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Doctors propose telehealth solutions to reduce emergency maternal flights to Oʻahu

Honolulu EMS

Retired OB-GYN Dr. John Uohara coordinated the first maternal transport of a high-risk pregnancy from Hilo to Honolulu in 1979 on a single-engine plane.

His friend, also a doctor, needed to keep up his hours for his pilot's license.

"He flew the airplane and I was in the back tending to the woman," Uohara said earlier this month. "We transported her successfully to Kapiʻolani with ambulance waiting."

This was also the first time Uohara rode in an ambulance.

As a resident, he learned of this transportation method at a conference in California, which utilized helicopters and ambulances to transport pregnant patients to major hospitals rather than delivering a preterm infant.

"They showed a clear statistical benefit to transporting mothers, and using that mother as an incubator," Uohara explained.

While there have been many medical advancements since, the same premise is still used today throughout the state.

An average of 125 acute pregnancy patients are transported to Oʻahu by Hawaiʻi Life Flight, according to state health department data from 2018 to 2023. About half are from Hawaiʻi Island.

This travel can be tough on neighbor island families, Sonya Niess, president of the Pacific Birth Collective's Board of Directors, said. The strain isn't just pre-birth, but postpartum, too.

Oftentimes, Niess said, a baby will be flown to Honolulu for care, but since a mother had just given birth, she can't travel, too.

"The mom has to stay on Maui, she's not allowed to fly with her baby because she just gave birth, right?" Niess said. "And if she had a cesarean, she has to stay for two days."

Sometimes, the first option for a family to join a newborn will be by taking a commercial flight.

"Meanwhile, (the mother is) still trying to breastfeed or pumping to get her milk supply going, but mom and baby have been separated now for anywhere from 24 hours to two days," Niess said.

Dr. Men-Jean Lee, a maternal fetal medicine physician at Kapiʻolani Medical Center for Women & Children on Oʻahu, leads the state’s efforts to expand maternal telehealth. The top three issues with getting prenatal and maternal care in Hawaiʻi are transportation, child care and accessing specialty care on the neighbor islands.

Lee said the first step is seeing a primary care physician as soon as possible, and working with them to identify complications early on so that instead of a rushed transport to Oʻahu, pre-planning can take place.

"We've come up with the concept that we want to keep women that have pregnancy issues or unusual complications of pregnancy and be able to decide which patients really need to come over for this super high risk care, and those that are nice and healthy and can stay closer to home and deliver with their families posed by at their local hospital," Lee said.

Telehealth coordination throughout the state is key to that, but even more important is meeting people where they are.

Some programs to increase accessibility include increasing broadband access on Department of Hawaiian Home Lands lots, and working with local libraries to set up private and protected rooms patients can use for telehealth calls.

"The librarians have agreed to work with us in providing protected spaces where patients can come in and do telehealth appointments with their providers whether or not it's locally on their island, or if it's to Honolulu with a sub-specialist in a safe space with equipment that has telehealth and broadband access," Lee said.

Sabrina Bodon was Hawaiʻi Public Radio's government reporter.
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