Julia Perry*, a 30-year-old woman with a history of three early miscarriages, is 5 weeks pregnant and seeing a fertility specialist for a first transvaginal ultrasound. A nurse practitioner performs the ultrasound and Ms. Perry’s patient care navigator attends.

Ms. Perry, who’s nervous, focuses on the words, “Everything looks normal.” A few hours after returning home, she receives a text from her patient care navigator stating that they can’t find the pregnancy, followed by three consecutive texts with educational templates about ectopic pregnancies. Given the positive comment during the ultrasound, Ms. Perry assumes the text is a mistake and meant for someone else.

She texts back asking if she can speak with the navigator on the phone, but the navigator tells her she can’t talk and sends more information about ectopic pregnancy to Ms. Perry’s patient portal with a note saying, “Keep positive thoughts for your appointment next week” accompanied by heart and crossed fingers emojis.

In addition to worrying that she’ll lose this current pregnancy, Mr. Perry also is concerned about her own health. She’s left with only generic templates of information until next week’s ultrasound.

Communication with healthcare providers and mothers

Pregnancy is a unique time in a woman’s life with emotional ups and downs due to factors such as uncertainty, excitement, hormones, and lifestyle changes. The pregnant woman’s mental health is important not only for herself but also for the baby and its future development. Communication between expectant mothers and healthcare providers can negatively or positively shape the mother’s mental health and the pregnancy.

Stress effects on baby

The mother’s mental state is linked to the baby’s psychological functioning after birth and during initial development. Exposure to maternal anxiety during pregnancy puts children at a greater risk for anxiety disorders, attention deficit hyperactivity disorder, autism, schizophrenia, behavioral problems, and depression. These outcomes stem from increased cortisol, changes in gene expression, and alternations in the mother’s behaviors.

Avoiding unclear communication can help decrease stress. Healthcare providers require emotional intelligence to support the pregnant woman using clear communication.

Patient-centered communication

The American College of Obstetrics and Gynecologists recognizes the importance of patient-centered communication that’s based on the patient’s values and needs. Patient-centered communication has been shown to help with pregnancy outcomes and patient satisfaction by considering the social and emotional dynamics of pregnancy. It’s about prioritizing human connections.

When Delaney and Singleton interviewed pregnant women, they found common beneficial themes. They included a holistic approach from the healthcare provider, consideration of the woman as a whole person and not just a body, and personalized communication with the expectant mother.

In Ms. Perry’s case, the patient care navigator didn’t follow these holistic standards. They didn’t provide emotional support and they induced stress, which caused Ms. Perry to feel isolated. Empathy and human connection were missing as a result of impersonal text messages and unprofessional use of emojis.

Appropriateness of text messages

If used correctly in a patient-centered way, text message communication can prove beneficial. When they’re individualized, build rapport, and provide a sense of humanity, the patient feels valued, respected, and cared for. Text messages offer a quick way to communicate, but the healthcare provider should carefully edit them and know when a phone call or in-person communication is more suitable. Using a text message to tell Ms. Perry about a potential ectopic pregnancy was inappropriate, especially when the patient care navigator refused to call after the patient asked.

Better communication better outcome for mother and baby

Healthcare providers are responsible for communicating effectively with expectant mothers and to use patient-centered communication—whether in person, over the phone, or via text. The use of text messaging has its benefits, but providers should use caution and understand the implications of sending a text, especially when delivering bad news. Women shouldn’t feel alone, confused, or scared because of lack of communication by the healthcare provider, such as in Ms. Perry’s case. The goal is to decrease anxiety—for the mother and the unborn child.

*Name is fictitious.

Natalie Koval, BSN, RN, is a Clinical Development Instructor and Trainer at Western Reserve Hospital in Cuyahoga Falls, OH. She would like to acknowledge Marcy Caplin and Tina Saunders in reviewing and revising this manuscript. Their guidance and support have been felt when creating this manuscript. 

References

Delaney AL, Singleton G. Information and relationship functions of communication between pregnant women and their health care providers. Comm Stud., 2020;71(5):800-22. doi:10.1080/10510974.2020.1807376

Strohbach A, Hu F, Martinez NG, Yee LM. Evaluating the use of text message communication in a postpartum patient navigation program for publicly insured women. Patient Educ Couns. 2018;102(4):753-59. doi:10.1016/j.pec.2018.10.028

van den Heuvel MI. From the womb into the world: Protecting the fetal brain from maternal stress during pregnancy. Policy Insights Behav Brain Sci. 2022;9(1):96-103. doi:10.1177/23727322211068024