The COVID-19 pandemic has provided opportunities to explore telehealth out of pure necessity. And while sceptics believed it would lead to medical mishaps and misdiagnosis, the opposite is proving true – at least in maternity care. 

Undoubtedly, antenatal care presented a unique challenge during the pandemic, with most appointments usually occurring face-to-face in a hospital setting. However, a recent trial shows the level of care via telehealth is as good as in-person consultations for diagnosing common complications.

The trial, a collaboration between Monash University and Monash Health, delivered an integrated antenatal care program via telehealth and successfully reduced face-to-face consultations by 50 per cent.

The results showed that despite the telehealth delivery, detection and management of common pregnancy complications, including pre-eclampsia, foetal growth restriction, and gestational diabetes, was unaffected when compared with conventionally delivered antenatal care.

The telehealth consultations, developed by obstetric, midwifery and general practitioners, were supplemented with a suite of patient and staff information sheets and systems to support remote blood pressure checks and foetal growth assessments.

The study's author Dr Kirsten Palmer, Monash University School of Clinical Sciences and Monash Health, says care needed to be delivered via telehealth to protect pregnant women from potential exposure to the virus.

"We recognised that a key limitation of telehealth was the inability to do physical examinations, which are essential in antenatal care, but we were able to implement low-cost measures to support these assessments in the home.

"We have shown that such an approach seems to be safe for continuing to achieve a high standard of pregnancy care."

Associate Professor Ryan Hodges, Program Director of the Women's and Newborn Program and Director of Obstetric Services at Monash Health, says while provided out of necessity, the programme might offer many benefits to the future delivery of antenatal care.

"We are hoping to continue it as part of our antenatal care program as it supports women to receive more personalised care with the same excellent outcomes," says Professor Hodges.

Liz Wilkes, Managing Director of My Midwives, says while telehealth for antenatal care did have its critics, there's no doubt it can match and even improve care in many circumstances.

"Telehealth has been criticised for not being as personal and a poor cousin when replacing antenatal care.  But with the right strategies, many women can get as much, if not more, from their telehealth consultations."

Ms Wilkes points to many benefits of telehealth but being comfortable at home instead of waiting in a clinical or hospital setting is top of the list. 

"You are the expert on you, your body and what is happening in your pregnancy and may feel more able to assert your views when not in the same room as the care provider."

Tips on successful antenatal telehealth consults

So, how do care providers deliver successful telehealth antenatal appointments? And what's the secret to getting the most out of a telehealth consult? We interviewed three health care providers to find out.

Liz Wilkes, Managing Director of My Midwives

Care providers

• Makes sure you have all the information at hand and use the first few minutes of the consultation to summarise the situation for the woman.  It is important not to waste time going over elements you should already know.
• Use video links where possible rather than the phone.  The image provides a lot of information about the wellbeing of the woman.  It also generally provides an insight into how she is coping with the pregnancy.
• Allow sufficient time within the consultation and time between consultations for note-taking and review of information.  Telehealth means that you have to ensure that the woman feels heard and cared for differently.
• Do not substitute telehealth for all care.  It is important that at several key times along the antenatal journey, the woman and her partner have face-to-face contact with their care provider to ensure elements of physical wellbeing are checked.

Pregnant woman

• Make sure you have a written list…to give you prompts as to what you need to cover in the appointment.
• Try to use a visual communication tool with a video link like Microsoft teams, Zoom or Skype, not just a phone.  The visual allows you to show the care provider anything physical that they may need to examine.
• Telehealth works best with care providers you know.  Midwifery group practice, private midwives, GP's and obstetricians all will offer some form of continuity of care - even in the public health sector - so ask what is available locally.
• Treat telehealth the same as you would treat a face-to-face consultation, so ensure you have privacy, time and space.
• Make sure your care provider knows if you are worried and need a face-to-face consultation.  Telehealth does not replace all antenatal contact.

Hannah Willsmore – Registered Midwife

Care provider 

• Ensure you have a fast and reliable internet connection. I recommend trying a video call with a friend/family member to ensure no delays. This is important as it can be difficult to build rapport if the video/sound is delayed or cutting in and out.
• Look at the camera, not at your video! When looking at your own video, it appears to your client that you are looking off to the side, which can feel a little uncomfortable.
• Make sure the room is well lit - natural light is ideal, but even just ensuring the lights are on as bright as possible helps.
• Make sure you position yourself facing a light source, not with a window behind you.
• Familiarise yourself with the telehealth software you will be using - this helps you to be able to troubleshoot any issues and leads to increased client confidence with telehealth.
• Use headphones and a microphone for clear sound, especially if your environment is noisy.

Pregnant woman

• Treat it like an in-person appointment - block out work and other distractions so that you can focus on your appointment with your midwife or doctor.
• Use your computer or prop up your phone so that you don't have to hold it the whole time.
• If you get distracted by your own video, you can minimise this so you can't see yourself, but your care provider can.
• Have a pen and paper handy to jot down any notes - in a face-to-face consult, your provider may write down recommendations, so over telehealth, you will need to write these down yourself.
• Know that telehealth absolutely works, and you can still get all of your questions answered!

Claire Dunkley – Clinical Nurse Consultant

Care provider

• Invest in a clinic CRM software that has a telehealth video-conferencing facility inbuilt that utilises a secure and trusted platform.
• Conduct the video appointment from a computer (laptop or desktop) that has an inbuilt camera. A hot tip is to ensure the camera is at eye level when seated.
• Ensure the background space is tidy with room to stand up and demonstrate any physical activity you want the mother to do.
• For audio, invest in a microphone that can cover a greater sound area as having the mum hear you clearly, is very important. Recommend a lapel microphone with an extra-long cable to enable the physical demonstrations to be metres away from the computer jack. A hot tip would be to go wireless; however, be conscious of battery life considerations.
• Have pre-recorded videos of exercises that you would like the mother to do so that you can share that with them for them to watch over and over.

Bonus Tip to always look your best ... invest in a lighting setup so that the patient can clearly see what you are trying to demonstrate. An LED ring light on a stand is a great addition and can be picked up from as little as $35 from Kmart!

Pregnant woman

• Ensure you have a computer (laptop or desktop) with an inbuilt camera to attend the video appointment. This is vital to standing up and showing your health practitioner anything that is going on for you OR to obtain feedback on whether you are doing the requested physical activities correctly.
• Wear clothing that is easy to display your body to the health practitioner.
• If at all possible, have a friend or family member with you to assist with looking after any other kids and help you do any tummy measurements or other activities as required.