The association between the COVID-19 pandemic and postpartum care provision

Racial and Ethnic Disparities in Postpartum Depressive Symptoms Before and During the COVID-19 Pandemic

Background: Existing evidence regarding the impact of the COVID-19 pandemic on postpartum mental health is mixed, with disparate studies showing increased, stable, or even reduced risk of postpartum depression (PPD) amid the pandemic. Furthermore, although it is plausible that the pandemic impacted the mental health of mothers from vulnerable and underserved communities differentially, few studies have characterized racial and ethnic differences in the impact of the COVID-19 pandemic on PPD. Materials and Methods: Pregnancy Risk Assessment Monitoring System data for 2018-2019 (pre-pandemic period) and 2020 (peri-pandemic period) from 40 sites (n = 110,779, representing 5,485,137 postpartum women) were used to determine whether rates of PPD changed during the first year of the pandemic. Postpartum depressive symptoms were assessed using the Patient Health Questionnaire 2-item. Average marginal effects and contrasts of predictive margins derived from a multivariable logistic regression model were used to compare the risk of PPD before and during the pandemic in the overall sample and across racial/ethnic subgroups. Results: Adjusting for sociodemographic and clinical characteristics, we found that the overall risk for PPD remained stable (0.0 percentage points [pp]; 95% confidence interval [CI]: -0.7, 0.6 pp) in the first year of the pandemic. We detected no statistically significant changes in risk for PPD across seven of eight racial/ethnic groups considered; however, the risk of PPD among non-Hispanic Black women fell by 2.0 pp (95% CI: -3.5, -0.4 pp) relative to the pre-pandemic period. Conclusion: We identified important subgroup differences in pandemic-related changes in risk for PPD.

Birth setting decisions during COVID-19: A comparative qualitative study

BACKGROUND

The COVID-19 pandemic resulted in an increased number of out-of-hospital births in the United States and other nations. While many studies have sought to understand the experiences of pregnant and birthing people during this time, few have compared experiences across birth locations.

OBJECTIVE

The purpose of this study is to compare the narratives and decision-making processes of those who gave birth in and out of hospitals during the pandemic.

DESIGN

We conducted semi-structured narrative interviews with 24 women who gave birth during the COVID-19 pandemic.

METHODS

Interviews were transcribed and coded, and a thematic narrative analysis was employed. Final themes and exemplary quotes were determined in discussion among the research team.

RESULTS

Results from narrative analysis revealed three themes that played into participants' birth location decisions: (1) birth efficacy and values, (2) diverse definitions of safety, and (3) childcare and other logistics. In each of these themes, participants who gave birth in birthing centers, at the hospital, and at home describe their individualized approach to achieving a supportive birth environment while mitigating the risk of labor complications and COVID-19 infection.

CONCLUSION

Our study suggests that for some childbearing people, the pandemic did not change birthing values or decisions but rather brought enhanced clarity to their individual needs during birth and perceived risks, benefits, and limitations of each birthing space. This study further highlights the need for improved structural support for birthing people to access a range of safe and supportive birthing environments.

The Impact of COVID-19 and Policy Changes on Immediate Postpartum Contraception and Permanent Contraception at an Urban Hospital: A Retrospective Cohort Study

Objective: At the onset of the COVID-19 pandemic, in addition to increased use of telemedicine visits and a temporary suspension of interval tubal ligations, providers at the University of Maryland Medical Center were encouraged to counsel patients interested in long-acting reversible contraception (LARC) about immediate postpartum placement. We assessed immediate postpartum contraception uptake following these policy changes. Materials and Methods: In this retrospective cohort study, we compared patients who delivered a live born infant(s) before the pandemic ("pre-COVID cohort," December 16, 2019-March 1, 2020) and at the beginning of the pandemic ("during-COVID cohort," March 16-May 31, 2020). We collected electronic medical record data, including sociodemographic characteristics and contraception choices antenatally and through 1 year postpartum for 631 patients (321 pre-COVID, 310 during-COVID). Results: Odds of immediate postpartum LARC use in the during-COVID cohort were 33% higher than in the pre-COVID cohort, but this was not statistically significant (adjusted odds ratio 1.33, 95% confidence interval: 0.81-2.19). We found no difference in numbers of patients who received immediate postpartum tubal ligation (10% pre-COVID vs. 11% during-COVID). No patients in the during-COVID cohort obtained interval tubal ligations within 6 months of delivery. Contraceptive choices differed at postpartum visits (p = 0.03), with a decrease in delayed postpartum LARC placement in the during-COVID cohort (15% pre-COVID vs. 8% during-COVID). Conclusions: When COVID-19-related hospital policies prompted increased counseling on immediate postpartum LARC and suspension of interval tubal ligations, patients tended to be more likely to choose immediate postpartum LARC. Situational resource restrictions and targeted counseling may influence patient choices and access to desired contraceptive methods.

