Across rural America, maternity units have shuttered, OB-GYNs are in short supply, and long drives for routine prenatal visits are common. Even as the U.S. maternal mortality rate eased from its pandemic spike, the national picture still masks severe geographic disparities—especially for rural families. Telehealth isn’t a cure-all, but it’s one of the most practical tools we have right now to close the distance between pregnant patients and the care they need.

The access gap—by the numbers 

The maternal mortality rate fell to 18.6 deaths per 100,000 live births in 2023, down from 32.9 in 2021—the worst year of the pandemic—but still far above peer nations and with stark inequities by age and race. These are national figures; risks are higher where access to care is thinner.

Meanwhile, maternity care deserts—counties with no hospital or birth center offering obstetric care and no OB providers—touch more than 2.3 million women of reproductive age and about 150,000 births each year. Most of these deserts are rural, and families living in them receive later and less prenatal care and experience more preterm births.

What telehealth can (and can’t) do 

Telehealth in pregnancy generally falls into two buckets:

1. Virtual visits (synchronous care): scheduled video or audio encounters that replace or supplement in-person prenatal appointments, mental-health counseling, lactation support, and postpartum check-ins.
2. Remote patient monitoring (RPM): home devices that stream readings (blood pressure cuffs, weight scales, glucose meters) back to a clinic. RPM matters because hypertensive disorders and diabetes drive maternal morbidity; earlier detection and stepped-up management save Evidence—still growing—suggests that RPM programs can catch hypertension sooner and maintain tighter control between visits.

What telehealth can’t do: replace all hands-on care. High-risk scans, labs, vaccinations, and delivery still require brick-and-mortar access. The goal is not to eliminate in-person care, but to right-size it— reserving travel for what truly must be done on site and making everything else available at home.

A prenatal care model built for distance

Professional guidance has shifted away from a century-old, one-size-fits-all calendar of 12–14 in-person prenatal visits. In 2025, the American College of Obstetricians and Gynecologists (ACOG) endorsed tailored prenatal care, blending virtual and in-person touchpoints based on patient need, risk, and preference. This approach can lower barriers for rural families (fewer road miles and work absences) while preserving safety through smart escalation triggers.

A practical rural schedule might look like this:

• Early pregnancy intake (virtual): medical history, social needs screening, choice of place of birth, and education on warning signs.
• Baseline in-person visit: physical exam, labs, dating ultrasound, and training on home BP monitoring.
• Alternating virtual and in-person touchpoints: routine counseling, review of vitals and symptoms via remote devices; in-person for anatomy scan and tests that require clinic facilities.
• Postpartum care (hybrid): early virtual check for mood, lactation, hypertension; in-person visit at 6–12 weeks or sooner if complications arise.

Where telehealth moves the needle

• Hypertension & diabetes in pregnancy: Regular home BP checks with nurse follow-up can prompt earlier treatment and reduce severe disease. For gestational diabetes, uploading glucose logs between visits supports faster medication titration.
• Mental health: Virtual behavioral-health visits close a major gap for perinatal depression and anxiety—conditions for which rural therapist supply is especially thin. (Telepsychiatry also helps with medication management across state lines when licensure allows.)
• Health education & engagement: Shorter, more frequent virtual touchpoints improve adherence in populations for whom travel costs, child care, or shift work make clinic visits hard to keep.
• Fourth-trimester care: Telelactation, wound checks, blood-pressure surveillance, and contraception counseling reduce avoidable emergency visits and catch complications early, when intervention is simpler.

Policy and funding landscape

Federal programs have put real dollars behind rural maternal telehealth:

• HRSA’s Rural Maternity and Obstetrics Management Strategies (RMOMS) funds networks that integrate telehealth, transportation, and workforce supports to expand rural obstetric access.
• HRSA’s Telehealth Network Grant Program builds capacity for clinical telehealth networks serving rural communities.
• Dedicated telehealth research centers help evaluate what works and for whom, so rural systems aren’t left guessing.

On the clinical standards side, ACOG outlines the guardrails—licensure, credentialing, documentation, privacy, and emergency planning—needed to deliver obstetric telehealth safely.

The rural realities: barriers to solve

• Broadband and device access: Video visits and RPM depend on connectivity and reliable Phone-only options help, but they’re not equivalent for all needs. (Policymakers should align broadband investments with maternal-health priorities in care deserts.)
• Licensure and reimbursement patchwork: Rural catchment areas often cross state Variations in licensing, facility credentialing, and coverage rules make cross-border maternity telehealth harder than it needs to be. Standardizing coverage for prenatal/postpartum telehealth—including RPM—would stabilize programs.
• Workforce & unit closures: Telehealth can stretch limited clinicians farther, but it can’t keep a labor-and-delivery unit open on its Payment reforms and rural-hospital stabilization are still essential.
• Digital literacy & trust: Programs succeed when they are simple, culturally attuned, and backed by community health workers who can onboard families to devices and troubleshoot.

What high-functioning rural programs share

1. Hub-and-spoke networks: A regional hospital (“hub”) supports rural clinics (“spokes”) with 24/7 consults, shared protocols, and tele-MFM (maternal-fetal medicine) coverage.
2. Standardized remote kits: Bluetooth BP cuffs, scales, and—when indicated—glucometers, with clear thresholds that trigger nurse outreach or same-day in-person evaluation.
3. Integrated mental-health and social care: Warm handoffs to telebehavioral health, substance-use treatment, WIC, and transportation supports reduce no-shows and improve outcomes.
4. Data feedback loops: Dashboards track missed readings and visits, postpartum BP control, and depression screens—so teams can intervene fast.

Measuring impact—and being honest about the evidence

The evidence base is promising but still maturing. Trials and observational studies show better detection and management of hypertensive disorders with RPM and no detriment from substituting some virtual for in-person visits in low-risk pregnancies—provided escalation pathways are clear. We need larger rural-specific studies comparing blended models on outcomes like severe maternal morbidity, preterm birth, patient experience, and cost. Until then, the case for telehealth in rural maternity care rests on a pragmatic combination of early evidence, common sense about travel burdens, and equity.

A near-term roadmap

• Adopt ACOG’s tailored prenatal-care framework and publish a local schedule (which visits are virtual in-person, and why).
• Stand up RPM for hypertensive disorders with same-day nurse callbacks for red-flag readings, and a clear pathway to triage or L&D.
• Leverage HRSA funding to equip clinics, train staff, and create hub-and-spoke coverage with tele-MFM consults.
• Prioritize postpartum telehealth, including virtual mood checks at 2 weeks and BP monitoring for those with pregnancy-related hypertension.
• Track equity metrics (appointment completion, time to treatment, broadband gaps) and publish results to build community trust.

Rural families shouldn’t have to choose between a day’s wages and a prenatal check, or drive two hours to ask a five-minute question that could have been answered at home. With the right mix of policy support, clinical standards, and community partnership, telehealth can convert miles into minutes—bringing safer pregnancies and healthier births within reach for millions of Americans who live far from traditional maternity services. The recent decline in national mortality is good news, but sustaining that progress will depend on whether we deliver care where people actually are.