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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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Murray Cunningham S, McHugh Power J, Hyland P, Casey AM. Support for the Supporter: Paternal Postpartum Loneliness and Social Support During the COVID-19 Pandemic. Am J Mens Health 2024; 18:15579883241249921. [PMID: 38767285 PMCID: PMC11107328 DOI: 10.1177/15579883241249921] [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: 01/28/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 05/22/2024] Open
Abstract
During the postpartum period, fathers may be at risk of increased stress and loneliness, which may be offset or buffered by the provision of social support. This study aimed to explore fathers' postpartum experiences of loneliness, perceived stress, and social support. A constructivist grounded theory approach was used to inform study design and analysis. Semistructured interviews were conducted to collect data from 12 fathers, living in the Republic of Ireland, who had an infant aged 6 months or younger. A grounded theory entitled "support for the supporter," describing fathers' experiences with social support, and loneliness during the postpartum period, was derived. Participants described experiencing increased financial pressure and having difficulty balancing the role of "breadwinner" with fatherhood. Participants described feeling excluded from maternity care and lacked avenues for information within the Irish health care system. Participants linked their experiences of loneliness to the lack of social support in the postpartum period. This study offers a novel insight into Irish fathers' experiences with maternity care during the COVID-19 pandemic. This study is the first to qualitatively explore paternal postpartum loneliness and provides a good foundation for future research and intervention in this area. Findings suggest that it would be wise to promote social support from other experienced fathers, friends, family, and from partners to reduce paternal postpartum loneliness.
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Chapman M, Evans EC, Long MH. Midwifery Practice Leaders' Experiences of Practice Changes Early in the COVID-19 Pandemic: A Qualitative Exploration. J Midwifery Womens Health 2024; 69:236-242. [PMID: 37986664 DOI: 10.1111/jmwh.13584] [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] [Revised: 09/08/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic generated considerable upheaval in all sectors of the US health care system, including maternity care. We focused this inquiry on midwifery practice leaders' experiences and perspectives on changes that occurred in their practices early in the pandemic. METHODS This was a qualitative descriptive study using thematic analysis. The data were responses to an open-ended question in a survey of pandemic-related employment and clinical practice changes. Findings are presented from a constructivist perspective, describing the experiences and perspectives of a group of US midwifery practice leaders during the initial phase of the COVID-19 pandemic. RESULTS Two main themes emerged from the analysis: demands on midwives and driving forces. Demands on midwives were 3-fold: clients' needs, modification of care, and midwives' needs. These encompassed the psychological, physical, and emotional toll that caring for women during the pandemic placed on midwives. Driving forces were those entities that spurred and directed change and included regulations, institutions, financial logistics, and team dynamics. Survey respondents in community (home and birth center) practices reported substantial increases in inquiries and client volume, and many respondents expressed concern about withdrawal of students from clinical placements. DISCUSSION Midwifery practices experienced profound changes in their work environments during the COVID-19 pandemic, with both positive and negative characteristics. These challenges in providing birth care were similar to those reported in other countries. Results indicated existing guidance for maternity care during emergencies did not meet clients' needs. Coordinated planning for maternity care in future prolonged health emergencies should incorporate best practices and include midwives in the process.
