Maryland nurses are using AI to monitor contractions and fetal heart rates — sometimes from miles away

People giving birth within Maryland’s major hospital system are now receiving an extra layer of care during labor and delivery, but remotely from a building in Linthicum. 

That’s the home of NEST, a system staffed by 16 nurses who monitor in real-time every labor at all seven hospitals of the University of Maryland Medical System (UMMS) — about 9,000 births each year. 

UMMS launched the fetal monitoring center — the name stands for Neonatal Outcomes Impacted by Escalation Safety Telemetry — in May of 2024. With the assistance of an AI software program developed by North Carolina company Perigen, the nurses can watch for heartbeat and contraction trends during the birthing process, and raise flags if needed. 

The monitoring team at the center in Anne Arundel County is led by nurse manager Cristina Haas, who brings 10 years of experience as a traditional labor and delivery nurse.

“We always laugh in the NEST about how nobody really went to nursing school to be a remote labor and delivery nurse,” Haas said, “but it’s such a really groundbreaking and impressive initiative.”

As of last July, she and her staff remotely oversee births at all UMMS locations, including the downtown campus in Baltimore, the University of Maryland Capital Region Health in Largo and the medical centers in LaPlata and Glen Burnie.

The nurses at NEST work with the bedside teams at the hospitals to flag trends, and colors will appear on the computer screens at the center. It’ll indicate specific issues so healthcare teams can act faster, per Haas. 

From there, communication to bedside staff varies depending on the labor and delivery unit, and Haas said she’s avoiding changing those styles to make the process as easy as it can be for the healthcare providers. Mostly, it’s either alerting nurses by phone or through a secure messaging system, per Haas, but she prefers phone communication so alerts don’t get lost.

She’s found that often the nurses at NEST are faster at catching trends or abnormalities than the AI. The tech is an assistant, but still very useful, Haas said. 

For example, when monitoring fetal heart rates, sometimes it’s needed to evaluate down to a single beat. It’s helpful to have an aid to do that, she explained. 

“This program is fundamentally the nurses’ brains with the AI counterpart, just really sort of being a reinforcement and a help for them,” Haas said.

Using tech in healthcare is a ‘delicate balance’

Aza Nedhari, a certified midwife and cofounder and executive director at DC maternal health organization Mamatoto Village, stressed that tech in healthcare should be an extra layer of support — not a replacement for care. 

However, she added, it shouldn’t be overutilized, because that could result in unnecessary medical interventions. The continuous monitoring at NEST for every patient may not be effective because of this reason, she said. 

“It is that delicate balance of balancing the utilization of technology with clinical judgment,” Nedhari told Technical.ly. “And ensuring that every person receives personalized care that respects their individual needs and their preferences.”

Haas, the nurse manager at NEST, said the program is a new standard of care for every birth across the system, and was not something pregnant people could opt out of. However, a patient or family does have “the ability to decline a care intervention,” clarified Tiffani Washington, the director of media relations at the University of Maryland Medical Center.

But NEST can be a helpful tool for early interventions and for patients with at-risk pregnancies, Nedhari said. In more rural areas or places with less maternal health infrastructure, it’ll be a tool for providers to close some gaps in care. High-risk specialists are not at every hospital, she noted. 

It can also make the patient feel more comfortable to have that extra support. At the same time, the tech can only do so much in addressing maternal and infant mortality rates in the US, per Nedhari, which is significantly higher for Black women across the US and in Maryland.  

“No amount of monitoring is going to help solve that problem, because you have a human that’s making a decision to ignore somebody’s call for help,” she said. “Technology is only giving you information. It is not a predictor of the quality of care that that person is going to receive.”

Haas likened the program to a “blinded study” because the nurses do not see the patients or their personal information, and only click onto their files if they flag a trend in the fetal heart rate or contractions. The center is also working with the health equity department at UMMS for this program, she said. 

This tech could also be helpful outside of hospitals for pregnant people who want to labor at home for longer before going into a hospital, Nedhari noted. UMMS does not currently offer this tech to be used from people’s homes, per Haas. 

Haas said she hopes this program can be expanded to other hospitals eventually, but she’s still focused on perfecting it at UMMS. 

“I’m just enthusiastic about the program and what it’s doing,” Haas said, “but you have to walk before you can run.”