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Gravesteijn BY, Boderie NW, van den Akker T, Bertens LCM, Bloemenkamp K, Burgos Ochoa L, de Jonge A, Kazemier BM, Klein PPF, Kwint-Reijnders I, Labrecque JA, Mol BW, Obermann-Borst SA, Peters L, Ravelli ACJ, Rosman A, Been JV, de Groot CJ. Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study. Public Health 2024; 235:15-25. [PMID: 39033718 DOI: 10.1016/j.puhe.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/29/2024] [Accepted: 06/17/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVES The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy-related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March-June 2020) on provision of maternity care and maternal pregnancy-related outcomes in the Netherlands. STUDY DESIGN National quasi-experimental study. METHODS Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010-2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020. RESULTS A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, -3% [-5%,-0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [-1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, -1% [-2%, +0%]), obstetric anal sphincter injury (2%, +0% [-0%, +1%]), episiotomy (21%, -0% [-2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, -0% [-1%, +1%]). CONCLUSIONS During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.
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Affiliation(s)
- B Y Gravesteijn
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction & Development, Amsterdam, the Netherlands; Department of Public Health, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - N W Boderie
- Department of Public Health, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - T van den Akker
- Department of Obstetrics & Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands; Athena Institute, VU University, Amsterdam, the Netherlands; Department of Public Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - L C M Bertens
- Department of Obstetrics & Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - K Bloemenkamp
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Burgos Ochoa
- Department of Obstetrics & Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - A de Jonge
- Department of Midwifery Science, Amsterdam University Medical Center, Amsterdam, the Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; Department of Primary Care and Long-Term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - B M Kazemier
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction & Development, Amsterdam, the Netherlands; Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P P F Klein
- Department of Health Economics and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - I Kwint-Reijnders
- Department of Obstetrics & Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands; Care4Neo, Neonatal Patient and Parent Advocacy Organization, Rotterdam, the Netherlands
| | - J A Labrecque
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - B W Mol
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - S A Obermann-Borst
- Care4Neo, Neonatal Patient and Parent Advocacy Organization, Rotterdam, the Netherlands
| | - L Peters
- Department of Midwifery Science, Amsterdam University Medical Center, Amsterdam, the Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, the Netherlands; Department of Primary Care and Long-Term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - A C J Ravelli
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction & Development, Amsterdam, the Netherlands; Department of Medical Informatics, Amsterdam Public Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - A Rosman
- Perined, Utrecht, the Netherlands
| | - J V Been
- Department of Public Health, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Obstetrics & Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands; Division of Neonatology, Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - C J de Groot
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction & Development, Amsterdam, the Netherlands
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Olander P, Berglin L, Naurin E, Markstedt E, Zheng LR, Linden K, Sengpiel V, Elden H. The impact of exclusion due to COVID-19 restrictions on partners' satisfaction with Swedish hospital postnatal ward care: A multi-methods approach. Birth 2024; 51:612-619. [PMID: 38288558 DOI: 10.1111/birt.12816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/25/2023] [Accepted: 01/12/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND To prevent the spread of SARS-CoV-2, hospitals around the world adopted protocols that, in varying ways, resulted in the exclusion of partners from hospital postnatal care wards. The objective of this study was to examine the effect this exclusion had on partners' satisfaction with postnatal care. METHODS An online survey (the Swedish Pregnancy Panel) including free-text comments was conducted before and during the first wave of the COVID-19 pandemic; partners of pregnant women were recruited at an early ultrasound appointment and followed until 2 months after childbirth. Data were linked to the Swedish Pregnancy Register. RESULTS The survey was completed by 524 partners of women who gave birth during the pandemic and 203 partners of women who gave birth before. Partners' satisfaction with hospital postnatal care dropped 29.8 percent (-0.94 OLS, 95% CI = -1.17 to -0.72). The drop was largest for partners of first-time mothers (-1.40 OLS, 95% CI = -1.69 to -1.11), but unrelated to clinical outcomes such as mode of birth and most social backgrounds, except higher income. The qualitative analysis showed that partners (1) felt excluded as partners and parents, (2) thought the strain on staff led to deficiencies in the care provided, and (3) perceived the decision about partner restrictions as illogical. CONCLUSIONS The exclusion of partners from the hospital postnatal wards clearly impaired satisfaction with care, and partners of first-time mothers were particularly affected. Planning for future restrictions on partners from hospital wards should factor in these consequences.
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Affiliation(s)
- Petrus Olander
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Lisa Berglin
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elin Naurin
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Elias Markstedt
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Lucy R Zheng
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helen Elden
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abdul-Fatah A, Bezanson M, Lopez Steven S, Tippins E, Jones S, MacDonald H, Ysseldyk R. COVID-19 Public Health Restrictions and New Mothers' Mental Health: A Qualitative Scoping Review. QUALITATIVE HEALTH RESEARCH 2024:10497323241251984. [PMID: 39030700 DOI: 10.1177/10497323241251984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
Public health restrictions to protect physical health during the COVID-19 pandemic had unintended effects on mental health, which may have disproportionately affected some potentially vulnerable groups. This scoping review of qualitative research provides a narrative synthesis of new mothers' perspectives on their mental health during COVID-19 pandemic restrictions through pregnancy to the postpartum period. Database searches in PubMed, CINAHL, and PsycINFO sought primary research studies published until February 2023, which focused on new mothers' self-perceived mental health during the pandemic (N = 55). Our synthesis found that new mothers' mental health was impacted by general public health restrictions resulting in isolation from family and friends, a lack of community support, and impacts on the immediate family. However, public health restrictions specific to maternal and infant healthcare were most often found to negatively impact maternal mental health, namely, hospital policies prohibiting the presence of birthing partners and in-person care for their infants. This review of qualitative research adds depth to previous reviews that have solely examined the quantitative associations between COVID-19 public health restrictions and new mothers' mental health. Here, our review demonstrates the array of adverse impacts of COVID-19 public health restrictions on new mothers' mental health throughout pregnancy into the postpartum period, as reported by new mothers. These findings may be beneficial for policy makers in future public health emergency planning when evaluating the impacts and unintended consequences of public health restrictions on new mothers.
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Affiliation(s)
| | - Michelle Bezanson
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | | | - Emily Tippins
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Sarah Jones
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | | | - Renate Ysseldyk
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
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Mesquita A, Costa R, Dikmen-Yildiz P, Faria S, Silvestrini G, Mateus V, Vousoura E, Wilson CA, Felice E, Ajaz E, Hadjigeorgiou E, Hancheva C, Contreras-García Y, Domínguez-Salas S, Motrico E, Soares I, Ayers S. Changes to women's childbirth plans during the COVID-19 pandemic and posttraumatic stress symptoms: a cross-national study. Arch Womens Ment Health 2024; 27:393-403. [PMID: 38102527 PMCID: PMC11116223 DOI: 10.1007/s00737-023-01403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023]
Abstract
A considerable number of women giving birth during COVID-19 pandemic reported being concerned about changes to their childbirth plans and experiences due to imposed restrictions. Research prior to the pandemic suggests that women may be more at risk of post-traumatic stress symptoms (PTSS) due to unmet expectations of their childbirth plans. Therefore, this study aimed to examine if the mismatch between women's planned birth and actual birth experiences during COVID-19 was associated with women's postpartum PTSS. Women in the postpartum period (up to 6 months after birth) across 11 countries reported on childbirth experiences, mental health, COVID-19-related factors, and PTSS (PTSD checklist DSM-5 version) using self-report questionnaires (ClinicalTrials.gov: NCT04595123). More than half (64%) of the 3532 postpartum women included in the analysis reported changes to their childbirth plans. All changes were significantly associated with PTSS scores. Participants with one and two changes to their childbirth plans had a 12% and 38% increase, respectively, in PTSS scores compared to those with no changes (Exp(β) = 1.12; 95% CI [1.06-1.19]; p < 0.001 and Exp(β) = 1.38; 95% CI [1.29-1.48]; p < 0.001). In addition, the effect of having one change in the childbirth plan on PTSS scores was stronger in primigravida than in multigravida (Exp(β) = 0.86; 95% CI [0.77-0.97]; p = 0.014). Changes to women's childbirth plans during the COVID-19 pandemic were common and associated with women's postpartum PTSS score. Developing health policies that protect women from the negative consequences of unexpected or unintended birth experiences is important for perinatal mental health.
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Affiliation(s)
- Ana Mesquita
- School of Psychology, CIPsi, University of Minho, Braga, Portugal.
