A typical ob-gyn visit might fall somewhere between merely uncomfortable and absurd — the stirrups, the speculum, the scooching forward with your paper gown open in the front. If you’re getting a routine pelvic exam or you’re due for a Pap smear, there’s just no way to avoid these indignities. But they don’t need to be part of every ob-gyn appointment. In fact, a lot of gynecological and obstetric care can be accomplished through video visits.
“This is not replacing in-person care but augmenting it,” says Dr. Nathaniel DeNicola, an ob-gyn and chair of telehealth at the American College of Obstetrics and Gynecology. “It’s a way for doctors and patients to connect between visits or when in-office care isn’t possible. And many kinds of traditional gynecologic care lend itself to this.”
Services that can be done virtually include adjusting and refilling prescriptions, following up on existing issues, going over birth control options, managing PMS, talking about vaginal discharge or itching, reviewing lab results and discussing menopause. These types of visits are typically talk-heavy and may not include any type of physical exam. It’s very easy to conduct a thorough history-taking and counseling session over video, DeNicola says, and also to discuss any changes in medication.
Obstetrics can be harder to do remotely; during prenatal checkups, the doctor needs to check the fetal heart rate, the baby’s growth and the mother’s blood pressure. But unless any labs are needed, the doctor spends the rest of the visit asking the mother questions — about issues such as sleep and mental health, whether she’s had abdominal cramping or noticed fetal movement — and answering any questions she has. So, DeNicola says, “during this time [with COVID-19], some alterations of prenatal care have been made.” For example, some ob-gyns are encouraging patients to purchase fetal heart rate monitors, which may allow for less frequent in-person care. If a patient has a scale, a blood pressure cuff and a way to take her pulse, she can share these vitals over a video checkup too.
Once a woman gives birth, a doctor may also do some postnatal video visits, including ones focused on postoperative care. For example, a patient who delivered via C-section could take photos of her scar, or just show it to her doctor onscreen during her visit, to make sure she’s healing properly. A doctor may also ask a postpartum patient if she’s experiencing pain at the surgical site, changes in body temperature or vaginal discharge, adds Dr. Mary Jane Minkin, an ob-gyn and clinical professor at the Yale University School of Medicine.
Screening for postpartum depression can also take place virtually. “Typically we use a questionnaire with a scale,” explains Dr. Tamika Cross, an ob-gyn at Memorial Hermann Health System in Pearland, Texas. The doctor can ask these questions during a video visit or even a phone call, and use the results to determine if a patient needs further follow-up treatment, which a therapist can also provide remotely.