Effects of the COVID-19 Pandemic and Telehealth on Antenatal Screening and Services, Including for Mental Health and Domestic Violence: An Australian Mixed-Methods Study

Abstract

IntroductionAustralian antenatal care includes specific screening and service provision for domestic and family violence (DFV) and mental health. However, the COVID-19 pandemic resulted in major care changes, including greatly expanded telehealth. Given difficulties in a safe assessment and management of disclosures via telehealth, DFV and mental health service provision might be substantially impacted. This study therefore aimed to assess COVID-19 effects on DFV and mental health screening, as well as broader service provision from the perspective of local maternity service providers.MethodsMixed-methods study of staff surveys and interviews of staff directly involved in pregnancy care (doctors, midwives, and allied health) in three Sydney (Australia) maternity units, from October 2020 to March 2021. Surveys and interviews interrogated perceived effects of the COVID-19 pandemic on delivery (ensuring required services occurred), timeliness, and quality of (a) overall maternity care and (b) DFV and mental health screening and care; and also advantages and disadvantages of telehealth. Surveys were descriptively analyzed. Interviews were conducted online, recorded, and transcribed verbatim prior to thematic analysis.ResultsIn total, 17 interviews were conducted and 109 survey responses were received. Breakdown of survey respondents was 67% of midwives, 21% of doctors, and 10% of allied health. Over half of survey respondents felt the pandemic had a negative effect on delivery, timeliness, and quality of overall pregnancy care, and DFV and mental health screening and management. Perceived telehealth positives included convenience for women (73%) and reducing women's travel times (69%). Negative features included no physical examination (90%), difficulty regarding non-verbal cues (84%), difficulty if interpreter required (71%), and unsure if safe to ask some questions (62%). About 50% felt telehealth should continue post-pandemic, but for <25% of visits. Those perceived suitable for telehealth were low-risk and multiparous women, whereas those unsuited were high-risk pregnancy, non-English speaking, and/or mental health/psychosocial/DFV concerns. “Change to delivery of care” was the central interview theme, with subthemes of impact on mental health/DFV screening, telehealth (both positive and negative), staff impact (e.g., continuity of care disruption), and perceived impact on women and partners.DiscussionWhile telehealth may have an ongoing, post-pandemic role in Australian maternity care, staff believe that this should be limited in scope, mostly for low-risk pregnancies. Women with high risk due to physical health or mental health, DFV, and/or other social concerns were considered unsuited to telehealth.

Midwives’ experience of telehealth and remote care: a systematic mixed methods review

“…10 full-text studies were ultimately included in this review (see figure 1). Three lead authors were contacted for additional data and clarification regarding findings specific to midwives 22–24…”

“…The 10 studies meeting the review inclusion/exclusion criteria represented the views of 3354 midwives regarding telehealth in their midwifery practice. Of the 10 selected studies, 3 studies reported the telehealth experience of multiple types of providers (physicians, nurses, midwives), therefore only data pertinent to midwives was extracted 22–24 Tables 2 and 3. show the characteristics of each included study and table 4 displays the key thematic findings for each study.…”

“…The study designs can be broadly categorized as qualitative (n=4),23 25–27 quantitative (n=1),28 quantitative with content/thematic analysis (n=2),22 29 quantitative with descriptive analysis (n=1)30 and mixed methods (n=2) 24 31. The settings of nine studies were Australia (n=4),24 25 28 30 England (n=1),27 France (n=1),31 Switzerland (n=2)23 29 and the USA (n=1) 26.…”

“…The study designs can be broadly categorized as qualitative (n=4),23 25–27 quantitative (n=1),28 quantitative with content/thematic analysis (n=2),22 29 quantitative with descriptive analysis (n=1)30 and mixed methods (n=2) 24 31. The settings of nine studies were Australia (n=4),24 25 28 30 England (n=1),27 France (n=1),31 Switzerland (n=2)23 29 and the USA (n=1) 26. One large worldwide study conducted thematic analysis of open-ended survey questions about telehealth and reported with exemplar quotes from midwives in Nigeria, Costa Rica, Norway, Uganda, Kenya, Bangladesh, Germany, USA, Nepal, France and Argentina 22.…”

“…One large worldwide study conducted thematic analysis of open-ended survey questions about telehealth and reported with exemplar quotes from midwives in Nigeria, Costa Rica, Norway, Uganda, Kenya, Bangladesh, Germany, USA, Nepal, France and Argentina 22. The settings of clinical telehealth services differed widely across the studies: antenatal/pregnancy-related, birth and post partum (n=8)23–30 plus gynaecology, family planning and abortion (n=2) 22 31…”