Hans van den Heuvel

8 frequent use of smartphone, apps, and online searches for pregnancy education. 15 Literature reviews conclude that health outcomes for eHealth interventions in perinatal care are generally positive, resulting in lifestyle and mental health improvement or providing multiple other advantages while health outcomes were found equal (e.g. in gestational diabetes). 15 25 26 Social changes are demanding a shift to home-based patient-centered care, and remote monitoring provides flexibility to both physicians and patients to decrease the demand for more hospital personnel or clinic space. 27 Both groups embrace telemedicine because of its usability, tendency to improve access to care, communication and outcomes while decreasing clinic visits and travel time. 11 These changes are assumed to have profound cost-saving effects in favor of telemonitoring, an important aspect regarding the ever- increasing health care costs – and workloads. 14 Compared to usual care, possible additional time associated with telemonitoring (instructions for patients, daily telephone contact, and weekly outpatient visits) should be explored in cost-effectiveness studies. Organizations will potentially benefit from telehealth as it decreases missed appointments, waiting times and re-admissions, although reimbursement lacks to progress due to legislation and swift technological advancements. Implementation of (fetal) telemonitoring in pregnancy is not studied extensively, and further research is needed on the effectiveness on both health outcomes and costs of this innovative strategy. Furthermore, not much is known about the ethical considerations that are necessary for successful implementation. 28 Incorporating patients’ preference is important to ensure that care is provided based on the individual patient’s perspective, preferences, and needs. The findings of this study provide some suggestions for implementation from the patient perspective: these include the demand for patient education and a clear antenatal management plan, adequate participant selection for telemonitoring, daily contact (by telephone or teleconferencing) by a select group of staff for a continuum of care (as our Obstetric Telemonitoring Team) and weekly hospital visits. Regarding safety, it is recommended to work using strict protocols including equipment manuals for care providers and patients and a limit for travel time to the hospital. This study is one of the first to report on women’s perspectives on antenatal monitoring from home during high risk pregnancy. A strength of this qualitative study is the inclusion of both hospitalized women and women from the telemonitoring pilot within one center. Although there is existing knowledge of personal effects of hospitalization during pregnancy, these effects can differ due to different protocols of daily practice in different hospitals, for example visitation policies on ward, the number of private and shared rooms and other hospital facilities. By directly comparing both groups from our center, we were able to outline the different experiences and perspectives in these two groups. Our results must be interpreted in the context of the following limitations. Selection bias USER EXPERIENCES OF HOME-BASED TELEMONITORING IN PREGNANCY 137