Are Virtual, Home-Based Models of Care Safe and Effective for Providing Pregnancy Care? A Systematic Review of the Literature from High-Income Countries

Midwifery philosophy promotes optimising physiological processes for all women. However, when complications arise, women may be offered increased monitoring and/or admission to hospital. Research demonstrates negative experiences associated with this. Virtual care presents the opportunity for more individualised care and has shown higher satisfaction with comparable outcomes to standard care, at similar or lower cost. Virtual pregnancy care is established in many countries, but implementation has been slow in Australia. The aim of this review is to evaluate the safety and effectiveness of antenatal virtual care models that incorporate telemonitoring of maternal and/or fetal wellbeing. A systematic search of the literature published since 2010 was conducted. Quantitative and mixed-methods studies were reviewed to provide a summary of contemporary evidence. Evidence on virtual care (with telemonitoring) delivered in the antenatal period was synthesised. Postpartum virtual care models were outside the scope of this review. Twenty-five publications were included. Studies examined diverse telemonitoring interventions, often supported by telehealth consultations with health professionals. Compared with standard care, including hospital admission, virtual models were associated with higher maternal satisfaction, reduced costs and service use, and were not associated with increased adverse perinatal outcomes. Further implementation research is needed to support broader adoption and ensure women can access flexible models of care.