Rural Residents' Perinatal Experiences During the Initial Months of the COVID-19 Pandemic: A Qualitative Study in British Columbia

Depression in the time of COVID-19: Examination of prenatal and postpartum depression, rurality, and the impact of COVID-19

BACKGROUND

To determine the impact of the COVID-19 pandemic on prenatal and postpartum depressive symptoms in rural versus urban populations.

METHODS

A retrospective cohort study was conducted among 24,227 cisgender women who gave birth from 2010 to 2021 at an academic medical center located in a rural midwestern state. Exclusion criteria were <18 years old, incarcerated, or without a documented zip code. The Patient Health Questionnaire-9 (PHQ-9) was administered during pregnancy and the Edinburgh Postnatal Depression Scale (EPDS) during postpartum. A sub-cohort also completed a COVID-related questionnaire. Rurality was defined as living in a county with <50,000 people. The COVID-19 era was defined as 1/1/2020 to 9/25/2021. Chi-square and Fisher exact tests were used as appropriate. Significance was set at α < 0.05.

RESULTS

Rural participants were more likely (p ≤ 0.001) to exhibit clinical depression symptoms before the pandemic in both the prenatal (8.63 % of rural participants vs. 6.49 % of urban participants) and postpartum periods (11.19 % rural vs. 9.28 % urban). During the pandemic, urban participants had increased postpartum depression. Rural participants endorsed more financial and labor concerns, whereas urban participants expressed support system concerns.

LIMITATIONS

Study data were gathered from participants who gave birth at a single, midwestern hospital. Results may not be widely generalizable given the homogeneity of participants.

CONCLUSIONS

Rural women experienced higher rates of prenatal and postpartum depressive symptoms compared to their urban counterparts. The COVID-19 pandemic was a significant stressor, revealing specific mental health vulnerabilities among birthing people.

COVID-19 Public Health Restrictions and New Mothers' Mental Health: A Qualitative Scoping Review

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.

The determinants of maternal perception of antenatal care services during the COVID-19 pandemic critical phase: A systematic review

INTRODUCTION

The COVID-19 pandemic has exerted devastating effects on healthcare delivery systems, specifically those for pregnant women. The aim of this review was to determine the maternal perception of antenatal health care services during the COVID-19 pandemic critical phase.

METHODS

Scopus, Web of Science, SAGE, and Ovid were systematically searched using the keywords "maternal", "COVID-19 pandemic", "maternal health service", and "maternal perception". Articles were eligible for inclusion if they were original articles, written in English, and published between January 1, 2020, and December 12, 2022. This review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible articles were assessed using the Mixed Methods Appraisal Tool. Thematic analysis was used for data synthesis.

RESULTS

Of 2683 articles identified, 13 fulfilled the inclusion criteria and were included in the narrative synthesis. Five themes emerged regarding the determinants of maternal perception of antenatal healthcare services during the COVID-19 pandemic critical phase: lack of psychosocial support, poor maternal healthcare quality, poor opinion of virtual consultation, health structure adaptation failure to meet women's needs, and satisfaction with maternal health services.

CONCLUSION

Maternal perception, specifically pregnant women's psychosocial and maternal health needs, should be focused on the continuation of maternal care during the COVID-19 pandemic. It is critical to identify the maternal perception of maternal health services during the pandemic to ensure health service equity in the "new normal" future.

Seeking mental health support for feelings of perinatal depression and/or anxiety during the COVID-19 pandemic: A qualitative descriptive study of decision-making

BACKGROUND

Rates of perinatal depression and anxiety increased during the COVID-19 pandemic. It remains unclear how the COVID-19 pandemic influenced risk perception and help-seeking behaviours among pregnant and postpartum individuals.

OBJECTIVES

To explore pregnant and postpartum individuals' decision-making process about when and how to seek support for feelings of depression and/or anxiety during the COVID-19 pandemic.

DESIGN

A qualitative descriptive design was used.

METHODS

The current study is a secondary analysis of qualitative data collected for a larger mixed-methods project that recruited participants who gave birth from 1 May 2020, to 1 December 2021, in Ontario and British Columbia, Canada, using maximum variation and purposive sampling. Seventy-three semi-structured interviews were conducted over Zoom or telephone. This analysis focuses on 56 individuals who discussed their self-identified feelings of prenatal or postpartum depression and/or anxiety. Conventional (inductive) content analysis was employed with iterative stages of open coding, focused coding and cross-checking themes.

RESULTS

Most participants recognized their need to seek help for their feelings of depression and/or anxiety through discussions with a mental health professional or someone within their social circle. Nearly all participants accessed informal social support for these feelings, which sometimes entailed social contact in contravention of local COVID-19 public health policies. Many also attempted to access formal mental healthcare, encountering barriers both related and unrelated to the pandemic. Participants described the pandemic as having the dual effect of causing or exacerbating their feelings of depression and/or anxiety while also constraining their ability to access timely professional care.

CONCLUSION

Participants struggled to address their feelings of perinatal depression and anxiety during the COVID-19 pandemic, with many describing a lack of readily available resources and limited access to professional mental healthcare. This study highlights the need for improved provision of instrumental mental health support for pregnant and postpartum populations.

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

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.