Patient-centred Postpartum Care Provision:Virtual Delivery, Tiered Escalation, and Tensions between Efficiency, Preference, and Clinical Concern

Background: Good quality postnatal care is of key importance for maternal and infant health. During the pandemic, healthcare services were reconfigured with increased virtual delivery, reducing infection transmission risk for pregnant women, new mothers, newborn babies, and healthcare workers. Post-pandemic, this shift of maternity care from face-to-face towards virtual care provision has persisted. Whilst some have extolled this trend, the evidence is mixed, both for clinical outcomes and for patient perceptions and experiences. We sought to explore the experiences and perceptions of women affected by these changes, to inform ongoing maternity services development.<br/><br/>Methods: This study reports responses of women participating in the COVID Symptom Study Biobank, drawn from the King’s College London/ZOE COVID Symptom Study, representing a convenience sample of UK women of reproductive age (18–50 years). Participants were invited to complete an online questionnaire created and administered using Qualtrics survey software, from 7 September to 1 December 2021. Demographic analyses are presented for all respondents. Content analysis was used to analyse all free-text responses.<br/><br/>Results: Overall, 1036 respondents delivered at least one live baby during the pandemic, of whom 821 respondents provided a total of 1466 qualitative responses about their care in-person (n=550 responses), by video (n=125), or by telephone (n=791). Mothers liked the convenience and promptness of virtual care, and generally felt it was a good way to meet their healthcare needs, with two caveats. First, they appreciated the option to escalate care quickly (i.e., a tiered process), which seemed to occur with little difficulty in most cases. Second, they perceived physical examination as very important in certain circumstances, particularly when a baby was unwell. <br/><br/>Conclusions: Our findings show women are pragmatic and reasonable about the benefits and risks of differing modes of postpartum care delivery, including virtual care. Our study supports a tiered approach to the provision of postnatal care, which balances perceived efficiencies, preferences of the individual seeking care, and level of clinical concern.