As an experienced Midwife, I can think of numerous examples where variation in interpretation has affected patient safety.
This is an exciting space to be in and one development that does excite me is the recent Women’s Health Strategy (WHS). There are some heart-wrenching facts in the WHS, with 84% of women stating at times, they didn’t feel that their voice was heard. This is unacceptable and I hope this statistic will only live historically as we move forward. So how can data support in reducing these statistics? Well, the patient voice should be (and often is) enough alone, but I believe that real-time data can facilitate and help to amplify their voices further.
I have been a Midwife for over eight years and in my newly qualified days I had a complete disconnect with technology. So much so, that if my future-self had told me (who, at the time, was passionate only about clinical practice) that I was going to become fascinated by the world of health technology, I would have told you that I was wrong. But what I didn’t realise – was that clinical practice and digital health are intertwined. That digital technology can complement, and not replace the way we work. As stated in the WHS, education is key to our ambitions. As well as sharing this vision with patients and the wider general public, without healthcare professional engagement, this is lost. Some say that AI can give us false reassurance and make the care we provide, ‘less human’ but I disagree. I think there is an opportunity for it to do quite the opposite and support our care to be ‘more humanised.’ If we can feel reassured with our clinical decisions and implement tools that reduce the pressure of decision-making, then we can create more ‘mental room’ relieve clinical anxiety and allow us to streamline our focus on delivering the care we strive to achieve.
Keeping the momentum going
In this (relatively short) blog, there is not the space to cover the myriad of challenges and barriers to the implementation of good health technology in clinical practice, but I am very keen to keep the momentum of the conversation going – I was inspired to write this blog by the recent Women’s Health Panel at the Intelligence Minds Conference. If the future is looking ‘even more digital’ then let’s fuel our expertise within this sector to not only achieve but go above and beyond the aims stated in the Women’s Health Strategy.
To find out more about organisations relating to this topic, please visit:
https://www.wrh.ox.ac.uk/research/oxfordlabourmonitoringgroup