Virtual Maternity Ward for women with pregnancy complications: pilot evaluation

On October 7th 2025, the Royal Hospital for Women (RHW) in Randwick, NSW is launching a new model of maternity care called the 'Virtual Maternity Ward' (VMW) for women with pregnancy complications such as: a diagnosis of gestational hypertension, threatened premature labour (TPL), and/or premature pre-labour rupture of membranes (PPROM). Women who have traditionally required inpatient admission, will be offered the opportunity to be cared for at home by midwives and medical officers from the RHW. The midwifery team will consult with women regularly and collaborate with medical officers and escalate women’s care when required. The new model will combine remote blood pressure monitoring, a midwifery home visiting program and periodic outpatient visits to RHW. A Virtual Maternity Ward Working Group was established at RHW in June 2024, membership of which includes a multidisciplinary group of clinicians, managers, researchers, digital health experts and women with the ‘lived’ experience of receiving complex pregnancy care. This study, the ‘Virtual Maternity Ward Pilot Evaluation’ will evaluate the model of care, in a cohort of women who have been admitted to the VMW and are being cared for at home (n=20), partners/support people (n=15-20), health service managers (n=3-5) and clinicians (5-10). Women and their partner participants will be recruited from those already admitted to the Virtual Maternity Ward by their treating clinician. Women participants will not be asked to participate in any procedures other than their standard course of treatment, as agreed to with their treating clinician. Hence, this study is OBSERVATIONAL only. The aim of the ‘Virtual Maternity Ward Pilot Evaluation’ is to evaluate the model of care from the perspectives of technical, financial, operational, and logistic feasibility, and to pilot test the methods to inform the refinement of the model and design of future larger studies. Data collected will include 1) semi structured interviews, 2) cost diaries and 3) data collected from medical records, all collected after participants' discharge from VMW. 1) Semi structured interviews will be conducted by a GCP trained research midwife/PhD Candidate who will ask women participants about their views and experiences of being cared for at home in the Virtual Maternity Ward. Interviews are expected to take 20-30 minutes and will be conducted via an online platform or phone, according to the participants’ preferences Semi structured interviews with clinicians and managers will be also conducted, after the last participant has been discharged from the VMW. The interview will ask clinicians about their views and experiences of providing care in the Virtual Maternity Ward model. Interviews are expected to take 20-30 minutes and will be conducted at RHW in a private space, or by phone, according to the participants’ preferences. 2) A pilot costing study will be included at both individual and hospital levels. To identify the costs of the Virtual Maternity Ward, payroll data identifying the salary costs of Virtual Maternity Ward and standard care midwives during the trial time will be extracted to identify amount of standard care midwife time required to deliver virtual episodes of care. To identify additional background health service use, electronic medical records will be extracted to identify participating women’s inpatient, outpatient and emergency department health service use from onset of antenatal care through to 6 weeks postpartum. We will also establish out of pocket costs for women through cost diaries. 3) Data extraction form medical records: • Routinely collected perinatal outcomes data – eMaternity o Demographic information including age, gestation at birth, parity, ethnicity o Reason for admission o Mode of birth – normal vaginal birth, emergency caesarean section, instrumental birth o Medical and obstetric history o Outpatient presentations to hospital o Admissions as inpatients to hospital o Length of admission to VMW o Apgar scores below 7 at 5 minutes o NICU admission of over 48 hours o Length of stay in hospital