It seems like one thing from a science fiction novel, however Alabama officers’ plan to make use of robots to enhance look after rural pregnant ladies and their infants is actual.
Throughout a January White Home roundtable touting the primary grants to states below a brand new $50 billion rural well being fund, Facilities for Medicare & Medicaid Companies Administrator Mehmet Oz referred to as the thought “pretty cool.” Later that day, Sen. Bernie Sanders, the impartial from Vermont, mentioned it’s decidedly not cool. And obstetricians and others chimed in on social media to specific alarm, with one political activist calling it a “dystopian horror story.”
The disparate responses spotlight how pleasure over the tech-heavy concepts states pitched of their functions for the federal Rural Well being Transformation Program conflicts with the truth that there merely aren’t sufficient well being employees to serve sufferers in lots of rural communities. Now, as states put together to spend their first-year awards, stress is mounting, and nowhere is that pressure extra seen than in Alabama.
Oz has lauded the state’s proposal to put money into the comparatively new expertise of robotic ultrasounds.
“Alabama has no OB-GYNs in many of their counties,” Oz mentioned, sitting with President Donald Trump and Cupboard members. The dearth of care, he mentioned, prompted the proposal to make use of robots for ultrasounds on pregnant ladies.
Britta Cedergren directs the Alabama Perinatal High quality Collaborative and has a agency grip on actuality: “No one is using autonomous robots.”
Whereas robotic ultrasounds are a “really neat technology,” she mentioned, they don’t seem to be but getting used within the state. As a substitute, clinicians offering obstetric care lean on cellphone consultations and — when tools and web can be found — telehealth.
The aim, she mentioned, is to “support places where there is no care.”
Cedergren is a part of a number of state maternal and fetal well being teams and works each day with medical doctors, hospitals, and first responders. Whereas enhanced expertise is important for affected person care, it’s not a alternative for a well-trained workforce and a coordinated care and knowledge system, she mentioned.
In 2024, the latest yr for which knowledge is on the market, Alabama’s toddler mortality fee was 7.1 deaths per 1,000 dwell births. The nationwide fee was 5.5 per 1,000 dwell births, in line with provisional knowledge launched by the Facilities for Illness Management and Prevention.
Hospital-based obstetric unit closures, which frequently result in a lack of well being care suppliers who can look after expectant moms and their infants, are a long-standing, ongoing pattern in rural America. However Alabama’s lack of providers has been significantly profound.
In 1980, 45 of the state’s 55 rural counties had hospital-based obstetric providers. By 2025, solely 15 supplied such care, in line with state knowledge. And the losses aren’t slowing. 5 hospital obstetric models closed in 2023 and 2024, together with in three rural counties: Monroe, Marengo, and Clarke.
Katy Backes Kozhimannil, a professor on the College of Minnesota Faculty of Public Well being, discovered that closures in distant areas result in a rise in preterm births, a number one explanation for toddler mortality.
“People will be pregnant and give birth in communities all over the place,” she mentioned. “You have to be able to get to a place where you can be cared for.”
Almost all 50 states’ functions for the Rural Well being Transformation Program declared workforce shortages and maternal well being wants as priorities, however solely Alabama proposed utilizing robots to fill the hole. The agricultural fund, which Congress created as a last-minute sweetener in Trump’s One Huge Lovely Invoice Act final summer season, inspired states to be artistic, be revolutionary, and pitch tech options.
Alabama was awarded $203 million for the primary of this system’s 5 years. Amongst practically a dozen rural well being initiatives, the state’s software included bolstering its rural workforce in addition to bettering maternal and fetal well being.
Mike Presley, a spokesperson for the Alabama Division of Financial and Neighborhood Affairs, which is overseeing the plan, mentioned nobody was obtainable for an interview about telerobotic ultrasounds.
LoRissia Autery, an obstetrics and gynecology specialist in rural Alabama northwest of Birmingham, mentioned the robots received’t lower maternal and toddler mortality. There are nuances, she mentioned, to doing ultrasounds.
