Hans van den Heuvel

DISCUSSION The aim of this qualitative study was to compare the experiences of high risk pregnant women during hospital admission or telemonitoring. Although the uncertainty of high risk pregnancy remains an intense experience for both women and their families, telemonitoring seems to allow them to experience this considerably less stressful compared to hospital admission. Complications of pregnancy come with feelings such as fear and frustration, especially while being admitted to the hospital. As antenatal anxiety and depressive symptoms are common among obstetric inpatients, they increase the risk of post partum depression and adversely affect infant and child development. 21 The hospital admission group in our study reported a growing sense of boredom and anxiety during their admission, which is in line with earlier work on hospitalization during pregnancy: women report concerns for the health of their future baby, feeling of helplessness and loneliness while being separated from home, family and friends .10-12 Lack of privacy, when admitted, affected our patients’ contact with health care providers, partner, kids (if present) and other family and friends. In contrast, the experiences at home in our telemonitoring group were more positive: although they still felt like a patient at times, the TM group responded that the comfort of their own home and bed was very pleasant. In this group, only a minority of participants reported being anxious at times at home, while not having a physician or nurse nearby. Findings from our and previous studies reveal that telemedicine could provide important psychological benefits during pregnancy. 22 When women’s perception of high risk pregnancy and quality of care experience improve with telemonitoring, this may contribute to an increase in quality of life and reduction of antenatal anxiety and its consequences for mother and child. O’Brien et al. and Rauf et al. described the experiences of remote fetal monitoring during outpatient induction of labour in a low risk pregnancy group in 2009-2010. 23,24 Their study made use of wireless fetal-maternal monitoring device for remote non-invasive trans- abdominal monitoring of fetal heart activity, and electromyography for uterine activity. The participants concluded that telemonitoring during induction offered them freedom and familiarity of home environment, but feelings of reassurance depended on effective communication with hospital staff. These observations are in line with our findings, as our participants reported a positive effect of staying at home while being monitored daily by familiar midwives within the Obstetric Telemonitoring Team, opposed to tridaily changes in hospital staff on maternity ward. The experiences of our telemonitoring group correspond with trends of eHealth use in perinatal care: women of reproductive age are interested in e-Health, because of their CHAPTER 8 136