For almost a hundred years, prenatal care in the U.S. has followed a predictable rhythm: 12 to 14 in-person visits, spaced like clockwork, oftentimes regardless of a patient’s risk, resources, or preferences. But as digital tools become integral to modern care delivery — and as patients increasingly ask for flexibility — that one-size-fits-all approach is finally being reconsidered.
In today’s Telehealth Tuesday article we explore the depth of the maternal health problem — and offer digital health solutions that could at a minimum alleviate the hardship conditions many expecting mothers and fathers are facing. In 2025, in America.
The death of Birthing Units
The disparity between urban and rural couldn’t be more pronounced as in the statistics of maternal mortality from 2011 to 2016: A 63% higher rate of deaths per 100,000 live births in rural (23.8) vs. large metropolitan (14.6) counties.
Compare that with Western European countries: Here, the maternal mortality rate (using data from 2000-2020) ranges from 2 in Norway, 3 in Spain, and 4 in Germany to 7 in Switzerland, 8 in France, and 10 in the UK.
Now take the state of Maine: According to a 2024 article in the Maine Monitor over the past decade “nine hospitals have closed or announced plans to close their birthing units”. Now, “roughly half of Maine’s 36 hospitals do not offer birthing services”.
Nationwide, according to a study published in JAMA in December 2024, “between 2010 and 2022, there were 537 hospitals that lost obstetrics, split between rural hospitals (238) and urban hospitals (299).”
The reasons are manifold — cost cutting measures, shrinking birth rates, workforce shortages and the resultant difficulty of keeping obstetricians fulltime engaged.
And in light of all of this, we are holding on to a prenatal protocol that, according to the American College of Obstetricians and Gynecologists (ACOG), was first developed in the 1930s.
But in April of 2025, ACOG issued new clinical consensus guidance that encourages a new way of thinking: tailored prenatal care models that adjust visit frequency, content, and modality — including telehealth — based on patient needs and circumstances. It’s a signal that hybrid maternity care is no longer experimental. It’s expected.
Guidance alone, however, won’t deliver better outcomes. That will depend on how well we execute — and who we design and reimagine care delivery for.
Clinical Backing for Hybrid Models
ACOG’s 2025 guidance affirms what many digital health innovators have long advocated: care can be both flexible and evidence-based. Telehealth visits are clinically appropriate — and often preferred — for:
-
Initial counseling and goal setting
-
Mental health and substance use screening
-
Lactation support
-
Postpartum care and contraception counseling
The challenge is not just limited to birthing units. It’s also access to prenatal and postpartum care. According to an OBGYN Nurse Practitioner in rural West Virginia, one of her expecting moms walked 7 miles to make it to her routine prenatal visit. In the middle of summer.
For low-risk pregnancies, a hybrid model with fewer in-person visits can maintain safety (or in the case of the expecting mother mentioned above, create safety) and enhance patient satisfaction. And with remote patient monitoring (RPM) — especially for blood pressure and glucose tracking — care teams can detect early warning signs of preeclampsia or gestational diabetes, potentially avoiding complications or hospitalizations.
But this is more than a care redesign — it’s a systems challenge.
From Guidance to Ground Game
A few years ago, I wrote about the promise of “connected maternal care” as more than a convenience — it’s a strategy to close longstanding gaps in access, equity, and patient engagement. That vision is more urgent today than ever.
In practice, successful hybrid prenatal care models require:
-
User-friendly technology that creates enjoyable virtual experiences for clinicians and patients alike
-
Clear clinical criteria for each modality: what’s possible virtual, what’s required to be in-person — and why
-
Training and support for both clinicians and patients in using telehealth tools
-
Patient-centered design that meets cultural, linguistic, and accessibility needs
These aren’t tech problems. They’re care delivery process problems — and they demand intentional solutions.
Equity Is the Non-Negotiable
Both ACOG’s guidance and on-the-ground experience point to a key truth: digital care can widen disparities if we’re not careful.
Low-income patients, rural communities, and individuals with disabilities or limited English proficiency are often the least likely to have access to:
-
Reliable broadband
-
Private spaces for virtual visits
-
Digital literacy support
-
Remote monitoring devices
If hybrid prenatal models default to virtual without addressing these gaps, we risk entrenching the very inequities we aim to solve. But done right, connected care can actually expand access—especially for postpartum patients who face travel, work, or childcare barriers.
Designing for Flexibility, Delivering with Discipline
Personalized virtual prenatal care doesn’t mean ad hoc or unstructured care. It means smart, coordinated, and responsive care that adapts to the person and their situation — not the other way around, requiring the expecting mom to adhere to the system.
That shift in approach takes:
-
Policy support: reimbursement parity, licensure clarity, and Medicaid waivers that support RPM and hybrid visits
-
Workflow integration realized in technology: seamless handoffs between virtual and in-person care
-
Virtual team-based models: OBs, midwives, nurses, social workers, and doulas working in sync, even if they are not in the same building.
-
Shared decision-making: patients as partners in designing their care plan — virtual should be a choice.
This model is not about reducing visits. It’s about wielding the virtual care delivery modality as a clinical tool — so we can make every touchpoint count.
Looking Ahead
Hybrid prenatal care isn’t a luxury. It’s a necessity for 21st-century care models, especially given the maternal health deserts the current trend is creating at an alarming rate. ACOG has given us the green light. Patients are asking for it. The technology exists. What is the system waiting for?
The real test now is whether organizations will employ the expertise needed to craft the policies, build the workflows, select the technologies, and establish the support needed to create and implement a high-performing, sustainable maternal care delivery system that is flexible enough to personalize and disciplined enough to scale equitably.
Because the goal isn’t just better access. It’s better outcomes — for the previous, current, and next generation: the grandparents, parents, and their children.
How can you increase the use of telehealth to deliver better maternal care? How do you get your clinicians to embrace video visits and remote physiological monitoring?
Let’s talk — I’d be happy to share with you how we’re helping teams implement this model.
To receive articles like these in your Inbox every week, you can subscribe to Christian’s Telehealth Tuesday Newsletter.
Christian Milaster and his team optimize Telehealth Services for health systems and physician practices. Christian is the Founder and President of Ingenium Digital Health Advisors where he and his expert consortium partner with healthcare leaders to enable the delivery of extraordinary care.
Contact Christian by phone or text at 657-464-3648, via email, or video chat.