A lot of her sufferers have high-risk pregnancies with diabetes, hypertension, and hepatitis C, she mentioned. She mentioned she worries in regards to the type of care that might be given to her sufferers, a lot of whom drive an hour or extra to get to her, if robots are used as an alternative of a skilled specialist.
“It takes away just the care that we need to have for women,” mentioned Autery, who co-founded Walker Ladies’s Specialists. The clinic contains three medical doctors, attracts sufferers from 5 counties, and will use a further doctor to satisfy the demand, Autery mentioned.
“Probably for the past six or seven years, we’ve been putting out feelers trying to find a fourth partner,” Autery mentioned. “It’s difficult for a variety of reasons.”
In his social media remarks to Oz, Vermont’s Sanders referred to as the shortage of rural well being care suppliers within the U.S. an “international embarrassment.”
“In the richest country on earth, we need more doctors, nurses, dentists and mental health counselors, not more robots,” Sanders wrote on the social platform X.
A minimum of one nation is utilizing robots paired with skilled employees to lower deaths.
Within the distant Canadian village of La Loche, Julie Fontaine operates an ultrasound robotic at a clinic with two on-site nurse practitioners and rotating medical doctors. She mentioned sufferers just like the robotic as a result of it saves them the time and expense of touring to a much bigger regional well being care facility six to seven hours away.
“When people come in, they’re like, ‘Wow, like, technology these days,’” mentioned Fontaine, a member of the Métis individuals in northern Saskatchewan. “It’s something they’ve never seen before or even used.”
When working with sufferers, Fontaine connects the robotic ultrasound machine to a tele-sonographer at a management station in Saskatoon. The sonographer then remotely operates a robotic arm on the machine. A radiologist, who may be wherever, reads the scan’s report and sends it again to the household physician in La Loche, mentioned Ivar Mendez, a neurosurgeon and the director of Canada’s Digital Well being Hub. Most infants in Canada, he mentioned, are delivered by household medical doctors or midwives, not specialists.
“The most important thing is the identification of a high-risk pregnancy early enough so you can intervene,” mentioned Mendez, who added that the robotic ultrasound is “as good as the in-person ultrasound” however can’t be used when a affected person wants a extra invasive vaginal ultrasound. The mortality fee for moms and newborns within the north, website of the La Loche clinic, is 20 to 25 occasions better than in the remainder of the nation, he mentioned.
“One of the reasons is that there’s no availability of prenatal ultrasonography in those communities, so pregnant women have to travel to cities and they’re put up at hotels,” he mentioned.
In a 2022 paper, Mendez and his group on the College of Saskatchewan examined 87 telerobotic ultrasounds and located that 70% of the time, the robotic ultrasound made journey for care pointless. Almost all of the sufferers mentioned they might use the robotic once more.
The identical robotic ultrasound expertise was authorised in 2017 to be used within the U.S.
Nicolas Lefebvre, chairman and chief government of the robotic’s creator and producer, AdEchoTech, mentioned the corporate has “U.S. maternity-specific projects that are currently under preparation.” The typical value of a robotic might be $250,000 to $350,000, in line with AdEchoTech’s U.S.-based enterprise growth guide.
Utilizing robotic ultrasounds is one a part of Alabama’s proposed maternal and fetal well being initiative, in line with the state’s software. Acknowledging lack of hospital obstetric models, officers mentioned they deliberate to attach smaller rural suppliers and well being care amenities that lack “high-quality maternal and fetal health services” to regional care hubs that may present the providers digitally, together with by telerobotic ultrasound.
For his or her workforce initiative, state officers proposed coaching packages for medical doctors, emergency providers, and nurse-midwives.
The estimated required funding for the maternal and fetal well being initiative is $24 million over 5 years. Alabama officers proposed $309.75 million for his or her workforce initiative over 5 years.
