Birthing under the Condition of the COVID-19 Pandemic in Germany: Interviews with Mothers, Partners, and Obstetric Health Care Workers

The socioemotional impact of the COVID-19 pandemic on pregnant and postpartum people: a qualitative study

BACKGROUND

The social isolation and safety measures imposed during the COVID-19 pandemic differentially burdened pregnant and postpartum people, disrupting health care and social support systems. We sought to understand the experiences of people navigating pre- and postnatal care, from pregnancy through to the early postpartum period, during the pandemic.

METHODS

In this qualitative investigation, we conducted semistructured interviews with people residing in British Columbia and Alberta, Canada, during the second half of pregnancy and again at 4-6 weeks' post partum between June 2020 and July 2021. Interviews were conducted remotely (via Zoom or telephone) and focused on the impact of the COVID-19 pandemic on pre- and postnatal care, birth and labour planning, and the birthing experience. We used content and thematic analysis to analyze the data, and checked patterns using NVivo.

RESULTS

We interviewed 19 people during the second half of pregnancy and 18 of these people at 4-6 weeks' post partum. We identified 7 themes/subthemes describing how the COVID-19 pandemic affected their experiences: disrupted support systems, isolation, disrupted health care experiences (pre- and postnatal care, and labour and birth/hospital protocols), violated social norms (including typical rituals such as baby showers), impact on mental health and unexpected benefits (such as a no-visitor policy in hospitals after the birth, which provided a quiet period to bond with baby).

INTERPRETATION

Pregnant and postpartum people were uniquely vulnerable during the COVID-19 pandemic and would have benefited from increased access to support in both health care and social settings. Future work should investigate maternal and infant/child functioning and behaviour to assess the long-term impact of the pandemic on Canadian families and developing children, with an aim to increase support where necessary.

Psychosocial Processes in Healthcare Workers: How Individuals' Perceptions of Interpersonal Communication Is Related to Patient Safety Threats and Higher-Quality Care

Interpersonal communication, as a central form of social resource derived from social relations, is crucial for individuals coping with threats in the workplace, especially for hospitals that provide high-quality care and patient safety. Using social system mentalization as a theoretical background, we applied psychosocial processes and a psychodynamic system approach to get insights on how healthcare workers interact with team members and patients. The goal was to test the following hypotheses: H1: Better communication is associated with fewer patient safety threats (H1a) and higher-quality care (H1b). H2: The associations between communication and patient safety threats (H2a) and higher-quality care (H2b) are mediated by psychological safety. In this two-studies design, we conducted a cross-sectional hospital survey (N = 129) and a survey of obstetric team members (N = 138) in Germany. Simple mediation analyses were run. Results revealed that communication is associated with safety performance. Further, the mediating effect of psychological safety between communication and safety performance was demonstrated. These findings contribute to an understanding of social relation representations, as individuals' communication interrelates with safety performance mediated by psychological safety to complement healthcare and public health strategies. With a better understanding of communication and psychological safety, tools, routines, and concrete trainings can be designed.

[Violated birth integrity during the COVID-19 pandemic in Germany: experiences of women with maternity care]

INTRODUCTION

The COVID-19 pandemic may increase women's vulnerability through violations of their integrity during birth. In a cross-sectional study (March 2020 to March 2022), we investigated how women giving birth experienced maternity care during the pandemic in Germany and which factors were associated with their birth integrity.

METHODS

In a survey (validated questionnaire and two open-ended questions), women ≥ 18 years described their experiences of maternity care. We conducted quantitative analyses using descriptive statistics and logistic regressions to investigate factors associated with dignified care and emotional support, which are understood as proxies of birth integrity. We analysed the open-ended questions through inductive content analysis.

RESULTS

We included data from 1271 participants and 214 comments. The majority of respondents felt emotionally supported (71%) and treated with dignity (76%). One third reported not always being involved in decision-making, while 14% felt they were subjected to physical, verbal or emotional abuse. For 57% of women, their companion of choice was absent or their presence limited. Those factors were all associated with the chances of feeling treated with dignity and emotionally supported. The qualitative comments provided an insight into what specifically women perceive as violating their integrity.