- ProChild CoLab Against Poverty and Social Exclusion - Association (ProChild CoLAB) Campus de Azurém, 4800-058, Guimarães, Guimarães, Portugal.
| | - Raquel Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal
- Hei-Lab: Digital Human-Environment Interaction Lab, Lusófona University, Porto, Portugal
| | | | - Susana Faria
- Centre of Mathematics, Department of Mathematics, University of Minho, Guimarães, Portugal
| | | | - Vera Mateus
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Eleni Vousoura
- Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
| | - Claire A Wilson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - Ethel Felice
- Department of Psychiatry, University of Malta, Msida, Malta
| | - Erilda Ajaz
- Department of Education and English Language, Beder University College, Tirana, Albania
| | - Eleni Hadjigeorgiou
- Department of Nursing, School of Health Science, Cyprus University of Technology, Limassol, Cyprus
| | | | - Yolanda Contreras-García
- Departamento de Obstetricia y Puericultura Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | | | - Emma Motrico
- Department of Psychology, University of Loyola, Sevilla, Spain
| | - Isabel Soares
- School of Psychology, CIPsi, University of Minho, Braga, Portugal
| | - Susan Ayers
- Department of Psychology, University of Loyola, Sevilla, Spain
- Centre for Maternal and Child Health Research School of Health and Psychological Sciences, City, University of London, London, United Kingdom
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Abderhalden-Zellweger A, de Labrusse C, Gemperle M, Grylka-Baeschlin S, Pfund A, Mueller AN, Mariani I, Pessa Valente E, Lazzerini M. Women's experiences of disrespect and abuse in Swiss facilities during the COVID-19 pandemic: a qualitative analysis of an open-ended question in the IMAgiNE EURO study. BMC Pregnancy Childbirth 2024; 24:402. [PMID: 38822258 PMCID: PMC11143635 DOI: 10.1186/s12884-024-06598-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 05/21/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has challenged the provision of maternal care. The IMAgiNE EURO study investigates the Quality of Maternal and Newborn Care during the pandemic in over 20 countries, including Switzerland. AIM This study aims to understand women's experiences of disrespect and abuse in Swiss health facilities during the COVID-19 pandemic. METHODS Data were collected via an anonymous online survey on REDCap®. Women who gave birth between March 2020 and March 2022 and answered an open-ended question in the IMAgiNE EURO questionnaire were included in the study. A qualitative thematic analysis of the women's comments was conducted using the International Confederation of Midwives' RESPECT toolkit as a framework for analysis. FINDINGS The data source for this study consisted of 199 comments provided by women in response to the open-ended question in the IMAgiNE EURO questionnaire. Analysis of these comments revealed clear patterns of disrespect and abuse in health facilities during the COVID-19 pandemic. These patterns include non-consensual care, with disregard for women's choices and birth preferences; undignified care, characterised by disrespectful attitudes and a lack of empathy from healthcare professionals; and feelings of abandonment and neglect, including denial of companionship during childbirth and separation from newborns. Insufficient organisational and human resources in health facilities were identified as contributing factors to disrespectful care. Empathic relationships with healthcare professionals were reported to be the cornerstone of positive experiences. DISCUSSION Swiss healthcare facilities showed shortcomings related to disrespect and abuse in maternal care. The pandemic context may have brought new challenges that compromised certain aspects of respectful care. The COVID-19 crisis also acted as a magnifying glass, potentially revealing and exacerbating pre-existing gaps and structural weaknesses within the healthcare system, including understaffing. CONCLUSIONS These findings should guide advocacy efforts, urging policy makers and health facilities to allocate adequate resources to ensure respectful and high-quality maternal care during pandemics and beyond.
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Affiliation(s)
- Alessia Abderhalden-Zellweger
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011, Lausanne, Switzerland.
| | - Claire de Labrusse
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011, Lausanne, Switzerland
| | - Michael Gemperle
- Research Institute of Midwifery and Reproductive Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Susanne Grylka-Baeschlin
- Research Institute of Midwifery and Reproductive Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Anouck Pfund
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011, Lausanne, Switzerland
| | - Antonia N Mueller
- Research Institute of Midwifery and Reproductive Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Ilaria Mariani
- WHO Collaborating Center for Maternal and Child Health, Institute for Maternaland , Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Emanuelle Pessa Valente
- WHO Collaborating Center for Maternal and Child Health, Institute for Maternaland , Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marzia Lazzerini
- WHO Collaborating Center for Maternal and Child Health, Institute for Maternaland , Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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Oliveira ICDP, Geraldo LMCS, Faria APV, Silva TPRD, Amorim T, Pereira PF, Souza KVD, Matozinhos FP. Repercussions of SARS-CoV-2 infection and the pandemic on birth routes: a cross-sectional study. Rev Gaucha Enferm 2023; 44:e20220320. [PMID: 37851838 DOI: 10.1590/1983-1447.2023.20220320.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/28/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE To assess the repercussions of SARS-CoV-2 infection (suspected or confirmed) and the context of the pandemic on the birth route and humanized assistance during childbirth. METHOD Cross-sectional epidemiological study, nested within a cohort and comparative with the research "Birth in Belo Horizonte: Survey on Childbirth and Delivery".The medical records of three reference maternity hospitals in Belo Horizonte were assessed, with a final sample of 1,682 pregnant women, in the months of May, June and July 2020. A descriptive analysis was carried out, with absolute and relative frequency, and a comparative one, with a Pearson's chi-square test. RESULTS It was observed that 2.02% of pregnant women were infected with SARS-CoV-2.Before the pandemic, out of a total of 390 pregnant women, 74.10% gave birth vaginally.During a pandemic, among infected women, 51.61% gave birth via cesarean section and 48,39% via vaginal delivery;among uninfected, 26.99% cesarean sections and 73.01% vaginaldeliveries. CONCLUSION There was an increase in the percentage of cesarean sections and a possible influence of the pandemic on the rates of indication of cesarean sections at the time of admission to the maternity ward.
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Affiliation(s)
| | | | - Ana Paula Vieira Faria
- Universidade Federal de Minas Gerais (UFMG), Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem. Belo Horizonte, Minas Gerais, Brasil
| | - Thales Philipe Rodrigues da Silva
- Universidade Federal de Minas Gerais (UFMG), Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem. Belo Horizonte, Minas Gerais, Brasil
| | - Torcata Amorim
- Universidade Federal de Minas Gerais (UFMG), Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, Minas Gerais, Brasil
| | | | - Kleyde Ventura de Souza
- Universidade Federal de Minas Gerais (UFMG), Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, Minas Gerais, Brasil
| | - Fernanda Penido Matozinhos
- Universidade Federal de Minas Gerais (UFMG), Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, Minas Gerais, Brasil
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Dennehy R, Hennessy M, Dhubhgain JU, Lucey C, O′Donoghue K. 'An extra level of kind of torment': Views and experiences of recurrent miscarriage care during the initial phases of COVID-19 in Ireland-A qualitative interview study. Health Expect 2023; 26:1768-1782. [PMID: 37300364 PMCID: PMC10349219 DOI: 10.1111/hex.13791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Maternity services underwent much change during the COVID-19 pandemic. Research on the impact on miscarriage care and experiences during this time is sparse. Within a national evaluation of recurrent miscarriage care, we qualitatively explored stakeholder views and experiences of recurrent miscarriage services in Ireland. This study describes the impact of the COVID-19 pandemic on those experiences and perceptions of care. METHODS People with professional and lived experience of recurrent miscarriage and service engagement were actively involved in this qualitative study from idea generation to analysis and reporting. We recruited women and men with two or more consecutive first-trimester miscarriages, and people involved in the management/delivery of recurrent miscarriage services and supports. We used purposive sampling to ensure that perspectives across disciplinary or lived experience, geographical, and health service administrative areas, were included. We conducted semi-structured interviews, virtually all due to COVID-19 restrictions, between June 2020 and February 2021. These were audio-recorded, and data were transcribed, and subsequently analyzed using reflexive thematic analysis. RESULTS We interviewed 42 service providers and 13 women and 7 men with experience of recurrent miscarriage. We actively generated two central themes during data analysis. The first-'Disconnected'-describes how many women navigated miscarriage diagnosis and management and care in subsequent pregnancies alone; many felt that this resulted in increased trauma. At the same time, men struggled with not being present to support their partners and described feeling disconnected. The second theme highlighted 'The perceived dispensability of recurrent miscarriage services and supports'. Some service providers felt that service reduction and redeployment demonstrated a lack of value in the service. Virtual clinics facilitated access to services, but a preference for in-person care was highlighted. CONCLUSION Our analysis provides rich insights into the significant impacts that the COVID-19 pandemic has had on the way recurrent miscarriage care is provided and experienced, with important implications for early pregnancy, miscarriage and recurrent miscarriage care. Services have undergone significant changes and, while these may be temporary, how services should be delivered in the future requires consideration, particularly given the deficits in care and care experiences highlighted prepandemic. PATIENT OR PUBLIC CONTRIBUTION Members of the multidisciplinary RE:CURRENT Project Research Advisory Group (including four parent advocates, two of whom are co-authors on this article) were actively involved throughout the study, including the generation of topic guides and the refining of themes.
