Bridging the maternal care gap

In Australia, there has been a trend towards shorter postnatal stays between 2011 and 2021, with 27% of mothers discharged less than two days after giving birth in 2021 (17% in 2011) and 11% of mothers staying five or more days (18% in 2011). This is according to data from the Australian Institute of Health and Welfare (AIHW).

The World Health Organization (2022) recommends that after an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth. Postnatal care in hospital allows health professionals to monitor the mother and baby after birth and provide mothers and their partners and/or family with advice and support around physical recovery, breastfeeding, parenting skills and linking to supports in the community (Rayner et al. 2008; World Health Organization 2022).

Quality of care

The average number of days women spend in hospital following childbirth has steadily declined from 3.0 days in 2011 to 2.5 days in 2021. Often some mothers are ready to leave a maternity ward in favour of the comforts of home, but others, especially those giving birth for the first time, report feeling confused, battered and out of their depth when asked to leave so soon after their baby’s arrival.

The decline in the number of working midwives is a contributing factor, with advocates blaming workload pressures and exposure to birth trauma, resulting in 25,557 practitioners working in midwifery in 2022 — a 4.8% decrease on 2016 figures.

This shortage is affecting the quality of care and potentially other outcomes, according to NSW Nurses and Midwives Association counsellor, lactation specialist and registered midwife Emma Gedge, who warned that specialist medical staff are increasingly lending their expertise to plug the midwifery gap, leaving them unable to properly respond to specialist care needs.

Based on data released by NSW Health, Gedge could be right. The ‘Mother and Babies 2021’ report found that the number of babies fully breastfed after they and their mothers are released from the hospital has declined for five years in a row in NSW, dropping from 78.5% in 2017 to 73.1% in 2021².

Many hospitals are struggling to cope with the high demand and low midwife availability. Experts warn that early cost-containment and understaffing could lead to missed opportunities for education and support — opportunities that could mitigate the risk of a raft of complexities and challenges for mother and baby in the longer term if seized while mum and baby are under the care and supervision of healthcare professionals.

Midwives play a vital role in empowering women to recognise and evaluate their own risks, enabling informed decision-making throughout the perinatal journey. Results from focus groups with midwives and mothers revealed that nurturing connections, offering flexibility and ensuring care continuity are key elements of high-quality midwifery-led care³. This approach gives women a genuine sense of choice and control over their maternity experience.

Technology to alleviate strain

Health care delivered via digitally enabled software and devices can alleviate some of the strain maternity wards are facing and the distress mothers are experiencing from the antenatal period right through the time that they are navigating the early stages of home life with their new addition.

Assiamira Ferrara, PhD, a Senior Research Scientist at Kaiser Permanente, a healthcare provider in Northern California, conducted a study on the impact of virtual visits on maternal healthcare outcomes during the pandemic. The study, published in JAMA Network Open⁴, revealed that telemedicine visits increased from comprising 11% to 21% of pregnancy appointments.

Surprisingly, despite no increase in overall appointments, health outcomes remained unaffected. A mixed-mode approach combining in-person and virtual visits yielded comparable rates of preeclampsia, eclampsia, severe maternal morbidity, C-section delivery and preterm birth when compared to an in-person-only approach.

This approach could potentially overcome barriers for individuals with limited time due to inflexible work schedules, lack of transportation or childcare responsibilities.

Digitally enabled care

Local hospitals are introducing Hospital in the Home (HITH) programs for their maternity patients as an inpatient substitution service. Patients remain under the care of a treating hospital team, receiving the same treatment and considerations as they would in the hospital.

Using a blend of capabilities like digital assessments, remote patient monitoring using Bluetooth-enabled home health monitoring devices and telehealth, for example, clinicians and care teams can provide hospital-standard clinical care to the patient in their home.

A significant majority of Australian consumers, around 80%, are familiar with virtual care or have used it. Furthermore, 90% of those who have experienced virtual care express a level of satisfaction ranging from “somewhat” to “very”. In particular, convenience (72%), avoidance of in-person care settings (57%) and flexibility (50%) are frequently cited as the most notable advantages. This highlights a continued preference for easily accessible care options that eliminate the inconvenience of hospital visits or stays⁵.

While there is no silver bullet for the healthcare staffing crisis, digitally enabled maternal health care has the potential to bridge the gap between low midwife availability and high patient demand.

By facilitating real-time patient monitoring and continuous provider communication, timely intervention can be coordinated, easing the strain on the system and supporting new mums at a time when women experience uncertainty, anxiety and feelings of loneliness and social isolation in coping with the demands of caring for a newborn.

^{[1] Mothers and Babies 2021 - HealthStats NSW}

^{[2] Exploring the qualities of midwifery-led continuity of care in Australia (MiLCCA) using the quality maternal and newborn care framework - ScienceDirect}

^{[3] Prenatal Health Care Outcomes Before and During the COVID-19 Pandemic Among Pregnant Individuals and Their Newborns in an Integrated US Health System}

^{[4] ‘It’s going to get worse’: Providers tap into health tech tools to prevent maternal health emergencies.}

^{[5] Virtual hospitals could cure many healthcare ills | McKinsey}

*Deepak Biswal is a founder and CEO of CareMonitor. His passion lies in using digital technology to create solutions that can help ease the burden of our healthcare system.

Image caption: iStockphoto.com/shironosov