Health technology has been slowly but steadily invading every niche of medicine for the past years. The year 2020 and the COVID-19 pandemic that came with it only accelerated current technology trends in healthcare, forcing remote patient monitoring, mhealth apps, and digital assistants into the lives of most patients and health professionals.
The maternity niche is no exception. However, technology is advancing at a much slower pace in this area of medicine. In the United Kingdom, the speakers of The Royal College of Midwives have recently issued a statement where they claim that for a long time, the maternity services have been overlooked, passed over or left at the back of the queue when it comes to digital investment. They point out that improvements have been happening, but at a much slower pace than it is required.
This is a real problem, since maternity health services are just as overworked and understaffed as in other niches, if not more. Every mother acts as a long-term patient, and to ensure her wellbeing throughout the course of pregnancy and childbirth one needs extensive human resources or advanced digital support.
There is also no internal reason for digitization to avoid the maternity niche. In countries where digitization of health services is a real possibility, the Internet and smartphone access is widespread among pregnant women and women who just gave birth. In a study from as far as 2014, it was found that 95% of pregnant women in developed countries used the Internet for pregnancy information. In a 2019 study in China, it was found that 70% of Chinese women used pregnancy apps on their smartphones. For the lack of a better alternative, women search for the information themselves, use digital apps they see fit, and ask clinicians for recommendations. In most cases, they want personalized and evidence-based mhealth apps in addition to popular digital resources that mostly provide a “digital mirror” to pregnancy experience. Those aren’t useless, but generally there is a huge room for improvement when it comes to digital support.
In this article, we’ll look at what the options for digital support in maternity are, how healthcare facilities can benefit from digitizing this field, and what has already been implemented.
What can be done and how can the maternity niche benefit from digital support?
For things to catch up, one has to introduce digital support into all areas of the pregnancy pathway: antenatal, labour, birth, and postnatal. Digital support should first and foremost include electronic medical records that are accessible at any time to both clinicians and patients. Electronic records should include data on all aspects of care that women receive throughout their pregnancy time. Health professionals should have appropriate electronic equipment to facilitate care. This includes those in disadvantaged and rural areas. In addition to electronic records, healthcare software companies propose tools that make it easier to manage and analyze large amounts of patients’ data. For example, an Elinext case study describes Measure Management & Administration health analytics tool that’s integrated with Electronic Medical Records (EMR) software to help providers manage performance-based contracts and improve quality reporting measures.
As the resources available at the moment don’t cover it all ― women still report not having enough information when it comes to pregnancy and giving birth ― all personalized health information should be available in digital format. This measure will increase the time health professionals spend providing direct care from 30 to 70 percent. This will also allow mothers to have a better understanding of their health and find relevant information. Finally, having electronic records will reduce the cost of collecting and sharing information and improve data quality.
But of course, this is not all. Digital support can greatly improve the experience of pregnancy and giving birth for women. It can improve the safety of care, ensure better communication with health professionals, and take personalization of care to a whole new level. For example, women could complete personalised care and support plans online, which will not only free up midwife’s time but also ensure the mothers’ personal needs are being considered.
When it comes to psychological wellbeing, digital resources might also help to refocus from avoiding diagnosed illnesses to increasing the mothers’ overall wellbeing before and after birth. With limited resources, which is always a problem when it comes to employing people, health professionals focus on preventing and mitigating postnatal depression, the risk for which they evaluate with quantitative measurement methods. While this is obviously important, a number of studies have shown that pregnancy-related stress is a better indicator of adverse maternal and neonatal effects than measures of depression. Pregnancy-related stress is often missed due to the lack of reliable quantitative measurement methods and overstretched midwifery workforce.
Initiatives and examples of digital support for maternity
In the UK, the National Health Service created a long-term plan in which all paper notes should be replaced with digital services by 2023/2024. It’s stated that all women should be able to access their information and maternity notes with the help of an app on a smartphone or on any other device. This digital maternity app was introduced as a pilot program that was available to 100 000 women in the UK. They can now access their test results, monitor their baby’s movements, keep a diary of their symptoms, and access their pregnancy notes.