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Affiliation(s)
- Rebecca Dennehy
- Pregnancy Loss Research Group, Department of Obstetrics and GynaecologyUniversity College CorkCorkIreland
- INFANT Research CentreUniversity College CorkCorkIreland
| | - Marita Hennessy
- Pregnancy Loss Research Group, Department of Obstetrics and GynaecologyUniversity College CorkCorkIreland
- INFANT Research CentreUniversity College CorkCorkIreland
| | - Jennifer Ui Dhubhgain
- RE:CURRENT Research Advisory Group, Pregnancy Loss Research Group, Department of Obstetrics and GynaecologyUniversity College CorkCorkIreland
- Miscarriage Association of IrelandCarmichael CentreDublinIreland
| | - Con Lucey
- RE:CURRENT Research Advisory Group, Pregnancy Loss Research Group, Department of Obstetrics and GynaecologyUniversity College CorkCorkIreland
| | - Keelin O′Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and GynaecologyUniversity College CorkCorkIreland
- INFANT Research CentreUniversity College CorkCorkIreland
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Jackson C, Brawner J, Ball M, Crossley K, Dickerson J, Dharni N, Rodriguez DG, Turner E, Sheard L, Smith H. Being pregnant and becoming a parent during the COVID-19 pandemic: a longitudinal qualitative study with women in the Born in Bradford COVID-19 research study. BMC Pregnancy Childbirth 2023; 23:494. [PMID: 37403018 PMCID: PMC10320984 DOI: 10.1186/s12884-023-05774-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/10/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Uncertainty around the risk of COVID-19 to pregnant women and their babies prompted precautionary restrictions on their health and care during the pandemic. Maternity services had to adapt to changing Government guidance. Coupled with the imposition of national lockdowns in England and restrictions on daily activities, women's experiences of pregnancy, childbirth and the postpartum period, and their access to services, changed rapidly. This study was designed to understand women's experiences of pregnancy, labour and childbirth and caring for a baby during this time. METHODS This was an inductive longitudinal qualitative study, using in-depth interviews by telephone with women in Bradford, UK, at three timepoints during their maternity journey (18 women at timepoint one, 13 at timepoint two and 14 at timepoint three). Key topics explored were physical and mental wellbeing, experience of healthcare services, relationships with partners and general impact of the pandemic. Data were analysed using the Framework approach. A longitudinal synthesis identified over-arching themes. RESULTS Three longitudinal themes captured what was important to women: (1) women feared being alone at critical points in their maternity journey, (2) the pandemic created new norms for maternity services and women's care, and (3) finding ways to navigate the COVID-19 pandemic in pregnancy and with a baby. CONCLUSIONS Modifications to maternity services impacted significantly on women's experiences. The findings have informed national and local decisions about how best to direct resources to reduce the impact of COVID-19 restrictions and the longer-term psychological impact on women during pregnancy and postnatally.
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Affiliation(s)
- Cath Jackson
- Valid Research Ltd, Sandown House, Sandbeck Way, Wetherby, LS22 7DN, UK.
| | | | - Matthew Ball
- Justice Studio, 10 Portfleet Place, De Beauvoir Road, London, N1 5SZ, UK
| | - Kirsty Crossley
- Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Josie Dickerson
- Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Nimarta Dharni
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | | | - Ella Turner
- Justice Studio, 10 Portfleet Place, De Beauvoir Road, London, N1 5SZ, UK
| | - Laura Sheard
- York Trials Unit, Department of Health Sciences, University of York, Heslington, YO10 5DD, York, UK
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9
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Skelton E, Smith A, Harrison G, Rutherford M, Ayers S, Malamateniou C. The effect of the COVID-19 pandemic on UK parent experiences of pregnancy ultrasound scans and parent-fetal bonding: A mixed methods analysis. PLoS One 2023; 18:e0286578. [PMID: 37267279 DOI: 10.1371/journal.pone.0286578] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/18/2023] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Companionship in antenatal care is important for facilitating positive parental experiences. During the COVID-19 pandemic, restrictions on partner attendance at fetal ultrasound scans were introduced nationally to minimise transmission of the virus. This study aimed to explore the effect of these restrictions on maternal and paternal experiences of pregnancy scans and evaluate their potential effect on parent-fetal bonding. METHODS A UK-wide, anonymous cross-sectional survey was completed by new and expectant parents (n = 714) who had, or were awaiting a pregnancy scan during the COVID-19 pandemic. The CORE-10 and an adapted version of the Prenatal Attachment Inventory were used to evaluate psychological distress and prenatal bonding. Additional survey questions captured parental experiences of scans. Separate statistical and thematic analyses of the data were undertaken. A joint display matrix was used to facilitate integration of quantitative and qualitative claims to generate a comprehensive interpretation of study findings. FINDINGS When fathers did not attend the scan, feelings of excitement and satisfaction were significantly reduced (p<0.001) and feelings of anxiety increased (p<0.001) in both parents. Mothers were concerned about receiving unexpected news alone and fathers felt excluded from the scan. Mean paternal bonding (38.22, SD 10.73) was significantly lower compared to mothers (47.01, SD 7.67) although no difference was demonstrated between those who had attended the scan and those who had not. CORE-10 scores suggested low-to-mild levels of psychological distress, although the mean difference between mothers and fathers was not significant. Key themes described both parents' sense of loss for their desired pregnancy scan experience and reflected on sonographers' central role in providing parent-centred care during scans. CONCLUSION Restrictions on partner attendance at scans during the COVID-19 pandemic had a negative effect on parental experiences of antenatal imaging. Provision of parent-centred care, which is inclusive of partners, is essential for improved parental experiences.
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Affiliation(s)
- Emily Skelton
- Division of Radiography and Midwifery, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Alison Smith
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gill Harrison
- Society and College of Radiographers, London, United Kingdom
| | - Mary Rutherford
- Perinatal Imaging and Health, King's College London, London, United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Christina Malamateniou
- Division of Radiography and Midwifery, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
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Silverio SA, De Backer K, Brown JM, Easter A, Khazaezadeh N, Rajasingam D, Sandall J, Magee LA. Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis. BMC Pregnancy Childbirth 2023; 23:368. [PMID: 37210485 DOI: 10.1186/s12884-023-05641-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023] Open
Abstract
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.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 6th Floor Addison House, Great Maze Pond, Southwark, London, SE1 1UL, UK.
| | - Kaat De Backer
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Jeremy M Brown
- Health Research Institute, Medical School, Faculty of Health, Social Care & Medicine, Edge Hill University, St. Helen's Road, Ormskirk, L39 4QP, Lancashire, UK
| | - Abigail Easter
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Nina Khazaezadeh
- Chief Midwifery Office, NHS England and Improvement, Wellington House, 133-155 Waterloo Road, Southwark, London, SE1 8UG, UK
| | - Daghni Rajasingam
- Maternity Services, St. Thomas' Hospital, Guy's and St. Thomas's NHS Foundation Trust, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Laura A Magee
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 6th Floor Addison House, Great Maze Pond, Southwark, London, SE1 1UL, UK
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11
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Uchida M, Okawa S, Hosokawa Y, Tabuchi T. Decline in Partner-Accompanied Births during the COVID-19 Pandemic in Japan: A Nationwide Cross-Sectional Internet-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4546. [PMID: 36901555 PMCID: PMC10002132 DOI: 10.3390/ijerph20054546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
The study objective was to describe trends in partner-accompanied birth between January 2019 and August 2021 and examine the associations of partner-accompanied birth with women's psychological distress and partners' housework and parenting. A total of 5605 women who had a live singleton birth between January 2019 and August 2021 and had a partner participated in this nationwide internet-based survey between July and August 2021 in Japan. The percentages of women's intentions and actual experience of partner-accompanied births were calculated per month. Associations of partner-accompanied birth with scores on the Kessler Psychological Distress Scale (K6) ≥10, partners' participation in housework and parenting, and factors associated with having a partner-accompanied birth were examined using a multivariable Poisson regression model. The proportion of women who had partner-accompanied births was 65.7% between January 2019 and March 2020, dropping to 32.1% between April 2020 and August 2021. Partner-accompanied birth was not associated with a K6 score ≥10, but was significantly associated with the partner's daily housework and parenting (adjusted prevalence ratio 1.08, 95% CI 1.02-1.14). Partner-accompanied births have been substantially restricted since the beginning of the COVID-19 pandemic. The right to a birth partner should be protected, while addressing infection control.
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Affiliation(s)
- Mai Uchida
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Sumiyo Okawa
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Yoshihiko Hosokawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan
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12
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Lalor JG, Sheaf G, Mulligan A, Ohaja M, Clive A, Murphy-Tighe S, Ng ED, Shorey S. Parental experiences with changes in maternity care during the Covid-19 pandemic: A mixed-studies systematic review. Women Birth 2023; 36:e203-e212. [PMID: 35973917 PMCID: PMC9364727 DOI: 10.1016/j.wombi.2022.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, pregnant women were identified as a high-risk and vulnerable group. To reduce risk of transmission, maternity healthcare services were modified to limit exposure but maintain services for pregnant women. However, the change in hospital practice may have compromised quality maternal care standards. Therefore, this review aims to explore parental experiences and views with maternity care received from healthcare institutions during the COVID-19 pandemic. METHODS A mixed studies systematic review was conducted. Six electronic databases (Medline, CINAHL, Embase, PsycInfo, Web of Science, and Maternity and Infant Care) were searched for qualitative, observational, and mixed method studies from the year 2019 to February 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Quantitative findings were converted to narrative findings. Data was synthesised thematically using a convergent synthesis design. RESULTS Fifty-eight articles were included. Four themes were generated: (1) Distress associated with COVID-19 regulations (perception of hospital restrictions, confusion with ever changing policies), (2) adaptability with maternity services (prenatal: changes in birth plans, prenatal: altered antenatal appointments, education, and care, intrapartum: medicalization of birth, postpartum: varied views on care received and Breastfeeding woes, postpartum: skin-to-skin contact and mother infant bonding) (3) importance of support persons, and (4) future direction for maternity services. CONCLUSIONS Parental experiences highlighted how maternity care during the COVID-19 pandemic did not adhere to WHO standards of quality maternity care. This calls for healthcare institutions to continuously appraise the implementation of restrictive practices that deviate from evidence-based frameworks underpinning quality care.
