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All hands on deck (from a distance): remote care for traumatized moms and babies

Dear colleague,

Coronavirus is forcing providers and allied professionals serving mothers and babies to make unprecedented decisions. Should pregnant women needing care go through our hospital quarantine entrance? Should moms deliver without partners, family or doulas present? Be sent home early before key screenings or jaundice treatment are completed?

To make matters worse, our systems aren't ready for basic remote care of mothers and infants now "socially distanced". Prenatal, post-partum and well-baby visits are being cancelled or moved to phone but healthcare and most home visitors lack basic technology  and training to keep mothers educated, engaged, and healthy remotely. We all fear mental illness, deaths of despair, and pregnancy-related maternal mortality will rise from isolation and/or mis-steps.

If you're worried about trauma and outcomes induced by covid panic (including by our well-meaning healthcare and public health responses), please join this webinar FRIDAY 3/20 at 10am PACIFIC.

Hosted by Mahmee, a maternal-infant health care coordination platform committed to equity, we will discuss how to make adjustments to clinical workflows and triage prenatal and postpartum concerns. Best practices will be offered for identifying patients who should continue receiving in-clinic and in-home appointments vs. those who can and should have care managed virtually.

Mahmee was designed to help diverse practitioners collaborate and deliver comprehensive, women-centered virtual care. The session will include a brief walk-through of Mahmee's tools, including telehealth visits and support groups, charting and screening, secure messaging and file sharing, closed-loop referrals, and effective flagging of high-risk patients for care team escalation.  

This weekend Mahmee's leadership and I decided to make it free for all professionals and moms during this crisis. Telehealth shouldn't just be made available to those whose insurers or health systems can afford it!

Working together we can reduce the trauma burden of covid-19 and prevent an otherwise inevitable cascade into ACEs. I hope you'll join us tomorrow to discuss how we can get it done.

Hope to see you there! 

Jonathan Goldfinger, MD, MPH, FAAP

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I would like to see infant mental health folks comment on this because what you are proposing is very serious and can have serious lifelong  adverse consequences. How about any of the Pediatric Doctors out of Ed Tronick’s UMass program?   How about anyone from that program or similar programs comment here? What would Dr. Brazelton think? 

There is so much you can do face to face with the mother and baby that you just cannot do on a screen because it is the actual feeling of presence and connection in context of safety that communicates information.  The concept of Epistemic Trust is valid here. Humans communicate information to other humans in connection and you cannot connect on a screen or develop Trust from a screen with this artificial distance that communicates mistrust.  I’m very worried that stuff like this is terribly disrespectful to human developmental biology and I would like to know what the Infant Mental Health experts think and have to say.  

When you are alone and present with mom and baby, You can point out infant communication cues, work with the mom on the dyad.  That is really important.  Isolated moms and babies do terribly.

Everything I have heard Dr. Perry say is connection, connection, connection. Connection heals Us, so please let’s think about this before we rush to take it away. 

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