Right now, there are four programmes that aim to digitize care for women in maternity services. Their goals are the following:
- ensure investment in electronic maternity records to reduce the administrative burden of information recording and sharing;
- provide women with quick and easy access to digital sources of information;
- create a digital tool that collects personal health records and returns personalised information;
- ensure these solutions are accessible to everyone involved outside the hospital settings.
The four digitization programmes are the following:
- Maternity Digital Maturity Assessment, which collects information to later recommend proper investment and adoption of digital technology in maternity settings.
- Interoperable Maternity Records, which aims to create a professionally agreed standard for maternity records, ensure health professionals use standard terminology within the maternity record so that different systems can share and interpret the information, and finally enable healthcare professionals to search for and retrieve maternity records.
- Women’s Digital Care Record, which works to provide women with access to their electronic maternity record.
- A Digital Toolset, which offers access to evidence-based and locally specific pregnancy and birth related information, including information about people’s circumstances, choices available and their own personal care plans.
In Germany, it was only in 2019 when the government introduced the Act to Improve Healthcare Through Digitization and Innovation (Digital Healthcare Act) (English summary). The act allows patients to receive health apps, including pregnancy apps, by prescriptions if there’s a need for that. It’s also now easier in Germany to access virtual midwives and access electronic medical records.
As we can see, government-led programs are slowly evolving from mere ideas to adoption. At the same time, healthcare software companies are already deeply involved and have been for a rather long time. Pregnancy and fertility digital apps have been providing digital support, both informational and psychological for at least a decade. In 2016, this app category boasted 200 millions downloads. Now, apps assist with conception, pregnancy, delivery, postpartum recovery, lactation, and early childhood development, even though the market still lacks an end-to-end solution which would also have additional information on infertility, adoption and surrogacy.
Maternity apps often focus on providing informational, evidence-based content and emotional support. In terms of their actual features, they are often divided into three general categories:
- Tracking ovulation and fertility;
- Providing a digital mirror of pregnancy pathway;
- Providing access to nurses and specialists, navigating assisted reproductive technology, or managing care coordination.
National Health Service offers a list of credible apps that could be useful for mothers. The list includes Family Assist that provides information on pregnancy and birth and allows you to chat with health professionals; Kicks Count that keeps track of your baby’s movements in the womb and monitors changes; Peanut that provides an online community for mothers to meet up, share advice and support each other; GDm-Health that monitors glucose levels during pregnancy if you have, or are at risk of, diabetes, and many others. Trusted sources often have their own maternity digital support tools. For example, WebMD has a WebMD pregnancy app that provides regular tips and health-related information, tracks baby kicks, blood pressure, and contractions, helps you to keep a pregnancy journal and creates a community where expectant mothers could share what they are going through.
What are some challenges for introducing digital support?
Introducing digital support into the maternity niche of healthcare obviously has its challenges. However, when it came to actual implementation, perceived challenges and real challenges faced by implementation teams differed a lot. First of all, the absolute majority uses the internet and smartphones for pregnancy information. Even women who are socially disadvantaged report high levels of digital media usage. So as opposed to what was expected, there was no problem with adoption of new technology by pregnant people. There were also concerns that staff would be reluctant to use new technology and a parallel paper system might emerge. This didn’t turn out to be the case. The challenges that the implementation teams faced were rather different. Digital Maternity Challenge 2017 reports a number of things, such as that Wi-Fi troubles were more serious than expected. Communication with health professionals and training of clinical staff was challenging, mainly due to inadequate human resources. The lack of opportunity for staff to ‘play’ on a training domain was also a major deficit. Hopefully, these challenges are being dealt with during current processes of digital support implementation.
Digital support has plenty of benefits for both patients and health professionals. These include but are not limited to improved access to health information for everyone involved, better understanding of the pregnancy experience and emotional support for women, improved communication between mothers and midwives, reduced administrative burden on health workers, and reduced cost for health services.
In no way, however, digital support is a replacement for the existing health services. There is no aim to move maternity into the digital world. Face-to-face appointments are and will still be happening. Midwives still have to carry out screenings, check the blood pressure, measure the bump, and often provide patients with face-to-face or over the phone emotional support. As usual, when it comes to digital support in healthcare and many other fields, the golden rule is for patients to use digital support in addition to real-life care. And let us not forget that 140 million women give birth each year, which means the target audience for all kinds of maternity digital support is not going anywhere any time soon.