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Affiliation(s)
- Joan Gabrielle Lalor
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier St, Dublin 2, Ireland
| | - Greg Sheaf
- The Library of Trinity College Dublin, Dublin 2, Ireland
| | - Andrea Mulligan
- School of Law, Trinity College Dublin, House 39, New Square, Dublin 2, Ireland
| | - Magdalena Ohaja
- School of Nursing and Midwifery, National University of Ireland Galway, Ireland
| | - Ashamole Clive
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier St, Dublin 2, Ireland
| | | | - Esperanza Debby Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11,10 Medical Drive, 117597, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11,10 Medical Drive, 117597, Singapore.
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13
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Rice K. Re-centering Relationships: Obstetric Violence, Health Care Rationalities, and Pandemic Childbirth in Canada. Med Anthropol Q 2023; 37:59-75. [PMID: 36367145 DOI: 10.1111/maq.12739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Emerging evidence suggests that the COVD-19 pandemic is eroding childbirth rights. Drawing on narratives of women who gave birth in Canada during the pandemic, this article exposes a paradox in that policies aimed at limiting interpersonal contact implicitly acknowledge the connection between health, well-being, and the social context of people's lives, yet they frame this relationality as a liability to be eliminated. They do this despite the many benefits that social support is known to confer for pregnancy and childbirth. I suggest that obstetric violence theory could be expanded to include the perinatal health care system's failure to consider the well-being of pregnant and birthing persons as necessarily interdependent with that of close others. Conscientiously and routinely making the safeguarding of these relationships a priority in perinatal health care planning may strengthen existing health care systems against certain forms of obstetric violence. [childbirth, COVID-19, obstetric violence, relational personhood, Canada].
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14
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Corazza I, Ferrari A, Bonciani M, Corazza I. Effectiveness of measures to preserve labour and childbirth companionship at the times of COVID-19 outbreak. Health Policy 2023; 129:104703. [PMID: 36642625 PMCID: PMC9769027 DOI: 10.1016/j.healthpol.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Although childbirth services were accessible after COVID-19 outbreak, the measures taken by the Italian Government for contagion containment required some restrictions on the presence of trusted persons for mothers, forcing them to isolation during hospitalization. To preserve companionship, the Regional Health Authority of Tuscany issued a resolution providing partners with the possibility to be present during labour and childbirth for non-asymptomatic women. OBJECTIVES In this study, we: 1) analyse the impact of pandemic on companionship in terms of significant reduction of the possibility for women to be accompanied by a trusted person during labour and childbirth; and 2) ascertain if the regional resolution issued was effective in containing the reduction of companionship. METHODS We performed an interrupted time series analysis to measure the variation of the possibility for women to be accompanied by a trusted person during labour and childbirth, in response to formalization of lock-down due to COVID-19 outbreak and the introduction of the regional resolution aimed at contrasting negative effects on companionship. RESULTS AND CONCLUSIONS The ITS analysis showed that there was a significant decrease in the women-reported experience of companionship in the month of the formalization of lock-down, namely March 2020, followed by a slight increase in the upcoming months. A trend reversal was observed after May 2020, when the regional resolution was fully operational.
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Affiliation(s)
- Ilaria Corazza
- Management and Health Laboratory, Institute of Management, Scuola Superiore Sant'Anna, Via S. Zeno, 2, Pisa, PI 56127, Italy.
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15
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Kuhlmann E, Lotta G, Fernandez M, Herten-Crabb A, Mac Fehr L, Maple JL, Paina L, Wenham C, Willis K. SDG5 "Gender Equality" and the COVID-19 pandemic: A rapid assessment of health system responses in selected upper-middle and high-income countries. Front Public Health 2023; 11:1078008. [PMID: 36817917 PMCID: PMC9935821 DOI: 10.3389/fpubh.2023.1078008] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction The COVID-19 pandemic disrupted healthcare and societies, exacerbating existing inequalities for women and girls across every sphere. Our study explores health system responses to gender equality goals during the COVID-19 pandemic and inclusion in future policies. Methods We apply a qualitative comparative approach, drawing on secondary sources and expert information; the data was collected from March-July 2022. Australia, Brazil, Germany, the United Kingdom, and the USA were selected, reflecting upper-middle and high-income countries with established public health and gender policies but different types of healthcare systems and epidemiological and geo-political conditions. Three sub-goals of SDG5 were analyzed: maternity care/reproductive health, gender-based violence, and gender equality/women's leadership. Results We found similar trends across countries. Pandemic policies strongly cut into women's health, constrained prevention and support services, and weakened reproductive rights, while essential maternity care services were kept open. Intersecting gender inequalities were reinforced, sexual violence increased and women's leadership was weak. All healthcare systems failed to protect women's health and essential public health targets. Yet there were relevant differences in the responses to increased violence and reproductive rights, ranging from some support measures in Australia to an abortion ban in the US. Conclusions Our study highlights a need for revising pandemic policies through a feminist lens.
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Affiliation(s)
- Ellen Kuhlmann
- Clinic for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Gabriela Lotta
- Department of Public Administration, Getulio Vargas Foundation, São Paulo, Brazil
- Center for Metropolitan Studies, São Paulo, Brazil
| | - Michelle Fernandez
- Institute of Political Science, Universidade de Brasília, Brasília, Brazil
| | - Asha Herten-Crabb
- Department of Health Policy, London School of Economics and Political Science (LSE), London, United Kingdom
| | - Leonie Mac Fehr
- Clinic for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Jaimie-Lee Maple
- College of Health and Biomedicine, University of Victoria, Melbourne, VIC, Australia
| | - Ligia Paina
- Johns Hopkins Bloomberg School of Public Health, Boston, MA, United States
| | - Clare Wenham
- Department of Health Policy, London School of Economics and Political Science (LSE), London, United Kingdom
| | - Karen Willis
- College of Health and Biomedicine, University of Victoria, Melbourne, VIC, Australia
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16
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van den Berg LMM, Balaam MC, Nowland R, Moncrieff G, Topalidou A, Thompson S, Thomson G, de Jonge A, Downe S, Ellison G, Fenton A, Heazell A, de Jonge A, Kingdon C, Matthews Z, Severns A, Thomson G, Topalidou A, Wright A, Akooji N, Balaam MC, Cull J, van den Berg L, Crossland N, Feeley C, Franso B, Heys S, Moncrief G, Nowland R, Sarian A, Booker M, Sandall J, Thornton J, Lynskey-Wilkie T, Wilson V, Abe R, Awe T, Adeyinka T, Bender-Atik R, Brigante L, Brione R, Cadée F, Duff E, Draycott T, Fisher D, Francis A, Franx A, Erasmus M, Frith L, Griew L, Harmer C, Homer C, Knight M, Mansfield A, Marlow N, Mcaree T, Monteith D, Reed K, Richens Y, Rocca-Ihenacho L, Ross-Davie M, Talbot S, Taylor M, Treadwell M. The United Kingdom and the Netherlands maternity care responses to COVID-19: A comparative study. Women Birth 2023; 36:127-135. [PMID: 35422406 PMCID: PMC8979792 DOI: 10.1016/j.wombi.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/17/2022] [Accepted: 03/31/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises. AIM To compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains: choice of birthplace, companionship, and families in vulnerable situations. METHOD A multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders. FINDINGS Both countries had an infection control focus, with less emphasis on the impact of restrictions, especially for families in vulnerable situations. Differences included care providers' fear of contracting COVID-19; the extent to which community- and personalised care was embedded in the care system before the pandemic; and how far multidisciplinary collaboration and service-user involvement were prioritised. CONCLUSION We recommend that countries should 1) make a systematic plan for crisis decision-making before a serious event occurs, and that this must include authentic service-user involvement, multidisciplinary collaboration, and protection of staff wellbeing 2) integrate women's and families' values into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events.
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Affiliation(s)
- Lauri M M van den Berg
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, The Netherlands.
| | - Marie-Clare Balaam
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Rebecca Nowland
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Gill Moncrieff
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Anastasia Topalidou
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Suzanne Thompson
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, The Netherlands; Research Centre of Midwifery Science Maastricht, Zuyd University, The Netherlands
| | - Gill Thomson
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Ank de Jonge
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development, The Netherlands
| | - Soo Downe
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
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DeYoung SE, Jackson V, Callands TA. Maternal stress and social support during Hurricane Florence. Health Care Women Int 2023; 44:198-215. [PMID: 35616344 DOI: 10.1080/07399332.2022.2046750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In theoretical research on disaster vulnerability, access to resources is critical for optimal outcomes. Studying the impact of a hurricane on maternal stress can expand theories of disaster vulnerability. This is a cross-sectional mixed-methods prospective study of maternal stress during Hurricane Florence in the United States. Results from chi-squares compared the proportion of respondents who reported having support for a financial emergency were significant, specifically that higher income respondents indicated the ability to rely on someone in case of an emergency. A regression analysis indicated that social support was significant and negatively related to stress as a dependent variable, while evacuation status and pregnancy status were not significant predictors of stress. Five themes emerged from the overall qualitative data: concerns about infant feeding, evacuation logistics, general stress, family roles, and 'other' issues.