DISCUSSION

During the COVID-19 pandemic, the vulnerability of parturients lies in the violation of their birth integrity. Measures to promote respectful maternity care of women who give birth include comprehensive structural and political solutions as well as further research on the determinants of birth integrity.

Pregnancy Care during the COVID-19 Pandemic in Germany: A Public Health Lens

The COVID-19 pandemic has led to various challenges in German health care, including pregnancy care. This paper aims to provide an overview of the pandemic-related challenges faced by pregnant women, new mothers, and their families in maternal and newborn care. A literature review was performed by including international literature as well as recommendations of institutions and official stakeholders. These challenges refer to restrictions at all stages of pregnancy, including wearing masks during labour, limitations of a companion of choice during birth, and restrictions of unvaccinated women from attending, e.g., antenatal classes. Compared with the general population, COVID-19 vaccination of pregnant women was recommended later, as pregnant women were initially excluded from clinical trials. Women who gave birth during the COVID-19 pandemic also reported mental health issues. The findings stress the importance of the inclusion of pregnant women in clinical trials. This might also help to overcome vaccine hesitancy among pregnant women and women seeking family planning. Taking the COVID-19 pandemic as an example, one must weigh the changes and restrictions associated with the potential disadvantages for mothers, newborns, and their families in pregnancy care against the measures to control the pandemic.

SDG5 "Gender Equality" and the COVID-19 pandemic: A rapid assessment of health system responses in selected upper-middle and high-income countries

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.

Parental Postnatal Depression in the Time of the COVID-19 Pandemic: A Systematic Review of Its Effects on the Parent-Child Relationship and the Child's Developmental Outcomes

The international literature has shown that maternal and paternal postnatal depression (PND) is one of the most common mental illnesses in the perinatal period, with significant consequences for parent-infant relationships and infant development. The COVID-19 pandemic has increased the rates of prevalence of PND, exacerbating the mental health risk for new families. This systematic review aims to examine the effect of maternal and paternal PND on parent-infant relationships and children's development in the first 36 months after childbirth during the COVID-19 outbreak. Eligible studies were identified using the following databases: Medline, CINAHL, SCOPUS, PsycINFO, PsycARTICLES, ScienceDirect, and Web of Science. Of the 1252 studies considered, 10 studies met the inclusion criteria. Results showed that maternal PND significantly affected the quality of the early mother-infant relationship and the infant's motor, self-regulation, and socio-emotional development. In addition, the detrimental impact of maternal PND on the quality of early mother-infant relationships seems to become stronger as COVID-19 concerns increase. No studies included fathers. These findings strengthened the importance of planning targeted prevention and treatment strategies to prevent PND and its short- and long-term consequences, especially in the case of stressful and traumatic events. They also suggested the urgent need for further exploration of fathers.

Experiences of giving birth during the COVID-19 pandemic: a qualitative analysis of social media comments through the lens of birth integrity

BACKGROUND

Social media offer women a space to discuss birth-related fears and experiences. This is particularly the case during the COVID-19 pandemic when measures to contain the spread of the virus and high rates of infection have had an impact on the delivery of care, potentially restricting women's rights and increasing the risk of experiencing different forms of mistreatment or violence. Through the lens of birth integrity, we focused on the experiences of women giving birth in Germany as shared on social media, and on what may have sheltered or violated their integrity during birth.

METHODS

Using thematic analysis, we identified key themes in 127 comments and associated reactions (i.e. "likes", emojis) posted on a Facebook public page in response to the dissemination of a research survey on maternity care in the first year of the COVID-19 pandemic.

