Researchers call for personalized tiered model of postpartum care

A new study from researchers at the University of Liverpool and King's College London reveals that whilst women may value the convenience of virtual postpartum care, they remain concerned about the need for physical examinations and how to access them.

The researchers have called for a personalized and tiered model of care which balances efficiency, individual preference, and clinical concern.

Understanding experiences of postnatal care during and post-pandemic

During the recent pandemic, maternity services were rapidly reconfigured to reduce infection risks for pregnant women, new mothers, newborn babies and healthcare staff. This led to a significant increase in virtual appointments and fewer face-to-face interactions. Whilst this shift was initially driven by public health necessity, many elements of virtual maternity care have persisted beyond the pandemic.

The research team sought to understand how women of reproductive age felt about these changes, and to explore the perceived strengths and limitations of in-person, video and telephone-based postnatal care.

The study analysed responses from women participating in the COVID Symptom Study Biobank, drawn from the King's College London/ZOE COVID Symptom Study. Between September and December 2021, participants completed an online questionnaire about their maternity care experiences.

A total of 1,036 respondents reported delivering at least one live baby during the pandemic. Of these, 821 women provided 1,466 qualitative responses describing their experiences of care delivered in person (550 responses), by video (125 responses), or by telephone (791 responses). Researchers report on demographics and conducted a content analyses of the free-text responses.

Convenience balanced with caution

Overall, mothers viewed virtual care positively, highlighting its convenience and promptness. Many felt it was an effective way to meet their healthcare needs-particularly when managing the practical demands of caring for a newborn.

However, two important caveats emerged. First, women valued the ability to escalate care quickly when needed. They appreciated a 'tiered' system, in which concerns raised during a virtual consultation could lead to rapid in-person review. In most cases, respondents reported that this escalation process worked well.

Second, participants emphasised the importance of physical examination in certain situations-especially when a baby was unwell. In these contexts, virtual care alone was often perceived as insufficient or potentially risky.

The findings suggest that women are pragmatic in weighing the benefits and risks of different modes of care.

A call for personalized, tiered care

The researchers conclude that healthcare policymakers and providers must carefully navigate the continued shift towards virtual maternity care. While virtual provision may offer efficiencies, perceptions remain mixed and some evidence suggests clinical outcomes may be inferior compared with in-person care in certain contexts.

The team recommends a personalized, tiered approach to postnatal care-one that considers:

• The most efficient and equitable mode of care for each situation
• The mother's preferences, particularly when infants are involved
• The clinical urgency and level of concern regarding the baby's condition
• The ability to escalate promptly from virtual to in-person care when necessary

Lead author Dr Sergio A. Silverio said: "It is imperative that we listen to women about how they perceive and desire their reproductive and perinatal healthcare interactions. The positives should be built on and innovated, whilst the negatives of in-person, video, and telephone care must be taken seriously and addressed, whilst women and their babies are accommodated within our healthcare system.

"Our findings show that mothers value the convenience and promptness of virtual care, but they also want reassurance that physical examinations will take place when clinically necessary-particularly when their baby is unwell.

"We endorse a personalized, tiered approach to postnatal care provision-one which balances efficiency, individual preference, and clinical concern, and where escalation from virtual to in-person care is not only possible, but enacted to ensure the safest possible care for new mothers and their infants."

The researchers hope the findings will inform ongoing development of maternity services across the UK, ensuring that innovation in care delivery remains centred on the needs, preferences and safety of women and their babies.