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18
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Gribble K, Cashin J, Marinelli K, Vu DH, Mathisen R. First do no harm overlooked: Analysis of COVID-19 clinical guidance for maternal and newborn care from 101 countries shows breastfeeding widely undermined. Front Nutr 2023; 9:1049610. [PMID: 36741988 PMCID: PMC9889271 DOI: 10.3389/fnut.2022.1049610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/14/2022] [Indexed: 01/19/2023] Open
Abstract
Background In March 2020, the World Health Organization (WHO) published clinical guidance for the care of newborns of mothers with COVID-19. Weighing the available evidence on SARS-CoV-2 infection against the well-established harms of maternal-infant separation, the WHO recommended maternal-infant proximity and breastfeeding even in the presence of maternal infection. Since then, the WHO's approach has been validated by further research. However, early in the pandemic there was poor global alignment with the WHO recommendations. Methods We assessed guidance documents collected in November and December 2020 from 101 countries and two regional agencies on the care of newborns of mothers with COVID-19 for alignment with the WHO recommendations. Recommendations considered were: (1) skin-to-skin contact; (2) early initiation of breastfeeding; (3) rooming-in; (4) direct breastfeeding; (5) provision of expressed breastmilk; (6) provision of donor human milk; (7) wet nursing; (8) provision of breastmilk substitutes; (9) relactation; (10) psychological support for separated mothers; and (11) psychological support for separated infants. Results In less than one-quarter of country guidance were the three key breastfeeding facilitation practices of skin-to-skin contact, rooming-in, and direct breastfeeding recommended. Donor human milk was recommended in under one-quarter of guidance. Psychological support for mothers separated from their infants was recommended in 38%. Few countries recommended relactation, wet nursing, or psychological support for infants separated from mothers. In three-quarters of country guidance, expressed breastmilk for infants unable to directly breastfeed was recommended. The WHO and the United Kingdom's Royal College of Obstetricians and Gynecologists were each cited by half of country guidance documents with the United States Centers for Disease Control and Prevention directly or indirectly cited by 40%. Conclusion Despite the WHO recommendations, many COVID-19 maternal and newborn care guidelines failed to recommend skin-to-skin contact, rooming-in, and breastfeeding as the standard of care. Irregular guidance updates and the discordant, but influential, guidance from the United States Centers for Disease Control may have been contributory. It appeared that once recommendations were made for separation or against breastfeeding they were difficult to reverse. In the absence of quality evidence on necessity, recommendations against breastfeeding should not be made in disease epidemics.
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Affiliation(s)
- Karleen Gribble
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Jennifer Cashin
- Alive & Thrive Southeast Asia, FHI 360, Washington, DC, United States
| | - Kathleen Marinelli
- Department of Pediatrics, University of Connecticut School of Medicine, Hartford, CT, United States
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Drandić D, Hartmann K, Barata C, Torguet R. Parent organizations' experiences of the pandemic response in maternity care in thirteen European countries. Eur J Midwifery 2022; 6:71. [PMID: 36591331 PMCID: PMC9773267 DOI: 10.18332/ejm/156902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/03/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
We surveyed changes to maternity care services in the first 17 months of the COVID-19 pandemic in 13 different European countries, from the perspective of national maternity service (parent) organizations advocating for a human rights approach to maternity services. A qualitative study was conducted in November 2020. An open-question survey was sent to national maternity service (parent) organizations and members of COST Action 18211 in Europe, asking about COVID-19 measures in maternity services (antenatally, intrapartum, postnatally, and overall satisfaction). From the open answers, 16 core issues were extracted. Between February and August 2021, semi-structured interviews with the national representatives of 14 parent member organizations in Europe were conducted, collecting details on overall national situations and changes due to COVID-19 measures. The reported experiences of parent organizations from 13 European countries show wide variations in epidemiological containment measures during the first 17 months of the COVID-19 pandemic. Practices differed between facilities, resulting in emotional disquiet and confusion for parent-patients. Most countries maintained antenatal and postnatal care but restricted psychosocial support (antenatal and birth companions, visitors). Organizations from nine countries reported that women had to wear masks during labor, and all but two countries saw separations of mothers and babies. Most parent organizations described a need for more reliable information for new parents. During the pandemic, non-evidence-based practices were (re-) established in many settings, depriving women and families of many factors which evidence has shown to be essential for a positive birthing experience. Based on the findings, we consider the challenges in maternity services and propose a strategy for future crises.
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Affiliation(s)
- Daniela Drandić
- Roda - Parents in Action, Zagreb, Croatia,Human Rights in Childbirth, United States
| | | | - Catarina Barata
- Institute of Social Sciences, University of Lisbon, Lisbon, Portugal,Portuguese Association for the Rights of Women in Pregnancy and Birth, Lisbon, Portugal
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Suarez A, Yakupova V. The impacts of the COVID-19 pandemic on birth satisfaction and birth experiences in Russian women. Front Glob Womens Health 2022; 3:1040879. [PMID: 36619591 PMCID: PMC9810808 DOI: 10.3389/fgwh.2022.1040879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Women's satisfaction with their childbirth experiences has significant impacts on their health and the health of their children. Recently, childbirth and maternity care systems have been disrupted by the COVID-19 pandemic. This study aimed to investigate the association of birth satisfaction with mode of birth, medical interventions, support during labour, type of childbirth healthcare plan and antenatal education in the context of the COVID-19 pandemic in Russia. Methods 1,645 Russian women who gave birth during the first year of the COVID-19 pandemic and 611 matched controls who gave birth in the previous year participated in an anonymous Internet survey about their childbirth experience. The survey included questions regarding women's demographic and obstetric characteristics as well as their childbirth experiences. Birth satisfaction was measured using the Birth Satisfaction Scale Revised Indicator (BSS-RI). Results Birth satisfaction scores did not show notable changes before and during the pandemic (Pearson Chi-square = 19.7, p = 0.22). Women had lower BSS-RI scores if they tested positive for COVID-19 during labour (F = 9.18, p = 0.002), but not during pregnancy or postpartum (p > 0.32). In both cohorts women who had vaginal births rated birth satisfaction higher than those who had caesarean births. The more medical interventions there were, the lower were the BSS-RI scores (B = -0.234, 95% CI: -0.760; -0.506, p < 0.001), but only during the pandemic. Birth satisfaction was higher if women had a support person present during labour (F > 7.44, p < 0.001), which was not possible for over 70% of participants during the pandemic. In both cohorts birth satisfaction was associated with the childbirth healthcare plan (F > 5.27, p < 0.001), but not with antenatal education (F < 0.15, p > 0.43). Conclusions Our study highlights the significant impacts of the COVID-19 pandemic on the birth experiences of Russian women. Sustaining the rights of women to informed decisions during labour, respect for their preferred childbirth healthcare plan, presence of the birth team of choice and professional support for home birth are essential for higher birth satisfaction and better health outcomes for mothers and their infants.
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Skelton E, Malamateniou C, Harrison G. The impact of the COVID-19 pandemic on clinical guidance and risk assessments, and the importance of effective leadership to support UK obstetric sonographers. J Med Imaging Radiat Sci 2022; 53:S107-S115. [PMID: 36289027 PMCID: PMC9595413 DOI: 10.1016/j.jmir.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/05/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The COVID-19 pandemic had a profound impact on the provision of obstetric ultrasound services, leading to the publication of new guidance and requirement for individual departmental risk assessments in the UK. The impact of these changes on clinical practice for UK obstetric sonographers is not currently well reported in published literature. METHODS Obstetric sonographers working in the UK (n = 138) used the Qualtrics XMTM platform to complete an anonymous, online questionnaire about their experiences during the pandemic. Participants responded to closed-type questions about national guidance, risk assessment and their perception of support, and provided additional detail about their experiences in these areas through free-text response options. RESULTS Over 90% of respondents were aware of or had read guidance issued by professional organisations, although challenges for its implementation in departments were identified. These were commonly related to the clinical working environment and included limitations on physical space (76.3%), time constraints (67.5%) and ventilation (61.3%). Sonographers felt most supported by their ultrasound colleagues (83.5%) and line managers (41.2%). They felt least supported by senior management and leadership personnel (60.8%), other antenatal colleagues (51.5%) and professional organisations (41.2%). CONCLUSION Obstetric sonographers will need support from the wider service team and professional organisations to facilitate post-pandemic recovery of the workforce. Formal clinical supervision programmes may be beneficial in facilitating a more holistic approach to peer-support, although there is currently limited evidence of their use in sonographic practice.
