The purpose of this study was to understand the experiences of new mothers using virtual care for postnatal follow-up. The data suggests that virtual visits were considered a convenient, low-barrier, and accessible modality for healthcare delivery for postnatal follow-up care. In the context of being a new mother, virtual visit was able to address many challenges unique to this population, such as scheduling difficulties, needing to arrange for childcare, and time constraints due to busier routines. These findings are consistent with previous literature, where patients found virtual care to be convenient, time-saving, and accessible for patients with unique physical impairments15, 23.
1.4.1 Virtual care as a means towards patience compliance to follow-up care
While there have been relatively limited studies examining the use of virtual care in the form of video conferencing for maternal healthcare in the postpartum period, our results are consistent with previous literature examining patient satisfaction with virtual obstetric care in the prenatal period24. Virtual visits have been found not only be convenient, but to uphold the same level of rapport in the patient-provider encounter. In a U.S.-based cross-sectional survey examining patient’s preferences for telehealth visits, almost 1/3rd of participants expressed a preference for telehealth, and over ½ of participants rated telehealth to be just as good as traditional in person care25. Likewise, our participants expressed that virtual visit was comparable or even better than in-person visit where follow-up visits do not necessitate being seen for a physical examination.
The participants in this study also expressed enthusiasm for the use of virtual visit in the follow-up care context, where the convenience of being able to see a provider at home for a simple follow-up appointment was significant in terms of comfort, convenience, and costs. This is consistent with literature examining patient experiences with telehealth for follow-up care specifically26. In other studies examining the use of telemedicine for support in early discharge from childbirth, patients also reported feeling confident with the ease of the technology and did not perceive a threat to their privacy or personal information. In a pilot project based in Sweden, patients reported feeling confident that their concerns and questions were addressed to the same degree through video conferencing and that communication with their provider was not compromised27. This may be attributed to the fact that younger mothers may already incorporate technology in their daily lives 28. Resultantly, young mothers may more positively take up virtual care in comparison to other patient populations or age groups.
Our participants also expressed how virtual visit was able to address barriers to accessing healthcare related to financial constraints, distance, travel time, and arranging time off work, which is consistent with previous literature examining the benefits of virtual care visits in primary care settings. These findings are also consistent with other studies exploring the use of virtual care in other patient populations 13, 15, 23, 29 Overall, the perceived benefits of virtual care could provide insight into ways to increase patient compliance to post-natal follow-up care. In another study conducted by researchers at Kingston Health Sciences Centre, it was found that increasing distance from the hospital was significantly associated with poorer attendance at follow-up visits. To a less significant degree, it was also found that poorer follow up was associated with patients with a greater number of living children and women with no educational certificate, diploma, or degree10.
In our study, virtual care was found to be highly favored amongst participants living out of the city as they did not have to spend time, costs, and energy to attend to the hospital. Virtual care was also found to be useful for women with multiple children in our study as they were not required to make extra childcare arrangements, find caretakers, and spend associated costs. This was particularly relevant throughout the ongoing COVID-19 pandemic, as patients were not permitted to bring other children to the visits in order to prevent unwanted exposure. Several other participants recalled that they had forgotten to attend their appointments. However, all felt inclined to use virtual visits once they were reminded to do so through phone call by the clinic secretary due to its perceived ease of use. Other participants alluded that virtual care would not interrupt their source of income as they were able to conduct the virtual session otherwise.
1.4.2 Virtual care and the Social Determinants of Health
Virtual care appears to be an important modality for increasing compliance to post-natal follow-up care. This is likely due to the fact that virtual care addresses the various social and environmental factors that intersect to impact health care access. Income, geography, and educational background are commonly understood as some of the most significant social determinants of health18, 30, 31. Compounded by domestic tasks and expectations, women may feel overwhelmed, overburdened, or disinclined to attend postnatal follow-up clinics32. Since virtual care can be conducted at a place comfortable for the patient and at their own schedule, it may become easier for women to attend to attend regular follow-up visits for maternal health monitoring. As a result, virtual care should be positioned not only as a tool to facilitate compliance in follow-up, but as a tool to evaluate the various social and environmental determinants that may encourage or deter patients from attending follow-up clinics.
Our study did allude to one major limitation of virtual visit, in that the internet connection can vary considerably between patients and pose a potential barrier for conducting virtual care appointments33. This limitation can be exacerbated by various socioeconomic factors such as rurality or financial constraints. Patients who are unable to afford a high-speed internet connection or those who live in rural areas with poor connectivity may find themselves limited in their ability to access virtual care appointments23. This finding is consistent with previous literature indicating that virtual modalities for healthcare delivery in primary care can be limited when it comes to connection issues34, 35, 36, 37, 38.
1.4.3 Limitations of the study
This study was limited by the relative homogeneity of the sample. As many of the participants were white/Caucasian, married, Canadian-born, middle-class, well educated women, the perceived positive and negative aspects of virtual visit could be different if a more heterogenous sample was interviewed. For example, as Canada is an immigrant-dense country, language barriers, especially if virtual visit is not offered in multiple languages, could potentially be a limiting factor. Overall, however, participants were highly satisfied with the virtual visit platform for postnatal follow-up appointment visits and the comfort and convenience it provides to participants are relevant across patient demographics. The research team also acknowledges that the sample size for this study is relatively small. This could be attributed to a large number of patients who had declined to participate as well as the research team’s decision to take an ethnographic approach to the data in order to draw out rich details from the participants.
1.4.4 Future Directions
While this study showed that new mothers found virtual visit to be a suitable modality of healthcare delivery for postnatal follow-visits, our interviews alluded to a variety of challenges that new mothers experience that may differentially impact their ability to seek care. Therefore, future studies should investigate barriers to accessing in-person healthcare services for new mothers in order to better understand the unique determinants and barriers of this patient population. Intersectionality theory would serve well to illuminate the connections between social determinants and barriers to virtual care. Furthermore, virtual care has the potential to significantly shift the landscape of healthcare delivery in the COVID era, and further research should specifically examine patient experiences of virtual visit in relation to the ongoing pandemic.