Pandemic pregnancy care: Telehealth versus face-to-face

When Australia was plunged into a swathe of COVID-19 restrictions in early 2020, disruptions occurred across many areas of healthcare.
 
For pregnant women there was no exception, with one in 10 face-to-face antenatal care appointments being replaced with telehealth, the majority (87.5%) of which were telephone consults.

Following the March 2020 extension of telehealth to accommodate care during the pandemic, including MBS items to cover antenatal services, Australia reached peak uptake of telehealth antenatal services in April (17,987) and May (16,525).
 
These figures make up the latest report from the Australian Institute of Health and Welfare (AIHW), summarising nationwide antenatal care Medicare claims between January to December 2020, with comparisons to previous years.
 
In 2020, there were around 136,000 fewer face-to-face antenatal services compared with 2019, a decrease of 8.3%. However, face-to-face services still made up the majority (around 92%) of antenatal services processed during 2020.
 
Face-to-face antenatal services declined by 15% in the second quarter of 2020 compared with the same quarter in 2019. Nationally, more than 1.6 million MBS services for antenatal care were processed during 2020 – slightly fewer than 2019.
 
So, are there disadvantages in providing maternity care via telehealth versus face-to-face?
 
Dr Wendy Burton, Chair of the RACGP Antenatal and Postnatal Care Specific Interests believes there are some, but told newsGP telehealth can be beneficial when no antenatal physical examination is required if the pregnancy is considered low risk.
 
‘There are disadvantages, especially in the second half of the pregnancy,’ she said. 
 
‘This is when we monitor blood pressure [BP], fetal growth and fetal heart rate closely. But BP can be monitored remotely with home machines.’
 
Dr Burton says some local maternity services purchase home BP units for women to hire, or GPs can purchase them to loan out to patients.

‘Early BP, height and weight checks are recommended, and some of this can be done by the woman,’ she said. ‘Then most of the first half of pregnancy we can manage with telehealth rather than face-to-face if there are no additional risk factors.’
 
Telehealth appointments can also cover issues such as alcohol and other drug use, mental health and domestic violence, for which Dr Burton says screening should be considered on a case-by-case basis.
 
‘Domestic violence screening is more difficult and risky via telehealth – who might be listening?’ she said.
 
‘I feel we have had to learn how to manage mental health consultations via telehealth due to the demand, but there is so much that can be missed when you can’t pick up on body language and facial expressions.’
 
When speaking to newsGP at the start of the pandemic, Dr Burton’s advice at the time was that low-risk women attend only three antenatal visits in person throughout their entire pregnancy.
 
That advice remains the same, she says, with most state and territory guidelines allowing flexibility of visits depending on how many COVID-19 cases are present.
 
‘In areas with active COVID [low-risk women should have limited face-to-face visits],’ Dr Burton said.
 
‘My experience is that there have been much fewer public hospital attendances ­– so keeping women out of crowded spaces such as outpatient departments, including antenatal clinics, became a priority for hospitals who were keen to keep women safe.’  
 
While it is currently considered that pregnant women are not at increased risk of COVID-19, RANZCOG still consider them a vulnerable group and advise all precautions be taken to reduce the risk of infection. Recent updated advice for pregnant women recommends they can be routinely offered the Pfizer vaccine at any stage of pregnancy.
 
For most states and territories, the AIHW report shows a decline after the peak uptake in telehealth antenatal care services in April and May, with the exception of Victoria during its second wave of COVID-19 and increased restrictions. Services in the state increased again after June, reaching the highest peak in August when one in five antenatal care services processed were telehealth.
 
In April 2020, nearly 106,000 services for face-to-face antenatal care were processed, 19.2% fewer than April 2019. In May 2020, 112,000 antenatal care services were processed, 24.7% fewer than May 2019.
 
Overall, telehealth has been largely embraced by both GPs and patients, being lauded as ‘here to stay’ by RACGP President Dr Karen Price.
 
When it comes to providing pregnancy care, Dr Burton believes telehealth has its advantages.

‘Personally I prefer face-to-face, but telehealth is convenient for many consumers and it can complement the face-to-face visits and, in some situations, replace them,’ she said.
 
The AIHW report only includes antenatal services processed by Medicare during COVID-19 by GPs, participating midwives and Aboriginal and Torres Strait Islander health practitioners. Services provided within public hospitals not claimable on the MBS are not covered in the report.
 
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