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Affiliation(s)
- Emily Skelton
- Division of Radiography and Midwifery, School of Health and Psychological Sciences, City, University of London, EC1V 0HB, UK; Perinatal Imaging and Health, King's College London, SE1 7EH, UK.
| | - Christina Malamateniou
- Division of Radiography and Midwifery, School of Health and Psychological Sciences, City, University of London, EC1V 0HB, UK; Perinatal Imaging and Health, King's College London, SE1 7EH, UK; Haute Ecole de Santé Vaud, Lausanne, Switzerland.
| | - Gill Harrison
- Division of Radiography and Midwifery, School of Health and Psychological Sciences, City, University of London, EC1V 0HB, UK; Society and College of Radiographers, 207 Providence Square, London, SE1 2EW, UK.
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22
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Zheng X, Zhang J, Ye X, Lin X, Liu H, Qin Z, Chen D, Zhan C. Navigating through motherhood in pregnancy and postpartum periods during the COVID-19 pandemic: A systematic review and qualitative meta-synthesis. J Nurs Manag 2022; 30:3958-3971. [PMID: 36194367 PMCID: PMC9874529 DOI: 10.1111/jonm.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/06/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023]
Abstract
AIM The aim of this work is to critically appraise and synthesize the qualitative studies on the experiences, perspectives, and consequences of pregnant women experiencing motherhood during the COVID-19 pandemic. BACKGROUND The COVID-19 pandemic has posed a threat to the health of pregnant women. Such a pandemic disrupted their routine care, as well as normal daily life. However, little is known about their coping strategies to the changes brought by COVID-19. EVALUATION A qualitative systematic review was conducted according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist. A meta-aggregative approach rooted in pragmatism and Husserlian transcendental phenomenology was used to synthesize the findings. Dependability and credibility of both study findings and synthesized findings were appraised by Joanna Briggs Institute (JBI) ConQual process. KEY ISSUES Key issues include (a) pregnant women experienced changes in routine care, (b) pregnant women used a range of strategies to cope with the consequence of the pandemic, (c) pregnant women struggled to embrace motherhood, and (d) pregnant women received different levels of social support. CONCLUSION Facing challenges caused by the pandemic, pregnant women used a variety of strategies to cope with and adapt to the changes, but sometimes the adaption is limited. Emotional, instrumental, and informational support should be provided to them in an accessible way. IMPLICATIONS FOR NURSING MANAGEMENT As an essential part of policymakers, nursing managers should consider the balance between restriction and the accessibility of maternity care. It is also crucial for them to consider how to provide necessary support in an accessible way.
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Affiliation(s)
- Xutong Zheng
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina,School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
| | - Jiayu Zhang
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
| | - Xinxin Ye
- School of Public HealthZhejiang University School of MedicineHangzhouChina
| | - Xiaoyi Lin
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
| | - Huanju Liu
- Women's Hospital and the Institute of GeneticsZhenjiang University School of MedicineHangzhouChina
| | - Zhuzhu Qin
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
| | - Danfeng Chen
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
| | - Chenju Zhan
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
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A Missed Opportunity? How Prenatal Care, Birth Hospitalization, and Digital Health Could Increase Nonbirthing Partners' Access to Recommended Medical and Mental Healthcare. J Perinat Neonatal Nurs 2022; 36:330-334. [PMID: 36288436 PMCID: PMC9623469 DOI: 10.1097/jpn.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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O'Carroll JE, Zucco L, Warwick E, Arbane G, Moonesinghe R, El-Boghdadly K, Guo N, Carvalho B, Sultan P. Obstetric services in the UK during the COVID-19 pandemic: A national survey. Anaesth Crit Care Pain Med 2022; 41:101137. [PMID: 35914704 PMCID: PMC9335395 DOI: 10.1016/j.accpm.2022.101137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The management of obstetric patients with coronavirus disease 2019 (COVID-19) due to human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires unique considerations. Many aspects of labour and delivery practice required adaptation in response to the global pandemic and were supported by guidelines from the Royal College of Obstetrics and Gynaecologists. The adoption and adherence to these guidelines is unknown. METHODS Participating centres in "Quality of Recovery in Obstetric Anaesthesia study-a multicentre study" (ObsQoR) completed an electronic survey based on the provision of services and care related to COVID-19 in October 2021. The survey was designed against the Royal College of Obstetricians and Gynaecologists COVID-19 guidelines. RESULTS One hundred and five of the 107 participating centres completed the survey (98% response rate representing 54% of all UK obstetric units). The median [IQR] annual number of deliveries among the included sites was 4389 [3000-5325]. Ninety-nine of the 103 (94.3%) sites had guidelines for the management of peripartum women with COVID-19. Sixty-one of 105 (58.1%) sites had specific guidance for venous thromboembolism (VTE) prophylaxis. Thirty-seven of 104 (35.6%) centres restricted parturient birthing plans if a positive diagnosis of COVID-19 was made. A COVID-19 vaccination referral pathway encouraging full vaccination for all pregnant women was present in 63/103 centres (61.2%). CONCLUSION We found variability in care delivered and adherence to guidelines related to COVID-19. The clinical implications for this related to quality of peripartum care is unclear, however there remains scope to improve pathways for immunisation, birth plans and VTE prophylaxis.
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Affiliation(s)
- James Edward O'Carroll
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Liana Zucco
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Gill Arbane
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ramani Moonesinghe
- Surgical Outcomes Research Centre, Centre for Peri-Operative Medicine, University College London, London, UK
| | | | - N Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Pervez Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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25
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von Rieben MA, Boyd L, Sheen J. Care in the time of COVID: An interpretative phenomenological analysis of the impact of COVID-19 control measures on post-partum mothers' experiences of pregnancy, birth and the health system. Front Psychol 2022; 13:986472. [PMID: 36211889 PMCID: PMC9537098 DOI: 10.3389/fpsyg.2022.986472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Findings suggest pandemic control measures have modified maternal health practices, compromising the quality of care provided to new and expectant mothers and interfering with their birthing experiences. For this reason, this study explored the lived experiences of post-partum Victorian mothers during the pandemic as well as the potential influence of control measures over their perceptions regarding the health system. Methods This study used a qualitative approach. Recruitment was conducted between May and June 2021, using both the Australian Breastfeeding Association's social media pages and snowball recruitment. Interviews were semi-structured using open-ended questions relating to key themes. Seven Victorian post-partum mothers were identified and their transcripts analysed using Interpretative Phenomenological Analysis. Results Mothers described how unexpected changes to maternal care exacerbated feelings of uncertainty regarding pregnancy and birth. Mothers also differentiated between impacts by the health system and the role healthcare professionals played in moderating these effects. Whilst visitor restrictions provided some benefit, restrictions to familial and social support left many of the mothers feeling alone during their pregnancy and interfered with their immediate post-partum experience. Conclusion This study illustrates the importance of evidence-based practice in maternal care and provides insights for both health professionals and policy analysts in developing new or modifying existing guidelines that better balance the needs of expectant and post-partum mothers with pandemic control measures.
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Affiliation(s)
| | - Leanne Boyd
- Monash University, Eastern Health, Melbourne, VIC, Australia
| | - Jade Sheen
- School of Psychology, Deakin University, Burwood, VIC, Australia
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26
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Jones IHM, Thompson A, Dunlop CL, Wilson A. Midwives' and maternity support workers' perceptions of the impact of the first year of the COVID-19 pandemic on respectful maternity care in a diverse region of the UK: a qualitative study. BMJ Open 2022; 12:e064731. [PMID: 36127079 PMCID: PMC9490297 DOI: 10.1136/bmjopen-2022-064731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To explore midwives' and maternity support workers' perceptions of the impact of the COVID-19 pandemic on maternity services and understand factors influencing respectful maternity care. DESIGN A qualitative study. Eleven semistructured interviews were conducted (on Zoom) and thematically analysed. Inductive themes were developed and compared with components of respectful maternity care. SETTING Maternity services in a diverse region of the United Kingdom. PARTICIPANTS Midwives and maternity support workers who worked during the first year of the COVID-19 pandemic. RESULTS The findings offer insights into the experiences and challenges faced by midwives and maternity support workers during the first year of the COVID-19 pandemic in the UK (March 2020-2021). Three core themes were interpreted that impacted respectful maternity care: (1) communication of care, (2) clinical care and (3) support for families. 1. Midwives and maternity support workers felt changing guidance impaired communication of accurate information. However, women attending appointments alone encouraged safeguarding disclosures. 2. Maternity staffing pressures worsened and delayed care provision. The health service's COVID-19 response was thought to have discouraged women's engagement with maternity care. 3. Social support for women was reduced and overstretched staff struggled to fill this role. The continuity of carer model of midwifery facilitated supportive care. COVID-19 restrictions separated families and were considered detrimental to parents' mental health and newborn bonding. Overall, comparison of interview quotes to components of respectful maternity care showed challenges during the early COVID-19 pandemic in upholding each of the 10 rights afforded to women and newborns. CONCLUSIONS Respectful maternity care was impacted through changes in communication, delivery of clinical care and restrictions on social support for women and their infants in the first year of the COVID-19 pandemic. Future guidance for pandemic scenarios must make careful consideration of women's and newborns' rights to respectful maternity care.
