Virtual Maternity

| March 23, 2011

Collaborative internet based technologies have a positive role to play in improving the reach and quality of ante-natal and post-natal services that can (largely) be delivered outside of the hospital.

Maternity is about wellness not illness, and this has major consequences for the entire health system. For instance, there is a well established link between breastfeeding and subsequent health in adult life, which consequently impacts on the health system itself.

In developed nations most pregnancies and births involve some form of intervention from a ‘systemic’ maternity service, such as a public or private midwifery service or a community health service.

The ‘clients’ of  ‘maternity services’ are pregnant mothers-to-be, or mothers of infants, their partners and in some cases grandparents. 

The services are crucial to maternal education, the birth itself and for  the subsequent healthy development of the infant.

Most of the technological advances made in this area have been focused on acute care needs within the hospital, such as the care of extremely premature babies.

This brief blog, however,  focuses on the improvement in reach and quality of ante-natal and post-natal services that can (largely) be delivered outside of the hospital.

The stresses on existing maternity services in Australia are typical of those in many other developed nations, including:

  • Excessive caesarean rates – Australia has a caesarian rate three times above World health Organsiation (WHO) recommendations.
  • Unplanned presentation of complex cases, including emergency caesarians – Hospital based maternity services are placed under acute strain when ‘unregistered’ mothers-to-be arrive (unexpectedly) or when handling complex cases. The early identification of births which might be ‘non-routine’ and complex is therefore essential for service optimisation.
  • Geographical factors – Limited obstetric services in rural areas and wide geographic catchment areas often centered on a single hospital birthing centre.
  • Cultural factors – Difficulties in service delivery for multicultural and non-English speaking groups, including indigenous populations.
  • Prenatal nutrition
  • High rates of perinatal depression – This is a major concern. Each year approximately 15% of new mothers in Australia experience perinatal depression.

Effective use of Information and Communication Technologies (ICT), with some service re-design, could improve service quality, reach and the overall efficiency and effectiveness of peri-natal services. 

I outline below how internet and ‘Web 2.0’ technologies, in particular social networking and collaboration tools, could be used to augment physical face-to-face activity by providing maternity support services online. This ‘virtual’ approach can offer mothers and mothers-to-be convenient, multichannel access to some midwife support services  and these services can delivered in a customised and segmented manner.  

A virtual maternity service would require the following basic service features:

  • Registration, initial assessment  and service delivery planning.
  • A self-service/standard support option.
  • An intensive support option.

Typical functions could include:

  • Information Access.
  • An interactive website built using Web 2.0 and social networking technologies on the open internet. Information resources will be available 24 X 7 to mothers, fathers and their families, in particular there will be specific information for grandparents.
  • Online educational videos pre and post birth (c.f. YouTube).
  • Online information packs pre and post birth.
  • Client registration details and secure access to specific areas of the wider Healthcare network.
  • Peer Group Interaction.
  • Clients will be able to contact each other via a permission based mechanism through dedicated chat rooms, (moderated) blogs and Wiki based services.
  • Clients can post their own information via freely available social networking services including video’s and pictures.
  • Client and midwife satisfaction surveys can be automatically administered.
  • Midwife Support and Referral Services.
  • Selected self-administered online assessment tools for routine data collection including family and medical history, smoking, alcohol and other issues associated with lifestyle.
  • Automation of referrals to appropriate services  – these would be made as required asynchronously.
  • Email support for routine correspondence – e.g. for bookings and confirmation – with SMS reminders for clinics.
  • Scheduled follow-up: physical and/or virtual video call contact (as required or preferred) between the mother and a midwife.  Particularly for mothers who are geographically or socially isolated.
  • Care Management.
  • Clients with special conditions would have an electronic care plan linked to the midwife containing alerts, referrals and care process steps. 
  • Generation of an electronic pregnancy record.

There are likely to be three environments from which the virtual maternity services would be accessed:

  • From home:  for mothers who have access to a home PC and a mobile phone (over 75%  of Australian mothers fall into this category).
  • From the clinic or community library or community centre – for mothers without home access.  Such mothers could access the virtual drop-in clinic or scheduled midwife consultations at set times from (appropriately private) community facilities.
  • From the hospital or birth centre, for example via a dedicated virtual maternity workstation.

The service features and system functionality outlined above can deliver significant efficiency and quality improvements in (at least) three broad areas and these improvements can be achieved within existing workforce constraints. 

The adoption of a self-service support model for ‘standard’ low risk clients enables the redistribution of midwife effort that is needed for a  sharper focus to be given to those clients with the greatest needs.   The ‘electronic reach’ to mothers, in particular the opportunity for real-time online interactions and the provision of trusted, high quality information (within the context of a supportive relationship established physically during the birth process) can improve maternal education, clinic attendance rates and regulatory compliance . 

Specific clinical and process benefits will vary considerably by country and region.  An initial high level analysis suggest the following:

  • The incidence of unregistered (unidentified and unexpected) mothers and, as a subset, those with complex cases being booked for birthing services will significantly reduce.
  • The rationalisation and segmentation of services enabled  by mixing on-line and physical services will  deliver a ‘significant improvement’ in  the efficiency and effectiveness of the maternity care team.  This improvement arises mainly from improved collaboration.
  • Antenatal and post natal service reach will be significantly increased.
  • Improved rates of breast feeding and the subsequent contribution to improved baby health.
  • Staff productivity improvements.

Fundamentally, ‘Virtual Maternity’ – delivering support to all mothers through the deployment of Web2.0, Social Media and other information and communications technologies –  is about modernising maternity services, bringing them into the ‘information age’.  Implementing  virtual maternity services will require the redesign of current clinical processes and pathways but,  by enabling maternity care teams to focus on the cases of greatest need, virtual maternity  services will raise the overall standard of maternity care. 


Michael Gill is Director, Internet Business Solutions Group, Cisco Systems Inc. Currently, he is deeply involved in matters health from two unique perspectives: how connectivity can improve health outcomes and using Internet technologies for chronic care. He maintains a strong interest in the use of internet technologies in the areas of general nursing, maternity, aged care and mental health. Michael holds a degree in Statistics and Sociology and post graduate studies from the Australian National University. Michael is also Chair of the Australian National Consultative Committee on Electronic Health. In 2009 he chaired the GAP – Australian Centre for Health Research Health Congress held in Parliament House, Victoria.




  1. Jillian Clarke

    February 3, 2012 at 11:09 am

    Virtual maternity services

    Hi Michael, I have just started a 6 month project to virtualise maternity services at Caboolture hospital in QLD, Australia. Finding your blog & 2011 article – Virtual maternity care was very timely indeed. I would love the opportunity to chat with you and will attempt to contact you next week.  I have attched the details of my blog, if your interested.

    Regards Jillian Clarke