Interconception Care for Adolescent Women During the COVID-19 Pandemic

BACKGROUND AND OBJECTIVE

Interconception care (ICC) is a means of improving health outcomes for women and children by mitigating maternal risks between pregnancies. Within a pediatric medical home ICC is reliant on adherence to well-child visits (WCVs). We hypothesized that a pediatric-based ICC model would remain successful in providing access to services for adolescent women for those seen during the COVID19 pandemic. The objective of this study was to determine if the COVID19 pandemic influenced LARC use and repeat pregnancy for those seen for ICC in a dyadic pediatric medical home.

METHODS

The pre-COVID cohort was comprised of adolescent women seen for ICC from September 2018-October 2019. The COVID cohort was comprised of adolescent women seen for ICC from March 2020-March 2021. The two cohorts were compared across multiple characteristics including sociodemographic factors, age, education, number of visits, contraceptive choice and repeat pregnancy during the study interval.

RESULTS

The COVID cohort were significantly more likely to be primiparous, seen with a younger infant, and attend fewer visits than the pre-COVID cohort. The COVID cohort were equally likely to initiate long-acting reversible contraception but less likely to experience a repeat pregnancy.

CONCLUSIONS

The COVID19 pandemic limited access to routine healthcare and likely impacted access to ICC for many women. ICC provided during WCVs allowed access to care even amid the restrictions of the COVID19 pandemic. Both effective contraception and decreased repeat pregnancy were maintained, highlighting the effectiveness of this approach for ICC within a dyadic pediatric medical home.

Provision of Postpartum Contraception Before and After the Start of the COVID-19 Pandemic in Maine

OBJECTIVE

Preliminary findings from selected health systems revealed interruptions in reproductive health care services due to the COVID-19 pandemic. We estimated changes in postpartum contraceptive provision associated with the start of the COVID-19 pandemic in Maine.

METHODS

We used the Maine Health Data Organization's All Payer Claims Database for deliveries from October 2015 through March 2021 (n = 45 916). Using an interrupted time-series analysis design, we estimated changes in provision rates of long-acting reversible contraception (LARC), permanent contraception, and moderately effective contraception within 3 and 60 days of delivery after the start of the COVID-19 pandemic. We performed 6- and 12-month analyses (April 2020-September 2020, April 2020-March 2021) as compared with the reference period (October 2015-March 2020). We used Poisson regression models to calculate level-change rate ratios (RRs) and 95% CIs.

RESULTS

The 6-month analysis found that provision of LARC (RR = 1.89; 95% CI, 1.76-2.02) and moderately effective contraception (RR = 1.51; 95% CI, 1.33-1.72) within 3 days of delivery increased at the start of the COVID-19 pandemic, while provision of LARC (RR = 0.95; 95% CI, 0.93-0.97) and moderately effective contraception (RR = 1.08; 95% CI, 1.05-1.11) within 60 days of delivery was stable. Rates of provision of permanent contraception within 3 days (RR = 0.70; 95% CI, 0.63-0.78) and 60 days (RR = 0.71; 95% CI, 0.63-0.80) decreased. RRs from the 12-month analysis were generally attenuated.

CONCLUSION

Disruptions in postpartum provision of permanent contraception occurred at the beginning of the COVID-19 pandemic in Maine. Public health policies should include guidance for contraceptive provision during public health emergencies and consider designating permanent contraception as a nonelective procedure.

Implementing the individualized postpartum care with telemedicine during the COVID-19 pandemic at tertiary hospital in Thailand

Objective

This study sought to identify the impact of implementing the new postpartum care (individualized rescheduling postpartum visit) with telemedicine on postpartum services during the COVID-19 pandemic.

Study design

This is a retrospective cohort study conducted at Srinagarind Hospital, a tertiary hospital in northeast Thailand, to compare patient data before and after implementation. Delivery and postpartum data from May 2019 to December 2020 were retrieved from the hospital database. Intervention was implemented in March 2020. Data were analyzed to evaluate postpartum contact, contraceptive use, and breastfeeding using Wilcoxon rank sum and Chi-squared tests.

Results

There was a significant increase in postpartum contact from 48.0% (95% CI. 45.8 to 50.3) before the implementation of telemedicine to 64.6% (95% CI. 61.9 25 to 67.2) after (adjusted OR 1.5, 95% CI. 1.2 to 1.8). In the post-intervention group, contraception use also increased significantly (84.7% vs 49.7%; p < 0.001), and a higher proportion of women relied on long-acting reversible contraception (16.6% vs 5.7%; p < 0.001). However, patients in the post-intervention group were less likely to practice exclusive breastfeeding (46.6% vs 75.1%; p < 0.001).