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Affiliation(s)
- Isobel H M Jones
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Amy Thompson
- Department of Obstetrics and Gynaecology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - Amie Wilson
- Institute of Metabolism and Systems Research (IMSR), WHO Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
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Stulz VM, Bradfield Z, Cummins A, Catling C, Sweet L, McInnes R, McLaughlin K, Taylor J, Hartz D, Sheehan A. Midwives providing woman-centred care during the COVID-19 pandemic in Australia: A national qualitative study. Women Birth 2022; 35:475-483. [PMID: 34688582 PMCID: PMC8514642 DOI: 10.1016/j.wombi.2021.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The COVID-19 pandemic has caused isolation, fear, and impacted on maternal healthcare provision. AIM To explore midwives' experiences about how COVID-19 impacted their ability to provide woman-centred care, and what lessons they have learnt as a result of the mandated government and hospital restrictions (such as social distancing) during the care of the woman and her family. METHODS A qualitative interpretive descriptive study was conducted. Twenty-six midwives working in all models of care in all states and territories of Australia were recruited through social media, and selected using a maximum variation sampling approach. Data were collected through in-depth interviews between May to August, 2020. The interviews were recorded, transcribed verbatim, and thematically analysed. FINDINGS Two overarching themes were identified: 'COVID-19 causing chaos' and 'keeping the woman at the centre of care'. The 'COVID-19 causing chaos' theme included three sub-themes: 'quickly evolving situation', 'challenging to provide care', and 'affecting women and families'. The 'Keeping the woman at the centre of care' theme included three sub-themes: 'trying to keep it normal', 'bending the rules and pushing the boundaries', and 'quality time for the woman, baby, and family unit'. CONCLUSION Findings of this study offer important evidence regarding the impact of the pandemic on the provision of woman-centred care which is key to midwifery philosophy. Recommendations are made for ways to preserve and further enhance woman-centred care during periods of uncertainty such as during a pandemic or other health crises.
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Affiliation(s)
- Virginia M Stulz
- Western Sydney University, School of Nursing and Midwifery, Centre for Nursing and Midwifery Research. Nepean Hospital, NSW 2745, Australia.
| | - Zoe Bradfield
- Curtin University, School of Nursing, Bentley, WA, 6845, Australia; King Edward Memorial Hospital, Subiaco, WA, 6008, Australia.
| | - Allison Cummins
- University of Newcastle, School of Nursing and Midwifery, Central Coast Clinical School and Research Institute, Gosford, NSW, Australia.
| | - Christine Catling
- University of Technology Sydney, Centre for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, Australia.
| | - Linda Sweet
- Deakin University, School of Nursing and Midwifery, Centre for Quality Patient Safety, Western Health Partnership, VIC 3021, Australia.
| | - Rhona McInnes
- Griffith University and Gold Coast University Hospital, School of Nursing and Midwifery, QLD 4215, Australia.
| | - Karen McLaughlin
- University of Newcastle, School of Nursing and Midwifery, NSW, Callaghan campus, Wallsend, Australia.
| | - Jan Taylor
- University of Canberra, Discipline of Midwifery, Faculty of Health ACT 2617, Australia.
| | - Donna Hartz
- Charles Darwin University, Molly Wardaguga Research Centre, College of Nursing & Midwifery, Australia.
| | - Athena Sheehan
- Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia.
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Thorn-Cole H, De Labrusse C, Abderhalden-Zellweger A, Kaech C, Hammer R. Impact of the COVID-19 pandemic on maternity services in Europe: a mixed methods systematic review protocol. JBI Evid Synth 2022; 20:2303-2311. [PMID: 35989639 PMCID: PMC9593326 DOI: 10.11124/jbies-22-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Harriet Thorn-Cole
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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Radoš SN, Motrico E, Mesquita AM, Ganho-Avila A, Vousoura E, Lalor J. Changes in perinatal mental healthcare during the COVID-19 pandemic: a protocol for a collaborative research study between the COST actions RISEUP-PPD and DEVOTION. BMJ Open 2022; 12:e052411. [PMID: 35882459 PMCID: PMC9329731 DOI: 10.1136/bmjopen-2021-052411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Significant changes in routine maternity care have been introduced globally in response to the COVID-19 pandemic to reduce infection risk, but also due to lack of medical facilities, staff shortages and the unpredictable nature of the disease. However, it is yet to be established if specialised perinatal mental health (PMH) services have been similarly affected. As a Task Force in PMH and COVID-19 pandemic within Riseup-PPD COST Action, this study aims to identify changes in PMH practices, policies and protocols during the COVID-19 pandemic in Europe. METHODS AND ANALYSIS An online survey of experts in the PMH who are members of the COST Action 'Riseup-PPD' and the COST Action ''DEVOTION" across 36 European countries will be conducted. A questionnaire on changes in PMH care practices during the COVID-19 Pandemic will be administered. It consists of open-ended questions, checklists and ratings on a 7-point scale addressing seven domains of interest in terms of PMH: (1) policies, guidelines and protocols; (2) PMH care practices at a national level; (3) evidence of best practice; (4) barriers to usual care; (5) resources invested; (6) benefits of investment in the policies and (7) short-term and long-term expectations of the policies. Data will be collected using Qualtrics. Descriptive statistics will be reported and differences between countries will be examined using the χ2 statistic or Student's t-test. ETHICS AND DISSEMINATION Ethical approval was obtained from The Ethics Committee for Research in Life and Health Sciences of the University of Minho (Portugal) to undertake an anonymous online survey. The findings will be disseminated to professional audience through peer-review publication and presentations and shared widely with stakeholders, policy-makers and service user groups. A position paper will be developed to influence policy-making at a European level to alleviate the adversities caused by COVID-19. TRIAL REGISTRATION NUMBER NCT04779775.
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Affiliation(s)
- Sandra Nakić Radoš
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
| | - Emma Motrico
- Psychology, Universidad Loyola Andalucia, Dos Hermanas, Spain
| | - Ana M Mesquita
- Universidade do Minho - Campus de Gualtar, Braga, Portugal
| | - Ana Ganho-Avila
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Eleni Vousoura
- Psychology, The American College of Greece, Athens, Greece
| | - Joan Lalor
- Faculty of Health Sciences, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Brigante L, Morelli A, Jokinen M, Plachcinski R, Rowe R. Impact of the COVID-19 pandemic on midwifery-led service provision in the United Kingdom in 2020-21: findings of three national surveys. Midwifery 2022; 112:103390. [PMID: 35709677 PMCID: PMC9155188 DOI: 10.1016/j.midw.2022.103390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 12/03/2022]
Abstract
Background The COVID-19 pandemic required all healthcare systems to adapt quickly. There is some evidence about the impact of the pandemic on United Kingdom maternity services overall, but little is known about the impact on midwifery-led services, including midwifery units and home birth services. Objective To describe changes to midwifery-led service provision in the United Kingdom and the Channel Islands during the COVID-19 pandemic. Design Three national surveys were circulated using the United Kingdom Midwifery Study System (UKMidSS) and the Royal College of Midwives (RCM) Heads and Directors of Midwifery Network. The UKMidSS surveys took place in wave 1 (April to June 2020) and in wave 2 (February to March 2021). The RCM survey was conducted in April 2020. Findings The response rate to the UKMidSS surveys was 84% in wave 1 and 70% in wave 2, while 48% of Heads and Directors of Midwifery responded to the RCM survey. Around 60% of midwifery units reported being open as usual in wave 1, with the remainder affected by closures. Fewer unit closures (15%) were reported in the wave 2 survey. Around 40% of services reported some reduction in home birth services in wave 1, compared with 15% in wave 2. The apparent impact of the pandemic varied widely across the four nations of the United Kingdom and within the English regions. Conclusions The pandemic led to increased centralisation of maternity care and the disruption of midwifery-led services, especially in the first wave. Further research should focus on the reasons behind closures, the regional variation and the impact on maternity care experience and outcomes.
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Affiliation(s)
- Lia Brigante
- Royal College of Midwives, London, United Kingdom
| | - Alessandra Morelli
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | | | | | - Rachel Rowe
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom.
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Verhoeven CJM, Boer J, Kok M, Nieuwenhuijze M, de Jonge A, Peters LL. More home births during the COVID-19 pandemic in the Netherlands. Birth 2022; 49:792-804. [PMID: 35554962 PMCID: PMC9348372 DOI: 10.1111/birt.12646] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND The aim of this observational study was to examine whether the course of pregnancy and birth and accompanying outcomes among low-risk pregnant women changed in the COVID-19 pandemic compared to the prepandemic period. METHODS We analyzed data from the Dutch Midwifery Case Registration System (VeCaS). Differences in the course of pregnancy and birth, and accompanying maternal and neonatal outcomes, were calculated between women pregnant during the initial months of the COVID-19 pandemic (March 1 to August 3, 2020) and the prepandemic period (March 1-August 3, 2019). We also conducted a stratified analysis by parity. RESULTS We included 5913 low-risk pregnant women of whom 2963 (50.1%) were pregnant during the first surge of the COVID-19 pandemic, and 2950 (49.9%) in the prepandemic period. During the COVID-19 pandemic, more women desired and had a home birth. More women used pain medication and fewer had an episiotomy in the COVID-19 period than prior. Multiparous women had a higher suspected rate of fetal growth restriction during COVID; however, the actual rate of small for gestational age infants was not significantly increased. We observed no differences for onset and augmentation of labor or for mode of birth, though the rate of vaginal births increased. CONCLUSIONS During the COVID-19 pandemic, there was a higher rate of planned and actual home birth, and suspected growth restriction and a lower rate of episiotomy among low-risk pregnant women in the Netherlands.