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Affiliation(s)
- Meredith Chapman
- School of Nursing, University of Virginia, Charlottesville, Virginia
| | | | - Maryann H Long
- School of Nursing, University of Virginia, Charlottesville, Virginia
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Irvine LC, Chisnall G, Vindrola-Padros C. The impact of maternity service restrictions related to COVID-19 on women's experiences of giving birth in England: A qualitative study. Midwifery 2024; 128:103887. [PMID: 38007920 DOI: 10.1016/j.midw.2023.103887] [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: 06/02/2023] [Revised: 09/24/2023] [Accepted: 11/17/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic led to significant changes in maternity service delivery in England, including: antenatal appointments being cancelled or held by phone; women having to attend antenatal scans alone; partners not being allowed to accompany women during labor; visitor restrictions on postnatal wards; and limited postnatal support. METHODS We conducted semi-structured interviews with 46 women aged 18-45 who had low-risk pregnancies and gave birth to their babies using NHS services in England between 1st March 2020 and 1st March 2021. RESULTS Our thematic analysis of interview data generated key themes: profound negative impacts of birth partners not being allowed to accompany women (including on emotional wellbeing, birth preferences and care-seeking choices); deep frustration about policy variation between trusts and inconsistent implementation of guidance; women being more concerned about the risk of giving birth alone than of COVID-19 infection; and women turning towards private care or delaying seeking NHS care so that they could have the birth experience they desired. The latter two results are, to the best of our knowledge, unique to this paper. CONCLUSION Our participants reported significant negative affects to their emotional and physical wellbeing because of maternity service restrictions. Going forward, efforts are required by policymakers and health service providers to re-establish trust in NHS maternity care and ensure capacity to provide for potential shifts in birthplace preferences. Health systems strengthening efforts should prioritise protecting the rights of women to access high quality, person-centred care in the event of future health emergencies that strain NHS capacity.
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Affiliation(s)
- Lucy C Irvine
- Institute for Global Health, University College London, 30 Guildford St, London WC1N 1EH, United Kingdom.
| | - Georgia Chisnall
- Department of Targeted Intervention, University College London, London, United Kingdom
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Lasso-Olayo L, Pasierb D, Berdejo V, Gasch-Gallén Á. Psychological response of pregnant women during COVID-19 pandemic lockdown. Rev Esc Enferm USP 2023; 57:e20230088. [PMID: 38131440 PMCID: PMC10740368 DOI: 10.1590/1980-220x-reeusp-2023-0088en] [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: 04/25/2023] [Accepted: 10/18/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE In this study we explore anxiety and fear of COVID-19 in women in the process of pregnancy during lockdown due to the SARS CoV-2 pandemic and their relationship with sociodemographic and clinical factors in a tertiary referral level hospital. METHOD A descriptive cross-sectional study was carried out in pregnant women at the Lozano Blesa University Clinical Hospital in Zaragoza (Spain), from April 15, 2020 to May 15, 2020. A total of 168 women was recruited when they went to the hospital for a routine blood test for pregnancy. They answered a sociodemographic and clinical data questionnaire, the Spielberg state-trait anxiety questionnaire for anxiety, and a visual analog scale for fear of COVID. RESULTS Frequency of Trait anxiety was 50.7% (95% CI: 42.7-58.7) and 52.7% (95% CI: 44.7-60.7) for State anxiety. The mean visual analog scale for fear of COVID-19 in relation to pregnancy was 57.2 (95% CI: 52.4-61.8). A positive correlation was found between the scales. Statistically significant differences were found between rural and urban areas. CONCLUSION The emotional impact of the COVID-19 is high among pregnant women and the levels of anxiety are higher than usual in these groups of women during the pandemic lockdown.
