Mothers Back Virtual Postpartum Care for Convenience - but Draw a Line When Babies Are Unwell

The pandemic forced a rapid experiment in virtual maternity care. Across the UK and many other countries, face-to-face postpartum appointments were replaced almost overnight with telephone and video consultations, driven by infection control necessity rather than evidence about effectiveness. That experiment has not entirely ended. Many elements of virtual maternity care have persisted past the public health emergency that created them, raising the question of whether women's actual experiences support continuing them.

Researchers at the University of Liverpool and King's College London analyzed qualitative responses from 1,036 women who delivered babies during the pandemic, drawing on data from the COVID Symptom Study Biobank. The findings, published recently, describe a population that was largely pragmatic about virtual care - valuing its convenience for routine needs - but that held clear limits around when remote appointments felt adequate versus insufficient.

What 1,466 qualitative responses reveal

The study used an online questionnaire completed between September and December 2021 by participants in the King's College London/ZOE COVID Symptom Study. Of 1,036 women who reported delivering at least one live baby during the pandemic, 821 provided 1,466 qualitative text responses describing their experiences of care delivered in person (550 responses), by video (125 responses), or by telephone (791 responses).

The emphasis on qualitative responses - women's descriptions of their experiences in their own words - rather than only ratings or binary satisfaction scores gives the study texture that numerical surveys alone cannot provide. Content analysis of those free-text responses identified recurring themes across care modalities.

Overall, mothers described virtual care positively in terms of practicalities. Virtual appointments reduced travel time and childcare burden, offered faster scheduling, and fit more easily around the irregular rhythms of life with a newborn. Many women reported that telephone or video consultations met their needs in routine situations - medication questions, breastfeeding concerns, minor emotional support.

Where virtual care fell short

Two recurring concerns qualified that broadly positive picture. The first was about escalation: women valued virtual care most when they trusted they could quickly access an in-person review if a concern proved serious enough. When that escalation pathway was clear and functional, virtual appointments felt safe. When it was unclear or slow, the remote consultation felt riskier.

The second concern was more fundamental: physical examination. When babies were unwell - not merely for routine check-in, but when mothers observed symptoms that worried them - telephone and video consultation alone was widely perceived as inadequate or potentially dangerous. Assessing an infant's skin color, muscle tone, breathing pattern, and hydration requires physical presence. Parents know this intuitively, and the study found that this intuition translated into explicit dissatisfaction with virtual-only options in those situations.

The case for tiered, personalized care

The research team's recommendation is a tiered model of postpartum care rather than a binary choice between fully virtual and fully in-person provision. In this model, the default mode of an appointment - virtual or in-person - would be matched to the clinical and personal context: the mother's history, the baby's condition, the nature of the concern, and the mother's own preferences.

Crucially, any virtual consultation would operate with a clear and rapid escalation protocol to physical examination when warranted. Women in the study were not opposed to virtual care as a category; they were opposed to virtual care that could not quickly become in-person care when necessary.

The researchers note that clinical outcomes from virtual maternity care in certain contexts appear inferior to in-person care, based on evidence beyond this study. Efficiency gains from remote appointments need to be weighed against those outcome data, not assumed to offset them.

What the data cannot tell us

The study's sample comes from women who volunteered to participate in a COVID symptom tracking study - a self-selected group likely to be more health-engaged and technologically comfortable than the overall population of new mothers. Women with less digital literacy, those with language barriers, and those in socioeconomically disadvantaged circumstances may have had qualitatively different experiences with virtual care that this dataset does not fully represent.

The data comes entirely from the pandemic period, when virtual care was often the only option available rather than a choice. Women's responses reflect experiences under constraint. Their preferences in a world where both options are readily available might differ from what this study can measure.

The study also does not measure clinical outcomes directly - it captures perceptions of adequacy, not objective assessments of whether diagnoses were missed or treatments delayed. Perceptions and outcomes can diverge in both directions.