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COVID-19: why digital maternal health must be addressed now

The Australian Government is moving towards funding telehealth more widely, and some governments have started using SMS to keep people informed. But the moves are slow, way slower than in many other nations. Rebeccah Bartlett calls for action on digital maternal healthcare systems.

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Rebeccah Bartlett writes:

Telehealth has been actively utilised in rural and remote settings in Australia, and overseas, for decades.

Using mobile devices and tablets, likewise, has revolutionised healthcare for some of the hardest to reach communities across Asia, Africa and the Middle East, since mobile technology first became ubiquitous.

Urban populations are typically well-resourced, and the value of digital health is often only seen through the convenience of booking a doctor’s appointment online or witnessing your local health provider access your results through their integrated software system.

Need to get serious

Now, as we face the reality that many, if not most of us, might face months of home-based isolation due to COVID-19, we need to get serious about digital health.

Key communities to consider are the elderly, people chronic illness or disabilities and people who require frequent health check-ins with oftencomplex and coordinated care pathways.

We also need to consider how the healthcare journey will change for the 300,000+ women who are pregnant and give birth in Australia each year.

To ensure that Australia’s low maternal and newborn mortality and morbidity ratios aren’t affected and that quality healthcare continues to be offered despite the current pandemic, we need to explore how online maternal and child healthcare has been offered in countries less fortunate, economically, than our own.

Impact on the healthcare system

Acknowledging there are differences between COVID-19 and historical health crises, it’s important to recognise that many pregnant women died during the 2013–16 Ebola outbreak, not because of the disease itself but because of the devastating effect Ebola had on the healthcare system. Frontline healthcare workers died and hospitals were shut, some permanently. In countries that already experienced some of the highest maternal mortality ratios in the world, women were left to give birth in unsafe and unsanitary conditions, contributing to at least 3,600 additional maternal, neonatal and stillbirth deaths in the year 2014-15 in Sierra Leone, alone.

Despite the quality and advances of Australia’s healthcare system, we cannot afford to wait to develop our digital maternity care systems any longer. COVID-19 shows that having a well-developed, integrated and interoperable maternal digital healthcare system is essential. We should already have this now.

Women who now have to go through pregnancy and have babies outside their normal hospital due to travel restrictions and self-isolation need to know their health information can be shared immediately and in a safe, secure and appropriate way with their new midwives and doctors. We need to explore if the biometric data collected during routine antenatal appointments (foetal heart rate, blood pressure, fundal height, GBS swabs and urinalysis, where applicable) can be measured by women themselves. Self-monitoring for some of these measures has been tested before, in settings far less resourced than our own, with promising results. Importantly, determining how to support women, and their families after the baby comes, needs to be planned for as Australia’s current postnatal anxiety and depression rates are already alarmingly high. Lactation consulting, physiotherapy and postnatal counselling sessions can all be hosted online. It might not be ideal, but it may be the best alternative we have right now.

Digital and maternal health experts need to explore how to adapt these best practices to our current models of care and they need to do it now.

A strong system

Australia has a strong health system that utilises public-based, preventive models of care. Unsurprisingly, metropolitan settings provide more options and better access compared to regional or remote settings and you will also likely have better maternal health outcomes if you’re white and English-speaking than if you’re not.

Many of the women who fall into this second group are the ones who can most benefit from digital healthcare delivery. To ensure they do benefit however, we need to consider how we reach the tens of thousands of women who don’t speak English who required (now, video-) interpreters for their appointments. We also need to remember the estimated 20 percent of women who have disabilities  and who, if pregnant, may not be able to access a telehealth platform independently, the thousands of women who are homeless, and the estimated 1 in 5 who live in lowsocioeconomic areas with limited or no access to online care at all.

The maternal health sector can and should be leaders in digital health innovation. We save babies born far too early and mothers who are far toosick, every day. This is our time to step up and to lead. Indeed, it’s our responsibility to do so.

Rebeccah Bartlett is a registered nurse-midwife, a PhD candidate at Monash University and the founder of Shifra, a web app designed to improve sexual and reproductive health access for refugee and migrant populations