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Affiliation(s)
- Laura Lasso-Olayo
- Universidad de Zaragoza, Facultad de Ciencias de la Salud, Departamento de Fisiatría y Enfermería, Zaragoza, Spain
| | - Dominika Pasierb
- University of Rzeszow, Institute of Health Sciences, College of Medical Sciences, Rzeszow, Poland
| | - Víctor Berdejo
- Universidad de Zaragoza, Facultad de Ciencias, Departamento de Física Aplicada, Zaragoza, Spain
| | - Ángel Gasch-Gallén
- Universidad de Zaragoza, Facultad de Ciencias de la Salud, Departamento de Fisiatría y Enfermería, Zaragoza, Spain
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Pappu NI, Holmedahl J, Gudjonsdottir S, Erlandsson K, Byrskog U. Quality midwifery care during the COVID-19 pandemic in Bangladesh: A focus group study with midwives, nurses, and midwifery educators. Eur J Midwifery 2023; 7:41. [PMID: 38106465 PMCID: PMC10722304 DOI: 10.18332/ejm/174234] [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: 03/16/2023] [Revised: 09/26/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Bangladesh has made remarkable strides in the development of the midwifery profession. However, the COVID-19 pandemic has had profound effects on healthcare systems worldwide, including those related to reproductive, perinatal, and maternal health. Given the recent advancements in the midwifery field in Bangladesh, it is crucial to examine the pandemic's impact on existing barriers and the capacity of midwifery professionals to deliver high-quality care. The aim of this study is to describe the possibility of midwives being able to provide quality midwifery care in Bangladesh during the COVID-19 pandemic. METHODS To gather insights, data were collected from July to October 2020 via four qualitative focus group discussions online; 23 actively practicing midwives, nurses specializing in midwifery care, and midwifery educators, participated. The data analysis employed reflexive thematic analysis. RESULTS The COVID-19 crisis posed significant threats to women's safety and health, with lockdowns exacerbating gender inequalities in society. Midwives faced added challenges due to their relatively low professional status and increased workloads. Insufficient policy implementation further compromised midwives' safety. Fear of contracting the virus and working during their free time also raised concerns about the quality of care provided. Nevertheless, the pandemic provided opportunities for midwives to demonstrate their ability to deliver independent midwifery care in Bangladesh. CONCLUSIONS The pandemic underscored the importance of creating respectful and dignified working conditions for midwives. It revealed that professional midwives can work independently when provided with the necessary space and a supportive work environment. This opens the door for the implementation of a midwifery-led care model. Further research is recommended to investigate the medical safety and efficacy of independent midwifery care in the context of Bangladesh.
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Affiliation(s)
- Noor I. Pappu
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Jonna Holmedahl
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | | | | | - Ulrika Byrskog
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Lira V, Beltrami L, Cirimbelli F, Garbelli L, Merlo C, Prandelli EA, Sanfilippo M, Peli NE. Midwifery care for a COVID-19 cohort of women in Northern Italy: two years of pandemic. Minerva Obstet Gynecol 2023; 75:544-552. [PMID: 37326356 DOI: 10.23736/s2724-606x.23.05328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND The rapid development of the COVID-19 pandemic has altered the context of healthcare around the world. SARS-CoV-2 positive pregnant and postnatal women, being at greater risk of complications, require continuous midwifery surveillance as well as specialized medical care. Scientific literature lacks studies related to midwifery care models in hospital settings during the pandemic. The aim of this work is to describe hospitalizations in an obstetric-gynecological COVID care unit and to provide a descriptive analysis of the organizational and care model adopted. METHODS A cohort retrospective descriptive study was carried out. The sample was stratified by COVID-related care complexity and by obstetric risk. The sample recruited pregnant women, postnatal women, and gynecological patients with confirmed SARS-CoV-2 infection admitted to the obstetric-gynecological COVID unit of a birth center in Northern Italy, from March 16, 2020, to March 16, 2022. RESULTS A number of 1037 women were hospitalized, and of these, 551 were SARS-CoV-2 positive women. The 551 SARS-CoV-2 positive women included 362 pregnant women, 132 postnatal women, 9 gynecological patients with medical diagnosis while 17 with a surgical path, and 31 women undergoing voluntary interruption of pregnancy. The final sample included 536 women. 68.6% of women requested a low care complexity, 22.8% a medium one, and 8.6% a high care complexity. Among the obstetric women population, the majority (70.6%) showed a high obstetric risk. CONCLUSIONS The COVID-19 cohort of women required different levels of care with various care complexity and levels of obstetric risk. The model adopted allowed the acquisition of new technical and professional skills as well as the sharing of responsibilities and competences according to the care model of the Buddy System. Future studies could investigate COVID-related care models adopted internationally, but also deepen the technical and professional skills developed by midwives during the pandemic in order to enrich, improve and support midwifery profession.
