The Sunnyvale Sun
Cover Story
Photograph by Kevin White
Five-month-old Arush Das is alert and healthy. His mother, Priya Das, was monitored closely by her Kaiser Permanente nurse because Das developed several pregnancy-related complications.
Healthy Babies
Perinatal program at Kaiser couples RNs with at-risk moms-to-be
By MICHELLE MAGHRIBI
Can a weekly telephone call become a literal lifeline? Sunnyvale resident Priya Das 33, and her 5-month-old son, Arush Das, are proof it can.
Diagnosed by a Kaiser Permanente doctor as having gestational diabetes during her pregnancy, Das was offered a solution that included weekly telephone monitoring by professional nurses.
Das was monitored by registered dietitian Elaine Cheung Lee, who has been part of Kaiser's Regional Perinatal Monitoring Center for the past two years.
"The onset of the diabetes was discovered the 20th week of my pregnancy," Das said. "I was so nervous. It was my first pregnancy, and Elaine helped me through the process, telling me the condition was common."
The Kaiser Regional Perinatal Service Center in Cupertino is a doctor-ordered service. It offers monitoring and support to Kaiser's high-risk obstetrical patients such as Das, whose diagnoses include diabetes, high blood pressure and incompetent cervix. Each condition could end up in preterm labor and/or birth if not monitored closely.
The center utilizes technology and the telephone to help patients with support, education and direct communication. Translation services are provided by Kaiser through AT&T for those who speak languages other than English.
Program nurse manager Jenny Ching has been with the program since its inception 15 years ago. She said no other health plan has such a service.
"Our goal at the perinatal center is to empower the patient to take care of themselves and educate them on symptoms and signs of preterm labor and birth," Ching said. "Many patients are able to control their diabetes and high blood pressure without medication through diet and careful monitoring."
Das said the diabetic diet and the food pyramid was difficult and presented her with an extra challenge because she eats primarily Asian Indian food.
"My everyday life was so different from the food pyramid, and Elaine seemed to know a lot about Asian Indian food," Das said. "I used the first couple of weeks to experiment. Elaine would give me feedback on research I'd done, and by the fourth week I seemed to have gotten it down right."
Das said her nurse would spend whatever time it took to help with the process.
"Every meal was planned two hours in advance, and sometimes I would spend up to 20 minutes on the phone with her, and sometimes I would say, 'Elaine, I can't do this,' " Das said. "Because the service called every week, it was extremely supportive. Elaine would spend the time--whatever it took to help me."
Lee said that calls with patients can range anywhere from 15 minutes to one hour.
Lee said that as a patient, Das was always "on the ball."
"I remember Priya had a wonderful personality, and I felt she was excited about and expected my call," Lee said. "We spoke for about half of her pregnancy, and her proactive nature was wonderful. We spoke about other subjects as well, and she became a friend."
Lee said part of her training as a dietitian is to become familiar with many different ethnic foods. She has tried the diabetic diet and knows firsthand how hard it can be; she tailors her counseling to fit her patient.
"While Priya was a proactive patient, some are more hands-off, and some I help right on the spot while they are in the grocery store or at home reading the nutrition labels to me," Lee said.
According to Ching, the service operates around the clock with two shifts of six nurses from the hours of 7 a.m to 11:30 p.m., with one nurse on call in the late evening/early morning shift. Nurses wear headsets while they talk to patients and are able to view a patient's medical information on the computer.
Patients are first educated and trained on how to operate technical equipment needed for monitoring of blood sugar levels and, depending on the condition, readings are monitored carefully by a nurse on a weekly or daily basis.
Das said while she wasn't a dessert person, her diet did include a lot of rice.
"When I had my initial meeting with the nutritionist, they showed me what one cup looked like--it is very small. I could feel the blood draining from my face," Das said. "For me one-third cup of rice was a complete lifestyle change."
Das said having a weekly phone call to monitor her blood glucose levels really made her careful about what she ate.
She confessed the program, while being supportive, also put the "fear of God in her."
"I was worried about the baby and if I couldn't eat right, what was my baby getting?" Das said.
Das' father is diabetic. When her parents came to visit during her eighth month, they were surprised at her discipline.
She said watching their diets together became a healthy father-daughter bonding experience.
"My parents asked me, 'Why are you watching so closely?'" Das said. "I told them, 'You don't know, they are going to call me, and I don't want to read them values that aren't kosher.'"
She added, "whatever you think is healthy is usually not."
Although Das felt the gestational diabetes was difficult, she also says having the support of her health care provider made all the difference in the world.
Das delivered a healthy 7-pound, 4-ounce boy in January.
"I was depressed when I found out about the gestational diabetes, but the whole experience turned out to be so positive," Das said. "They hold your hand so well. While, at the beginning, I felt like I didn't want to do this again--I think it's doable."
About Kaiser's Regional Perinatal Service Center
The program is doctor-ordered for those Kaiser obstetrical patients who are considered high risk for preterm labor and/or birth. The center was founded in 1991 by Dr. Donald Dyson and was based on his 51/2 year study geared at finding the best way to care for at-risk mothers. According to Kaiser representative Karl Sonkin, the center was probably the first tele-medical program in Northern California. At its inception, more than 15 years ago, the center monitored approximately 20 patients. Today it is estimated the center services an average of 900 at-risk moms in Northern California. Regional coverage for the center extends as far south as Fresno and as far north as Santa Rosa. According to Sonkin, the perinatal service boasts a 94 percent patient satisfaction rating and reports indicate the rate of preterm births for Kaiser Permanente Northern California remains very low at 2.8 percent to 2.9 percent. Currently conditions that are monitored by the center include diabetes developed during pregnancy (gestational diabetes), high blood pressure, and a condition called incompetent cervix where a mom-to-be has problems carrying the child due to a weak or short cervix.