Conclusion

Rescheduling the timing of a comprehensive visit accompanied by telemedicine support improved postpartum contact and contraceptive utilization, especially during the coronavirus pandemic. However, the observed decrease in exclusive breastfeeding highlights the need for better telehealth support.ImplicationOur findings support that individualized postpartum care with telemedicine is a feasible and useful approach to sustain services during a pandemic.

The Power and Promise of Postpartum Self Care: Evaluation of a Web-Based Tool for Underserved Women

OBJECTIVES

Joyuus is a culturally diverse, comprehensive online tool designed to address the self-care needs of underserved postpartum women. The tool provides actionable self-care information, knowledge, and skills to improve postpartum health and identifies red flags for when self-care shifts to seeking care.

METHODS

We employed a mixed-methods multiphase design to evaluate the Joyuus prototype, including a pre-post evaluation (N = 87) to assess behavioral health outcomes before and after using the tool for a one-month period. 91% completed the post-test (N = 79). The analysis focused on estimation of treatment effect (via 95% confidence intervals) and fitness of instruments in this population.

RESULTS

Participants were between 6 months pregnant and one year postpartum, a mean age of 30 years, 100% female, 99% Black, with nearly equal distribution of married (55%) and not married (44%), and above (47%) and below (46%) annual income of $60 K. Key measures saw significant improvement from pre- (mean = 26.44, SD = 5.39) to post (mean = 28.29, SD = 5.26) on the Connor-Davidson Resilience Scale (p < 0.001) Trends toward improvement (not statistically significant) were noted for Depression (EPDS) (p = 0.624) and Anxiety (STAI) (p = 0.286), and no meaningful change on MOS Social Support or COVID-19 Mental Health Impacts Measures.

CONCLUSIONS FOR PRACTICE

This pilot study demonstrates that a self-care mobile tool has the potential to address significant health outcomes related to maternal morbidity and mortality. By providing a continuously available companion addressing physical, mental, and real-life questions, it creates value during postpartum for mothers who can often feel overwhelmed or isolated.

The Stress of Parenting in the Postpartum Period During the COVID-19 Pandemic

Background

The COVID-19 pandemic produced a major shift in parental roles, which disproportionally exacerbated existing challenges for low-income new parents. Our objective was to identify pandemic-related parenting challenges experienced by low-income postpartum individuals in the context of the early months of the COVID-19 pandemic.

Methods

Semistructured interviews with 40 low-income postpartum individuals were conducted within 10 weeks after giving birth in April 2020-June 2020. Interviews addressed maternal health and well-being, parental stress, including COVID-related barriers to providing for children, and access to essential services. Interview themes were developed using the constant comparative method.

Results

Half (n = 20) the participants identified as non-Hispanic Black and 38% (n = 15) as Hispanic; 75% (n = 30) were parents of multiple children. Parenting-related themes included challenges of parenting multiple children, barriers to maintaining self-care, and novel barriers to providing for children. Participants discussed handling new roles as educators, struggles with entertaining, allocating time among children, and effects of the pandemic on older children. Participants frequently described their lack of alone time, changes in self-care and coping strategies due to continuous parenting, and effects on maternal mental health like increased anxiety. Many participants reported lack of communal support, financial stress, and difficulty accessing services.

Conclusions

New burdens introduced by the pandemic challenged low-income individuals' health and well-being. Understanding these psychosocial stressors and developing interventions to ameliorate these burdens may be key to promoting family health during difficult times; one potential solution for preventing postpartum depression is offering continual social services. Clinical Trial No.: NCT03922334.

Utilization of Postnatal Care During the COVID-19 Pandemic: Perception and Intents of Postpartum Women at Tertiary Health Facility in Southwest, Nigeria

Coronavirus disease (COVID-19) pandemic took the world unawares and disrupted maternal health care services. This study assessed postnatal care (PNC) utilization, perception, and intent of postpartum women to use PNC. This was a descriptive cross-sectional study conducted during the COVID-19 pandemic over a 2-months period. Inclusion criteria—consenting women, aged ≥18years, and delivery at the study site; 115 women were selected by simple random sampling technique. The information included sociodemographic, obstetric characteristics, perceived effects of COVID-19 on maternal healthcare, and willingness to return for PNC using pre-tested interviewer-administered questionnaires. The maternal healthcare register was also reviewed for the proportion of women accessing services before and during the pandemic. Data were analyzed using IBM Statistical Package and Service Solutions (SPSS) Version 23. The total No. of deliveries and PNC attendance/month was reduced. Respondents were multiparous women (61.7%), with no pregnancy complication (73.9%). About 93% were counseled on PNC; while only 47.8% of the respondents had good knowledge of PNC. The pandemic affected antenatal care in 25.2%, 7.8% perceived it would affect PNC, 62.6% perceived themselves at risk of COVID-19; 13.9% had fears of coming for PNC. Despite this, more than 75% were willing to come for PNC. COVID-19 affected the use of maternal healthcare. Counseling on the role and benefits of PNC can improve its use.