Kirsten R Palmer and colleagues1 assessed integrated telehealth for antenatal care in Australia during the early COVID-19 pandemic. However, the estimated 50% reduction of in-person consultations does not represent the proportion of telehealth consultations received by women. Women included in the intervention gave birth between March 23 and July 26, 2020, which is equivalent to, at most, 4 months of a telehealth-integrated antenatal care schedule. Although not presented, the average duration of antenatal follow-up was probably 2 weeks (implementation period) and 6 weeks (integrated care period), allowing for a maximum of two telehealth visits with three face-to-face consultations. This limited exposure at the end of pregnancy is unlikely to show significant differences in outcomes and we are concerned that the conclusion of no compromise to pregnancy outcomes is premature. We need rigorous studies assessing the implementation of telehealth in comparison with a face-to-face model throughout the entire pregnancy.
Furthermore, the investigators' recommendation to adopt telehealth beyond the pandemic fails to consider dimensions of care quality and equity. Research shows that care quality is compromised by incorporating telehealth into routine maternity care.2, 3 High user satisfaction rates with telehealth should be interpreted within the context of the pandemic's restrictive measures and women's intent to reduce the risk of SARS-CoV-2 infection, because qualitative evidence shows that pregnant women who received telephone consultations felt distressed due to scarce face-to-face contact with health-care providers.4 More research is needed on women's perspectives of respectful and quality care during any antenatal care schedule that uses telehealth. Additionally, relying on telehealth can contribute to exacerbating inequalities in maternal health,5 in which financial barriers, technological illiteracy, and mistrust lead to excluding vulnerable women.2
Although Palmer and colleagues show that partial use of telehealth in antenatal care appeared to be a non-inferior alternative to prevent disruption of care during the period of COVID-19 restrictions in the Australian context, unjustified compromises to high-quality, person-centred, and equitable care should not be acceptable as a way forward.
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We declare no competing interests.
References
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