Will Telehealth Be a Part of Your Next Pregnancy?

The COVID-19 pandemic introduced us to telehealth, whether we were ready for it or not. It may be up for debate whether the pandemic is over, but people can agree that telehealth is here to stay. Telehealth may be coming soon to your ob-gyn or midwives’ practice. Why not learn more about how telehealth is changing OB care for the better? The Pulse has tips and suggestions to get the most out of your next telehealth OB visit.

Telehealth (also called virtual care) uses telecommunication technologies to support long-distance clinical health care. For example, you can meet with a healthcare provider via video or telephone in real-time or asynchronously via email or text communication. With asynchronous telehealth, data, images, or messages are recorded and shared with your healthcare provider later.

Telehealth can use a telephone, smartphone, or computer. It does not have to be via video, although some health insurance companies will only pay providers for telehealth visits if they happen via video.

A range of providers now use telemedicine as part of pregnancy care. In addition, many obstetrical and midwifery practices offer a hybrid model of prenatal care that combines some telehealth prenatal visits with in-person visits. Other types of pregnancy care provided via telehealth could include:

  • Home monitoring (if you have gestational diabetes, high blood pressure, or preterm labor, for example).
  • Consultation with remote specialists, including maternal-fetal medicine doctors.
  • Genetic counseling.
  • Early postpartum follow-up visits (before the typical 6-week postpartum appointment).
  • Lactation consultation and breastfeeding support.
  • Mental health, counseling, or postpartum support group appointments.

Ideally, some prenatal visits should be in-person, although some prenatal care, even via telehealth) is better than none, depending on individual patients’ barriers to accessing care. Most providers and patients prefer to meet each other, at least initially in person, before moving to telehealth. In the US, the Kaiser Family Foundation has proposed a hybrid prenatal care model combining approximately eight in-person OB visits with six telehealth visits to make prenatal care more accessible and improve continuity of care.

Routine prenatal care encompasses 14 prenatal care appointments. For the first part of pregnancy, most people have an appointment every four weeks until 28 weeks. Some of these early visits are well-suited to telehealth as long pregnancy is not high risk.

What are the benefits of having some of your prenatal visits via telehealth? First is the germ justification – the main reason telehealth gained popularity during the COVID-19 pandemic. In-home appointments reduce exposure to all the germs and viruses circulating these days. Pregnant people are more vulnerable to viruses and infections, so telehealth can help you and your provider to be healthier.

The second benefit of virtual healthcare is that it makes OB care more accessible. In the U.S., the number of women not receiving adequate prenatal care (attending at least 50 percent of their prenatal visits and starting care in the first trimester) has decreased over time, according to the U.S. National Vital Statistics System. Having some visits virtually may increase the likelihood that you attend all of your prenatal visits and have a healthier pregnancy. Virtual care increases continuity of care by making it easier for providers and patients to connect. Continuity of care describes an ongoing relationship between a healthcare provider (or team) over time (your pregnancy) that is complete, consistent, and connected.

With telehealth, you don’t have to take as much time off from work or spend time or money traveling back and forth to doctors’ appointments. Additionally, it may be easier for you to be seen by specialists during your pregnancy if you don’t live geographically close to major medical centers.

You might be worried that you won’t receive the same quality of care virtually compared to in-person care. Research from the COVID-19 pandemic tracked patient satisfaction, pregnancy outcomes, health and well-being of mothers and babies. The results showed that receiving care via telehealth is as safe and healthy as in-person care. A review of nineteen studies showed that pregnancy outcomes were similar between groups that received in-person care and OB telehealth visits.

But don’t pregnant people want to see their provider in person? Yes, but several studies conducted during the COVID-19 pandemic demonstrated that pregnant people were generally satisfied with the virtual care they received. Added benefits of virtual OB care included reduced travel time to and from appointments, fewer work absences, decreased in-clinic wait time, and reduced patient no-show rates. Telehealth increased continuity of care and boosted patient satisfaction, quality of care, and pregnancy outcomes.

There are some downsides to telehealth. First, laboratory tests (blood work, urine screens) and imaging (ultrasounds) still require in-person OB visits. Second, while insurance companies increasingly cover the cost of telehealth visits, some telehealth services may not be fully covered, leading to higher out-of-pocket costs for you. Thirdly, pregnancy can be an anxiety-ridden time. Many pregnant people appreciate the reassurance that an in-person abdominal exam provides. This exam usually involves checking the fetus’s position, measuring the baby’s size (fundal height), and listening for a heartbeat via a handheld Doppler ultrasound. A recent British Medical Journal study reported that the abdominal exam done at most in-person prenatal visits enhances the relationship between healthcare provider, mother, and baby, helping promote maternal-fetal bonding, reducing anxiety, and cultivating trust between provider and patient.

Time will tell whether telehealth’s benefits of accessibility, convenience, and continuity of care outweigh its potential downsides regarding pregnancy and postpartum care. However, as healthcare systems, insurers, and obstetrical practices work out how best to implement telehealth into maternity care, there are steps you can take to get the most out of any telehealth care you might have during your next pregnancy.

Before your first telehealth appointment, it can be helpful to:

  1. Write down your questions ahead of time.
  2. Then, prioritize your questions in order of importance before your appointment in case time is short.
  3. Write down your current medications (and any supplements) and doses (or gather the actual bottles)
  4. Let your healthcare provider know if you need accommodations. For example, you can request a screen reader, closed captioning, translator/interpreter, or other support.
  5. Test your technology before the visit (Wi-Fi connection, video, speakers, smartphone).
  6. Choose where you plan to have your telehealth visit – ideally, a well-lit, quiet, and private location.

On the day of your telehealth OB appointment, make sure to:

  1. Keep a pen and paper nearby to take notes.
  2. Check your email for instructions. Review emails, texts, or other communication from your provider’s office for information about how to log on and use related technology.
  3. Test your technology again.
  4. Reduce background noise. Turn off alarms and sounds on other devices.
  5. Close other applications on your device to improve your internet connection and reduce distractions.

Remember, it is your right to request to have your OB visits in person. If you know that you want all of your OB visits to be face-to-face, ask about telehealth when interviewing prospective OB providers. Whether or not telehealth becomes a universal part of obstetrical care remains to be seen, but in the meantime, take steps to make sure you get the most out of all of your prenatal care, be it in-person or via telehealth.

Amy Harris
Amy Harris is a certified nurse-midwife with a Master's Degree in Maternal and Child Health from Harvard Chan School of Public Health. Her passions are health literacy and women's reproductive health. A recent two-year sabbatical with her family in Spain was the impetus for becoming a freelance women's health writer. An exercise nut, she is happiest outdoors and on adventures abroad.

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