Polish maternity services in times of crisis: in search of quality care for pregnant women and their babies

Midwives' adaptation of their practice, role, and scope to ensure access to sexual and reproductive services during humanitarian crises: A scoping review

PROBLEM

Limited research has examined and synthesized the adaptation of midwives and midwife-led interventions during crises.

BACKGROUND

Evidence suggests that midwives are essential to respond to sexual and reproductive health care needs during disruptive times, and that they adapt to continue to provide their services during those circumstances.

AIM

To map the adaptations of midwives when providing care during crises globally. Secondary objectives include identifying which midwives adapted, what services were adapted and how, and the demographic receiving care.

STUDY METHODS

Scoping review using Levac's modifications of Arksey and O'Malley's methods. Publications and grey literature, in English and Spanish, with no limitations based on study design or date were included. Data was extracted and mapped using Wheaton and Maciver's Adaptation framework.

FINDINGS

We identified 3329 records, of which forty-two were included. Midwives' prior training impacted adaptation. Midwives adapted to the COVID-19 pandemic, epidemics, natural disasters, and World War II. They adapted in hospital and community settings around the provision of antenatal, labor and birth, postpartum, and contraceptive care. However, no specific data identified population demographics. Midwifery adaptations related to their practice, role, and scope of practice.

CONCLUSION

The limited available evidence identified the challenges, creativity, and mutual aid activities midwives have undertaken to ensure the provision of their services. Evidence is highly concentrated around maternal health services. Further high-quality research is needed to provide a deeper understanding of how midwifery-led care can adapt to guide sustainable responses to ensure access to sexual and reproductive health services during crises.

Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis

BACKGROUND

Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom - a region of high ethnic diversity with varied levels of social complexity.

METHODS

We conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research.

ANALYSIS & FINDINGS

Maternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) 'Reflective decision-making'; 2) 'Pragmatic decision-making'; and 3) 'Reactive decision-making'. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decision-making, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service.

CONCLUSIONS

Decision-making within maternity care was found to take three forms - where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and change-making in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation.

The "Blessing" of Pregnancy? Barriers to accessing adequate maternal care in Poland: A mixed-method study among women, healthcare providers, and decision-makers

OBJECTIVE

All women should have access to adequate and respectful maternal care to maximise health outcomes. In Poland, there is a mismatch between good maternal health indicators and poor care experiences. This study examined stakeholder views on access to adequate maternal care in Poland in terms of availability, appropriateness, affordability, approachability, and acceptability.

DESIGN

A mixed-methods study.

SETTING

Online survey and online semi-structured interviews conducted between March 2021 and May 2021.

PARTICIPANTS

Five-hundred fifty-seven (557) women who recently gave birth in Poland, maternal care providers and decision-makers active in the field of maternal health.

FINDINGS

The main barriers to adequate care were inappropriate communication of maternal care providers, insufficient compliance with standards of care, over-medicalisation of childbirth and suboptimal engagement of women in care provision, and high levels of out-of-pocket spending on maternal care services. Other barriers included limited availability of maternal care providers, particularly midwives, and low reproductive health literacy in women.

KEY CONCLUSIONS

Provision of adequate and women-centred maternal care remains erratic, despite substantial care provision advancements in recent years. Addressing the barriers could substantially improve the experience of and access to adequate maternal care in Poland.

IMPLICATIONS FOR PRACTICE

Barriers identified in the survey with women largely converged with those highlighted in the interviews. In addition, maternal care providers and decision-makers provided context-specific information and explanation of the current state of maternal care system. Consequently, this study provides direction-setting information for policy and practice in Poland and other Central and Eastern European countries, which share similar shortcomings related to adequate maternal care provision.

Experiencing Pregnancy during the COVID-19 Lockdown in Poland: A Cross-Sectional Study of the Mediating Effect of Resiliency on Prenatal Depression Symptoms

