Telehealth use in maternity care during a pandemic: A lot of bad, some good and possibility

Emma Collins; Hazel Keedle; Melanie Jackson; Belinda Lequertier; Virginia Schmied; Jacqueline Boyle; Sue Kildea; Hannah Grace Dahlen

doi:10.1016/j.wombi.2023.12.008

Telehealth use in maternity care during a pandemic: A lot of bad, some good and possibility

Women Birth. 2024 Mar;37(2):419-427. doi: 10.1016/j.wombi.2023.12.008. Epub 2024 Jan 12.

Authors

Emma Collins¹, Hazel Keedle¹, Melanie Jackson¹, Belinda Lequertier², Virginia Schmied¹, Jacqueline Boyle³, Sue Kildea⁴, Hannah Grace Dahlen⁵

Affiliations

¹ School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751 NSW Australia.
² Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Level 11, East Tower, 410 Ann Street, Brisbane, Qld 4000, Australia.
³ Monash Centre of Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, VIC 3168, Australia.
⁴ Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queensland, Australia.
⁵ School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751 NSW Australia. Electronic address: h.dahlen@westernsydney.edu.au.

PMID: 38218652
DOI: 10.1016/j.wombi.2023.12.008

Abstract

Background: To reduce transmission risk during the COVID-19 pandemic, 'telehealth' (health care delivered via telephone/video-conferencing) was implemented into Australian maternity services. Whilst some reports on telehealth implementation ensued, there was scant evidence on women and midwives' perspectives regarding telehealth use.

Methods: A qualitative study was conducted in Australia during 2020-2021 using two data sources from the Birth in the Time of COVID-19 (BITTOC) study: i) interviews and ii) surveys (open-text responses). Content analysis was utilised to analyse the data and explore telehealth from the perspective of midwives and women accessing maternity care services. In-depth interviews were conducted with 20 women and 16 midwives. Survey responses were provided from 687 midwives and 2525 women who were pregnant or gave birth in 2021, generating 212 and 812 comments respectively.

Findings: Telehealth delivery was variable nationally and undertaken primarily by telephone/videoconferencing. Perceived benefits included: reduced COVID-19 transmission risk, increased flexibility, convenience and cost efficiency. However, women described inadequate assessment, and negative impacts on communication and rapport development. Midwives had similar concerns and also reported technological challenges.

Conclusion: During the COVID-19 pandemic, telehealth offered flexibility, convenience and cost efficiency whilst reducing COVID-19 transmission, yet benefits came at a cost. Telehealth may particularly suit women in rural and remote areas, however, it also has the potential to further reduce equitable, and appropriate care delivery for those at greatest risk of poor outcomes. Telehealth may play an adjunct role in post-pandemic maternity services, but is not a suitable replacement to traditional face-to-face maternity care.

Keywords: Australian maternity services; COVID-19; Delivery of health care; Pandemic response; Pregnant women; Telehealth.

MeSH terms

Australia / epidemiology
COVID-19* / epidemiology
COVID-19* / prevention & control
Female
Humans
Maternal Health Services*
Pandemics / prevention & control
Pregnancy
Telemedicine*