RESULTS

Women contributing to the dataset gave birth during March and December 2020. They were most negatively affected by own mask-wearing -especially during the active phase of labour, not being allowed a birth companion of choice, lack of supportive care, and exclusion of their partner from the hospital. Those topics generated the most reactions, revealing compassion from other women and mixed feelings about health measures, from acceptation to anger. Many women explicitly formulated how inhumane or disrespectful the care was. While some women felt restricted by the tight visiting rules, those were seen as positive by others, who benefited from the relative quiet of maternity wards and opportunities for postpartum healing and bonding.

CONCLUSION

Exceptional pandemic circumstances have introduced new parameters in maternity care, some of which appear acceptable, necessary, or beneficial to women, and some of which can be considered violations of birth integrity. Our research calls for the investigation of the long-term impact of those violations and the reassessment of the optimal conditions of the delivery of respectful maternity during the pandemic and beyond.

Impact of the COVID-19 Pandemic on CSR Activities of Healthcare Providers

(1) Background: Corporate social responsibility (CSR) is important for every company that cares for sustainable structures. Healthcare providers especially have made social responsibility their goal. However, crises such as the COVID-19 pandemic impacted different activities within the healthcare sector including CSR and its monitoring. However, theory-driven CSR research within the healthcare sector is scarce and monitoring requires a structured understanding of the processes. Therefore, the objective of this study was to investigate the CSR practices and activities which healthcare providers have implemented in an exemplified country namely Germany and the effect of the pandemic in this process. (2) Methods: Participants were sampled based on their field of care (general, psychiatric, or rehabilitation), the type of organization (public, private, or non-profit), and group membership. A total of 18 healthcare providers were initially recruited, out of which nine participated in the interviews. They represent companies with yearly revenue of between EUR 110 million and EUR 6 billion, and have between 900 and 73,000 employees. (3) Results: CSR-related activities were postponed due to times of crisis. There was a necessity to rapidly digitalize processes. Frequent and precise communication turned out to be important for keeping employees' well-being, motivation, and satisfaction levels high. Environmental efforts were counteracted by new hygienic requirements and a shift in priorities. Many study participants expressed the hope that after the pandemic, newly established methods, processes, and structures (e.g., digital meetings, quicker and more inclusive communication) would be maintained and developed further. (4) Conclusions: The pandemic has been challenging and at the same time, these challenges also created opportunities to strike a new path using the learnings to overcome future health-related or economic crises.

The impacts of the COVID-19 pandemic on birth satisfaction and birth experiences in Russian women

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.

The Impact of a Communication Training on the Birth Experience: Qualitative Interviews with Mothers after Giving Birth at Obstetric University Departments in Germany

(1) Background: Patient safety is a pressing issue in healthcare. Besides economical and organizational issues, human factors play a crucial role in providing safe care. Safe and clear communication on both the healthcare workers' and patients' sides contribute to the avoidance of medical errors and increase patients' and healthcare workers' satisfaction. Globally, the incidence of experiencing at least one adverse event in obstetrics is about 10%, of which half are classified as preventable. According to international research, improving communication skills may decrease preventable adverse events. The research question was to what extent communication training for pregnant women impacts the quality of communication and mutual understanding during birth. (2) Methods: Communication interventions with pregnant women were conducted in two German university obstetric departments in a mixed methods research design, based on the Health Action Process Approach. The online classes covered the awareness of personal wishes, the understanding and usage of communication strategies, self-efficacy and empathy. This study presents the qualitative results. Out of 142 mothers who answered two questionnaires before the communication training and after the birth, 24 in-depth semistructured interviews were conducted to explore the subjective impact of the communication training. The results were analyzed with qualitative content analysis. (3) Results: The majority of participants felt incentivized to be aware of their personal wishes for birth and to express them. Perceived positive experiences with sufficient competency in communication, empathy and mutual understanding outweighed negative treatments and experiences in the hospital, some of which could be attributed to structural problems. (4) Discussion: The reported positive effects of the communication training underline the need but also the potential for communication lessons to reflect and improve communication skills in obstetrics. However, negative experiences due to structural problems in the healthcare system may be buffered by communication skills but not solved.