The COVID-19 pandemic in Poland brought uncertainty, not only to the general population but also to women preparing for childbirth, which increased the risk of mental health illnesses during this special period of life. Resilience, which refers to positive adaptation or the ability to maintain good mental health, can be a protective factor against the development of psychiatric problems such as depressive symptoms. This study aimed to assess the protective role of resilience in the relationship of such risk factors as traumatic childbirth perception and pandemic-related pregnancy stress with prenatal depressive symptoms. The study was performed at the end of the first wave of the COVID-19 pandemic. A total of 80 pregnant women took part. A mediation analysis, an independent t-test, and a Pearson correlation analysis were conducted. The lower resilience group declared the inclusion of slightly more participants (n = 41; 51.2%); 39 women (48.8%) demonstrated a higher risk of prenatal depression. The analysis revealed a significant direct effect between pandemic-related stress and prenatal depression (βc = 0.285, SE = 0.05, t = 2.63, p < 0.05) as well as between pandemic-related stress and resilience (βa = −0.283, SE = 0.07, t = −2.61, p < 0.05) and between resilience and prenatal depression (βb = −0.585, SE = 0.07, t = −6.34, p < 0.001). After the introduction of resilience as a mediator, the strength of the relationship not only decreased, but also ceased to be statistically significant (βc′ = 0.120, SE = 0.04, t = 1.29, p = 0.19), which indicates that it was in a full mediation state (R2 = 0.39, F = 25.31, p < 0.001; Z = 2.43, p < 0.05). The results indicate that in pregnant women, a high level of resilience protects them from the effects of pandemic-related stress on perinatal depression symptoms.

Impact of the COVID-19 pandemic on maternity services in Europe: a mixed methods systematic review protocol

OBJECTIVE

This review will synthesize and integrate the best available evidence on the changes caused by the COVID-19 pandemic in access to and the provision of maternity services in Europe. The review will also consider health care professionals' experiences in providing maternity care during the COVID-19 pandemic in Europe.

INTRODUCTION

Governments and maternity services have introduced various protective sanitary and organizational measures to reduce the spread of COVID-19 and protect the global population, including health care professionals. Since March 2020, the number of publications on this topic has soared, yet little is known about the effect of the pandemic and the accompanying measures on access to and the provision of maternity care in Europe.

INCLUSION CRITERIA

The review will consider quantitative, qualitative, and mixed methods studies on the impact of COVID-19 on European maternity services. For the quantitative component, the review will consider studies evaluating maternity services outcomes across all types of maternity care settings. For the qualitative component, the review will consider studies exploring maternity health care providers' experiences and perceptions of the impact of the pandemic on care provided to women and their babies.

METHODS

Six bibliographic databases will be searched for published and unpublished studies since March 2020. Study selection, critical appraisal, data extraction, and data synthesis will follow JBI's segregated mixed methods approach. The quantitative component will be adapted to follow the JBI requirements for systematic reviews of etiology and risk.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42021283878.

Implementation of Public Health England Infection Prevention and Control Guidance in Maternity Units in response to the COVID-19 pandemic

Background

This study aimed to explore the successes and barriers to the implementation of Public Health England (PHE) infection prevention and control guidance in English maternity units during the COVID-19 pandemic.

Methods

Qualitative semi-structured interviews with obstetricians, midwives and neonatologists who worked in a maternity unit in England, UK, between March 2020 and July 2021. A thematic analysis was performed.

Results

Successes to the implementation of PHE guidance were related to existing infrastructure, training satisfaction, and organisational culture where subthemes considered the importance of a multidisciplinary approach, COVID-19 dedicated roles and hospital-wide communication. Barriers to implementation related to the applicability of the guidance with subthemes highlighting contradictions between updates, specialties and hospitals, undesirable timings and frequency of guidance updates, reductions in staff compliance and delayed implementation. Finally, the layout of some units made it difficult to implement various aspects of the guidance (e.g., social distancing), and many detailed issues related to information technology compatibility, a lack of availability and accessibility to appropriate personal protective equipment (PPE), and variations in testing arrangements between units.

Conclusions

This research provides information on the experiences of healthcare professionals working on maternity units during the COVID-19 pandemic. Findings illustrate the importance of effective hospital-wide communication and the need for consistent, easily understood guidance. These results will be used to inform the content of an expert panel consensus meeting.

Suspected Labour as a Reason for Emergency Medical Services Team Interventions in Poland—A Retrospective Analysis

The purpose of this study was to present the characteristics of Emergency Medical Services (EMS) team responses to calls regarding suspected labour in out-of-hospital settings in Poland. We performed a retrospective analysis of EMS team interventions in cases of suspected onset of labour outside a hospital setting. The analysis included 12,816 EMS team responses to calls regarding women in suspected labour in the period between January 2018 and December 2019. The mean age of the patients studied was 28.24 years (SD = 6.47). The majority of patients were at term (76.36%) and in their second pregnancy (29.96%). EMS teams were most often dispatched in the summer (25.95%) and in urban areas (63.26%). Most EMS teams were basic (68.99%) and interventions most often took place between 19:00 and 06:59 (63.14%). Significant differences were observed between preterm and term pregnant women attended by EMS teams in terms of variables such as the age of the patient, number of previous labours, history of miscarriage, presence of vaginal bleeding, time of year, location of call, type and composition of EMS team dispatched, urgency code and time of call, duration of intervention, selected emergency medical procedures performed and test results.