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Affiliation(s)
- Corine J. M. Verhoeven
- Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development CenterAmsterdam University Medical Centres, Vrije Universiteit AmsterdamAmsterdamNetherlands,Department of Midwifery, School of Health SciencesUniversity of NottinghamNottinghamUK,Department of Obstetrics and GynaecologyMaxima Medical CentreVeldhoventhe Netherlands
| | - José Boer
- Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development CenterAmsterdam University Medical Centres, Vrije Universiteit AmsterdamAmsterdamNetherlands
| | - Marjolein Kok
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development CenterAmsterdam University Medical Centre, Universiteit van AmsterdamAmsterdamthe Netherlands
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery ScienceZuyd UniversityMaastrichtthe Netherlands,CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtthe Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG/Amsterdam Public Health Research InstituteAmsterdam University Medical Centres, Vrije Universiteit AmsterdamAmsterdamNetherlands
| | - Lilian L. Peters
- Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development CenterAmsterdam University Medical Centres, Vrije Universiteit AmsterdamAmsterdamNetherlands,Department of General Practice and Elderly Care MedicineUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
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McKinlay AR, Fancourt D, Burton A. Factors affecting the mental health of pregnant women using UK maternity services during the COVID-19 pandemic: a qualitative interview study. BMC Pregnancy Childbirth 2022; 22:313. [PMID: 35413807 PMCID: PMC9005019 DOI: 10.1186/s12884-022-04602-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/22/2022] [Indexed: 01/16/2023] Open
Abstract
Background People using maternity services in the United Kingdom (UK) have faced significant changes brought on by the COVID-19 pandemic and social distancing regulations. We focused on the experiences of pregnant women using UK maternity services during the pandemic and the impact of social distancing rules on their mental health and wellbeing. Methods We conducted 23 qualitative semi-structured interviews from June 2020 to August 2021, with women from across the UK who experienced a pregnancy during the pandemic. Nineteen participants in the study carried their pregnancy to term and four had experienced a miscarriage during the pandemic. Interviews took place remotely over video or telephone call, discussing topics such as mental health during pregnancy and use of UK maternity services. We used reflexive thematic analysis to analyse interview transcripts. Results We generated six higher order themes: [1] Some pregnancy discomforts alleviated by social distancing measures, [2] The importance of relationships that support coping and adjustment, [3] Missed pregnancy and parenthood experiences, [4] The mental health consequences of birth partner and visitor restrictions, [5] Maternity services under pressure, and [6] Lack of connection with staff. Many participants felt a sense of loss over a pregnancy experience that differed so remarkably to what they had expected because of the pandemic. Supportive relationships were important to help cope with pregnancy and pandemic-related changes; but feelings of isolation were compounded for some participants because opportunities to build social connections through face-to-face parent groups were unavailable. Participants also described feeling alone due to restrictions on their partners being present when accessing UK maternity services. Conclusions Our findings highlight some of the changes that may have affected pregnant women’s mental health during the COVID-19 pandemic. Reduced social support and being unable to have a partner or support person present during maternity service use were the greatest concerns reported by participants in this study. Absence of birth partners removed a protective buffer in times of uncertainty and distress. This suggests that the availability of a birth partner or support person must be prioritised wherever possible in times of pandemics to protect the mental health of people experiencing pregnancy and miscarriage. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04602-5.
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Affiliation(s)
- A R McKinlay
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - D Fancourt
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - A Burton
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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Goldstein JT, Eden AR, Taylor MK, Dotson A, Barreto T. Impact of COVID-19 on perinatal care: Perceptions of family physicians in the United States. Birth 2022; 49:719-727. [PMID: 35396870 PMCID: PMC9111605 DOI: 10.1111/birt.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient-centered care is the best practice in the care of pregnant and postpartum patients. The COVID-19 pandemic prompted changes in perinatal care policies, which were often reactive, resulting in unintended consequences, many of which made the delivery of patient-centered care more difficult. This study aimed to understand the impact of the COVID-19 pandemic on perinatal health care delivery from the perspective of family physicians in the United States. METHODS From October 5 to November 4, 2020, we surveyed mid- to late-career family physicians who provide perinatal care. We conducted descriptive analyses to measure the impact of COVID-19 on prenatal care, labor and delivery, postpartum care, patient experience, and patient volume. An immersion-crystallization approach was used to analyze qualitative data provided as open-text comments. RESULTS Of the 1518 survey respondents, 1062 (69.8%) stated that they currently attend births; 595 of those elaborated about the impact of COVID-19 on perinatal care in free-text comments. Eight themes emerged related to the impact of COVID-19 on perinatal care: visitation, patient decisions, testing, personal protective equipment, care continuity, changes in care delivery, reassignment, and volume. The greatest perceived impact of COVID-19 was on patient experience. CONCLUSIONS Family physicians who provided perinatal care during the COVID-19 pandemic noted a considerable impact on patient experience, which particularly affected the ability to deliver patient-centered and family-centered care. Continued research is needed to understand the long-term impact of policies affecting the delivery of patient-centered perinatal care and to inform more evidence-based, proactive policies to be implemented in future pandemic or disaster situations.
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Affiliation(s)
| | - Aimee R. Eden
- American Board of Family MedicineLexingtonKentuckyUSA
| | | | - Andrea Dotson
- Department of Family Medicine and Community HealthDuke University School of MedicineNorth Carolina
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Kluwgant D, Homer C, Dahlen H. “Never let a good crisis go to waste”: Positives from disrupted maternity care in Australia during COVID-19. Midwifery 2022; 110:103340. [PMID: 35504154 PMCID: PMC9013427 DOI: 10.1016/j.midw.2022.103340] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/26/2022] [Accepted: 04/10/2022] [Indexed: 11/22/2022]
Abstract
Objective Due to the COVID-19 pandemic, a number of changes to maternity care were rapidly introduced in all countries, including Australia, to reduce the risk of infection for pregnant women and their care providers. While many studies have reported on the negative effects of these changes, there is a paucity of evidence on factors which women and their providers perceived as positive and useful for future maternity care. Design Data was analysed from the Birth in the time of COVID-19 (BITTOC 2020) study survey. Conventional content analysis and descriptive statistics were used to analyse the data and examine which aspects of COVID-amended care women experienced as positive. Data from women were compared to data from midwives. Setting This project took place in Australia in 2020-2021. Participants The survey was distributed to women who gave birth and midwives who worked in Australia during the COVID-19 pandemic (March 2020 onwards). Measurements and findings Women reported a variety of positives from their maternity care during COVID-19. These included both care-related factors as well as contextual factors. The most commonly mentioned positives for pregnant and postnatal women were care-related, namely fewer visitors in hospital, having increased access to telehealth services. These were also the most commonly reported positives by midwives. Having midwifery continuity of care models, giving birth at home and having their partner work from home were also highlighted by women as positives. Key conclusions Despite the negative effect of COVID-19-related restrictions on maternity care, a variety of changes were viewed as positive by both women and midwives, with strong agreement between the two groups. Implications for practice These findings provide evidence to support the inclusion of these positive elements of care and ensure that the lessons learned from the pandemic are utilised to improve maternity care in Australia going forward.
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Diamond RM, Colaianni A. The impact of perinatal healthcare changes on birth trauma during COVID-19. Women Birth 2021; 35:503-510. [PMID: 34924337 PMCID: PMC8678623 DOI: 10.1016/j.wombi.2021.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022]
Abstract
Background Since the onset of COVID-19, giving birth has involved navigating unprecedented healthcare changes that could significantly impact the psychological birth experience. Aim Research has demonstrated increasing rates of birth trauma and birth plan alterations during the COVID-19 pandemic. This study specifically examined these intersecting experiences to understand how COVID-related healthcare changes have impacted birth trauma during the pandemic. Methods 269 people who gave birth in the U.S. during COVID-19 completed an online survey between November, 2020-May, 2021 which included questions about COVID-related perinatal healthcare changes and birth-related posttraumatic stress disorder (PTSD; The City Birth Trauma Scale). T-tests were run on birth demographics to assess for significant indicators of PTSD; variables having significant effects were used to build a hierarchical regression model to predict PTSD symptoms. Findings 5.9% of the sample met criteria for PTSD and 72.3% met partial criteria. The overall regression model predicted approximately 19% of variance in total PTSD symptoms. Labor and birth demographics were entered in Step 1 and predicted approximately 11% of variance: limited length of stay for support person, being allowed 1 support person who had to be the same, and mask requirements were significant predictors of PTSD. Variables related to birth plan changes were entered in Step 2 and predicted approximately 8% of variance: changes to support person(s) for labor and birth, breastfeeding plans, and birth location were significant predictors of PTSD. Conclusion The present study demonstrates the importance of COVID-related perinatal healthcare changes to the development of trauma symptoms following childbirth.
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Affiliation(s)
- Rachel M Diamond
- Couple and Family Therapy Department, Adler University, Chicago, IL, USA.
| | - Allison Colaianni
- Couple and Family Therapy Department, Adler University, Chicago, IL, USA
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