Home-based telemonitoring versus hospital admission in high risk pregnancies: a qualitative study on women’s experiences

Abstract

Background: Hospital admission during pregnancy complications is considered to be an event of significant impact. Besides conventional in-clinic maternal and fetal monitoring, recent technologies enable home-based telemonitoring with self-measurements in high risk pregnancy. This study is part of a feasibility pilot to explore the usability and acceptability of telemonitoring and aims to gain insight in the experiences and preferences of high risk pregnant women concerning the novel strategy of telemonitoring, opposed to women who were hospitalized in pregnancy. Methods: Using secured Facebook Groups, we conducted four online focus groups: two focus groups with women who were admitted during pregnancy (n = 11) and two with women who received home telemonitoring in the pilot phase (n = 11). The qualitative data were analyzed thematically. Results: Four major themes emerged from both participant groups: [1] care experience, [2] emotions regarding pregnancy, [3] privacy and [4] impact on daily life. Different views were reported on all four themes, resulting in a direct comparison of experiences during hospitalization and telemonitoring. Most admitted patients reported a growing sense of boredom and anxiety during their clinical admission. Lack of privacy on ward was a great concern, as it affected their contact with hospital staff and family. This issue was not reported amongst telemonitored women. These participants still felt like a patient at times but responded that the comfort of their own home and bed was pleasant. Only a minority of telemonitored participants reported being anxious at times at home, while not having a physician or nurse nearby. Being at home resulted in less travel time for partners or family for hospital visits, which had its positive effects on family life. Conclusions: Telemonitoring of a high-risk pregnancy provides an innovative manner to monitor fetal and maternal condition from home. Compared to the experiences of hospital admission in high risk pregnancy, it allows women to be in a comforting and private environment during an anxious time in their lives. As future studies should further investigate the safety and cost effectiveness of this novel strategy, women's views on the preference of telemonitoring need to be taken into consideration.

Home-Based Monitoring and Telemonitoring of Complicated Pregnancies: Nationwide Cross-Sectional Survey of Current Practice in the Netherlands

“…In 63% (12/19) of hospitals offering home-based monitoring, implementation of such monitoring was not preceded by a center-specific evaluation phase. However, home-based monitoring in these centers started mainly after the publication of the findings of 2 Dutch trials, which concluded positively about its patient safety and effects on satisfaction of care [7,8].…”

“…Ultimately, hospitalization is indicated in up to 11% of all pregnancies, usually extending to delivery and the postpartum period [5][6][7]. Antenatal admissions pose psychological stress to pregnant women because of separation from family and home, lack of activity, and feelings of uncertainty [8,9]. In addition, hospital admissions increase health care costs and workload, especially in high-income countries that are already experiencing difficulties as a result of professional staff shortage [10].…”

Patient Satisfaction with Virtual-Based Prenatal Care: Implications after the COVID-19 Pandemic

“…Given that pregnancy worries specific to the COVID-19 pandemic may play a role in satisfaction, providers may consider discussing with patients the extent to which a virtual prenatal care arrangement is a safe and alternative option for in-person visits, and how fetal monitoring will be maintained through in-person visits or remote monitoring equipment (blood pressure monitors, fetal heart monitoring, tape measures) should such monitoring take place virtually. Recent study findings suggest the accuracy, feasibility, and acceptability of home-based wireless fetal heart (FHR) monitoring systems among low and high-risk pregnant women (Heuvel et al, 2020 ; Porter et al, 2021 ), with evidence indicating home-based FHR readings to be equivalent to those obtained in the clinic setting (Porter et al, 2021 ). Moreover, there is data to suggest that most pregnant women are satisfied with home-based FHR monitoring (Heuvel et al, 2020 ).…”

“…Recent study findings suggest the accuracy, feasibility, and acceptability of home-based wireless fetal heart (FHR) monitoring systems among low and high-risk pregnant women (Heuvel et al, 2020 ; Porter et al, 2021 ), with evidence indicating home-based FHR readings to be equivalent to those obtained in the clinic setting (Porter et al, 2021 ). Moreover, there is data to suggest that most pregnant women are satisfied with home-based FHR monitoring (Heuvel et al, 2020 ). However, the consideration of such an arrangement should be fully discussed with the patient.…”

Exploring digital health interventions for pregnant women at high risk for pre-eclampsia and eclampsia in low-income and-middle-income countries: a scoping review

“…International guidelines including the European Society of Hypertension, American Heart Association, National Institute for Health and Care Excellence (NICE), and American Society of Hypertension guidelines, recommend self-monitoring for PE symptoms and recording of blood pressure for pregnant women at high risk for PE/E (HRPE/E) because of their potential benefits such as effective control of blood pressure, early risk identification, and treatment, and cost savings due to fewer hospital visits. [4][5][6] Self-monitoring also has a role in preventing conditions like white coat hypertension and masked hypertension in pregnant women at HRPE/E. WHO suggests home blood pressure monitoring for pregnant women at HRPE/E to detect changes in blood pressure between antenatal visits and to ensure care continuity.…”