Effects of the Covid-19 pandemic on maternity staff in 2020 - a scoping review

In the spring of 2020, the SARS-CoV-2 virus caused the Covid-19 pandemic, bringing with it drastic changes and challenges for health systems and medical staff. Among the affected were obstetricians and midwives, whose close physical contact with pregnant women, women who recently gave birth, and their children was indispensable. In the obstetric setting, births cannot be postponed, and maternity staff had to adapt to assure obstetric safety while balancing evidence-based standards with the new challenges posed by the pandemic. This scoping review gives a comprehensive overview of the effecs the Covid-19 pandemic had on maternity staff. We followed the evidence-based approach described by Arksey & O'Malley: we searched several databases for English and German articles published between January 2020 and January 2021 that discussed or touched upon the effects the pandemic had on maternity staff in OECD countries and China. We found that structural challenges caused by the crisis and its subjective effects on maternity staff fell into two main topic areas. Structural challenges (the first main topic) were divided into five subtopics: staff shortages and restructuring; personal protective equipment and tests; switching to virtual communication; handling women with a positive SARS-CoV-2 infection; and excluding accompanying persons. The pandemic also strongly affected the staff's mental health (the second main topic.) Attempting to meet challenges posed by the pandemic while afraid of contamination, suffering overwork and exhaustion, and struggling to resolve ethical-moral dilemmas had severe negative subjective effects. Several studies indicated increased depression, anxiety, stress levels, and risk of post-traumatic stress symptoms, although the crisis also generated strong occupational solidarity. Care for pregnant, birthing, and breast-feeding women cannot be interrupted, even during a pandemic crisis that requires social distancing. Maternity staff sometimes had to abandon normal standards of obstetric care and were confronted with enormous challenges and structural adjustments that did not leave them unscathed: their mental health suffered considerably. Researchers should study maternity staff's experiences during the pandemic to prepare recommendations that will protect staff during future epidemics.

Women's Healthcare Services since the COVID-19 Pandemic Outbreak in Poland

The COVID-19 pandemic had a direct impact on the extent of guaranteed healthcare services. Many gynecologists', obstetricians', and midwives' offices were closed, laboratories suspended their activities, the collection of necessary tests was delayed, and women had to wait much longer for test results than they had to previously. General women's healthcare prophylactic programs were suspended or delayed. In 2020, screening financed by public funds covered less than one-seventh of the female population in Poland. As medical teams, professionals, clinicians, and scientists, we have been facing a challenge to help, protect, and care for one of the most vulnerable population groups, pregnant women. A significant part of that challenge has been in preventing the spread of severe COVID-19, along with other preventable diseases, among women who are pregnant, who are in labor, or who have recently given birth.

Pandemic Stress and Its Correlates among Pregnant Women during the Second Wave of COVID-19 in Poland

Background: The ongoing COVID-19 pandemic has created numerous stressful conditions, especially for vulnerable populations such as pregnant women. Pandemic-related pregnancy stress consists of two dimensions: stress associated with feeling unprepared for birth due to the pandemic (Preparedness Stress), and stress related to fears of perinatal COVID-19 infection (Perinatal Infection Stress). The purpose of our study was to elucidate the association between various factors-sociodemographic, obstetric, pandemic-related, and situational-and pandemic stress in its two dimensions during the second wave of the COVID-19 pandemic in Polish pregnant women. Methods: A cross-sectional study with a total of 1119 pregnant women recruited during the second wave of the COVID-19 pandemic in Poland (between November 2020 and January 2021). Participants were recruited via social media to complete an online study questionnaire that included sociodemographic, obstetric, situational, and COVID-19 pandemic factors, as well as the Pandemic-Related Pregnancy Stress Scale (PREPS). Results: Nearly 38.5% of participants reported high Preparedness Stress; 26% reported high Perinatal Infection Stress. Multivariate analyses indicated that lack of COVID-19 diagnosis, higher compliance with safety rules and restrictions, and limited access to outdoor space were independently associated with moderate to severe levels of Infection Stress. Current emotional or psychiatric problems, nulliparity, limited access to outdoor space, and alterations to obstetric visits were independently associated with moderate to severe Preparedness Stress. Conclusion: Study findings suggest that particular attention should be focused on the groups of pregnant women who are most vulnerable to pandemic-related stress and therefore may be more prone to adverse outcomes associated with prenatal stress.