OB Nest: A new vision for prenatal care

March 19, 2021

Mayo Clinic's OB Nest prenatal research program envisioned a new, low-risk pregnancy care model. After rigorous research, the team launched OB Nest, which continues to thrive during the COVID-19 pandemic.

"In this new model, a low-risk pregnant mother receives at least half her prenatal visits in her home, or her nest," says Yvonne S. Butler Tobah, M.D., a Mayo Clinic obstetrician and OB Nest research program leader. "We're seeking to demedicalize prenatal care experience elements not needing a medicalized process. We're looking to empower women and offer them more home-based care."

The OB Nest prenatal care program allows obstetricians to provide more resources to high-risk obstetric patients with complications, according to a January 2018 article in American Journal of Nursing. By converting 40% to 50% of appointments to home for patients with low-risk pregnancies, physician time increases to manage patients with high-risk pregnancies. Yet, this benefit doesn't come at the expense of patients with low-risk pregnancies, says Dr. Butler Tobah, as they self-monitor at home.

Traditional prenatal care model

Obstetricians designed the medically intensive, established prenatal care model in an era when digital applications such as cellphones and home computers weren't prevalent, and innovative medical tools, including connected home-monitoring devices, hadn't been created. Traditional prenatal care also reflects its development when fewer women worked outside the home.

Dr. Butler Tobah reflects that the current prenatal care standard is based on a highly medicalized model, with limited evidence supporting effectiveness for 12 to 14 on-site clinical office visits during a low-risk pregnancy, without consideration for the productive work lives of women today.

New prenatal care model

In the Mayo Clinic OB Nest program, mothers with low-risk pregnancies are not viewed from an illness perspective; rather, they are viewed as well patients who are expecting. "In OB Nest, the hope is to normalize pregnancy — not as a disease or a disorder," says Dr. Butler Tobah. "For patients at low risk, this model works well and is safe as an intensive clinical approach."

OB Nest reduces office visits while ensuring patients feel well cared for. Providers give patients home vital-sign monitoring devices and fetal heart rate Dopplers and education on how to use them. The OB Nest program partners experienced nurses with patients; the nurses utilize synchronous and asynchronous communication methods with their care teams. Interactions include secure messaging through Mayo Clinic Patient Online Services, traditional phone communication, and more recently, video appointments. Women take their own measurements and communicate data through their preferred communication methods.

"Women are much more engaged in their care," says Dr. Butler Tobah, which is also noted in an April 2018 Mayo Clinic Proceedings article. "Patients can tell us, 'I've noticed my blood pressure is slowly creeping up at home. What does that mean?'"

The OB Nest program provides a reasonable alternative to capture critical data for busy, career-driven expectant mothers, and women who live in obstetric deserts or have obstacles preventing face-to-face appointments. Patient preference guides contact schedules with obstetrics, versus provider convenience, according to the 2018 article in American Journal of Nursing. Providers respond synchronously during business hours by phone or video, or asynchronously post-business hours by portal.

When COVID-19 arrived in the U.S., Mayo obstetricians were already transitioning all low-risk obstetric patients to OB Nest care; the pandemic increased the conversion's pace. The Mayo team felt fortunate to have experience in this type of care, says Dr. Butler Tobah, who thinks it will remain beyond COVID-19. "OB Nest is novel, especially for obstetric care," says Dr. Butler Tobah. "With the advent of COVID-19, this model is likely to continue."

Research behind OB Nest

Dr. Butler Tobah and colleagues have researched this prenatal care model, with a randomized, controlled study comparing OB Nest care to standard care. Study results were published in American Journal of Obstetrics & Gynecology in 2019. For this research, investigators needed a specific low-risk pregnancy definition, which Dr. Butler Tobah says emerged through extensive exclusion criteria: English language proficient pregnant women who were at least 18 years old and had no chronic medical conditions. These criteria are evolving, however, so patients slightly outside them can participate in OB Nest. This study reports that OB Nest patients felt more satisfied and less stressed during pregnancy than counterparts seen entirely in the office, despite fewer face-to-face appointments. Providers maintained care quality along with recommended lab testing and imaging.

Also, the research team conducted a qualitative analysis with focus groups, inquiring about patients' OB Nest experiences. Patients liked OB Nest's decreased interference with their workdays due to reduced office visits; fewer hassles with parking, leaving work or arranging sibling care; and decreased travel burden for visits while very pregnant. They also appreciated feeling connected to an OB team with the ability to contact them as concerns arose, and felt comforted by home-monitoring equipment, including fetal heart rate Dopplers, providing reassurance all was well with their pregnancies. Although not part of the original study, patients receiving OB Nest care during the current COVID-19 pandemic have reported appreciation for access to safe prenatal care without putting themselves at risk by visiting a populated medical facility.

Dr. Butler Tobah is interested in continuing to safely integrate innovative, flexible options in pregnancy care. "Technology has changed how we function in our daily lives," she says. "We haven't always applied these changes to medicine till now," she says. "This pandemic has opened our eyes to the fact that we can and should work differently."

Nationally, obstetrics community members have issued numerous calls to think differently and redefine how prenatal care is provided. As obstetricians work toward strategies for reducing maternal morbidity, increasing options for prenatal care delivery and addressing shortage of obstetric providers nationally, OB Nest serves as a model that may address some of these needs.

Model adoption, consult available

A small number of institutions currently practice an OB Nest-like model. Dr. Butler Tobah has presented the Mayo Clinic OB Nest care program to various national and international conferences and health systems, and her team has assisted several U.S. sites with establishing a similar obstetric care model. Dr. Butler Tobah is available for consultation, providing expertise and protocols for institutions that desire a program like OB Nest, at butlertobah.yvonne@mayo.edu.

For more information

Baron A, et al. Increasing the connectivity and Autonomy of RNs with low-risk obstetric patients. American Journal of Nursing. 2018;118:48.

Meylor de Mooij M, et al. OB Nest: Reimagining prenatal care. Mayo Clinic Proceedings. 2018;93:458.

Butler Tobah Y, et al. Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring. American Journal of Obstetrics & Gynecology. 2019;221:638.E1.