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Affiliation(s)
- Viviana Lira
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Laura Beltrami
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Francesca Cirimbelli
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Laura Garbelli
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy -
| | - Camilla Merlo
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Elena A Prandelli
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Massimiliano Sanfilippo
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Nives E Peli
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
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Lloyd B, Bradshaw C, McCarthy J, Tighe SM, Noonan M, Atkinson S. Midwifery students' experiences of their clinical internship placement during the COVID-19 pandemic in Ireland: A qualitative descriptive study. Midwifery 2023; 127:103861. [PMID: 37948792 DOI: 10.1016/j.midw.2023.103861] [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: 03/12/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To explore the impact of the COVID-19 global pandemic on midwifery students' experiences of clinical internship placement in the final year of their midwifery programme. DESIGN A qualitative descriptive study was conducted following ethical approval. Four online focus groups were facilitated. SETTING AND PARTICIPANTS To prepare for autonomous practice, BSc Midwifery students in the Republic of Ireland (RoI) undertake a 36-week internship in the final year of their programme. Midwifery students (n = 15), from one Higher Education Institute (HEI), who were undertaking internship across two clinical practice sites volunteered to participate in the study. FINDINGS Four overarching themes were identified: Fear and uncertainty of internship in the context of a pandemic, Consequences of COVID-19 within the clinical environment, Student supports, Opportunities and challenges during internship. Working within a health care environment dominated by the presence of COVID-19 had significant consequences for the students and their provision of care for women and families. Students were challenged with managing increased responsibility within the context of COVID-19 practice requirements and restrictions. Students balanced their need to progress to autonomous practice, whilst acknowledging their needs as learners. COVID-19 also brought unexpected benefits, which included enhancing students' ability to develop relationships with women in their care, and students described a sense of belonging within the midwifery team. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Midwifery students identified internship, during the COVID-19 pandemic as challenging and stressful. However, students also portrayed a sense of pride in their achievements. Support structures assisted students to cope during this period which included peer support, protective reflective time (PRT) in the HEI and support from clinical placement coordinators in midwifery (CPC-Midwifery) within clinical placements sites. It is essential that these support structures continue within midwifery educational programmes. Promoting peer support in a more formal support structure may need consideration. These support structures need to be protected and enhanced during unprecedented times, such as the COVID-19 pandemic.
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Affiliation(s)
- Barbara Lloyd
- Department of Nursing and Midwifery, University of Limerick, Ireland.
| | - Carmel Bradshaw
- Department of Nursing and Midwifery, University of Limerick, Ireland
| | - Jan McCarthy
- Department of Nursing and Midwifery, University of Limerick, Ireland
| | | | - Maria Noonan
- Department of Nursing and Midwifery, University of Limerick, Ireland
| | - Sandra Atkinson
- Department of Nursing and Midwifery, University of Limerick, Ireland
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Akselsen HM, Leknes EH, Engen T, Vik ES, Nilsen ABV. Midwives' experiences with providing home-based postpartum care during the COVID-19 pandemic: A qualitative study. Nurs Open 2023; 10:7333-7342. [PMID: 37653593 PMCID: PMC10563426 DOI: 10.1002/nop2.1986] [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: 10/18/2022] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023] Open
Abstract
AIM To explore midwives' experiences with providing home-based postpartum care during the COVID-19 pandemic in Norway. DESIGN A descriptive and explorative qualitative study. METHODS The study is based on semi-structured individual interviews with 11 midwives experienced in offering home-based postpartum care. We explored their experiences of such care during the first wave of the COVID-19 pandemic. Data collection occurred from October through November 2020. An inductive thematic analysis was performed using Systematic Text Condensation (STC) by Malterud (2012). RESULTS The following two main results emerged from the analyses: (1) the midwives adapted quickly to changes in postpartum care during the pandemic and (2) midwives saw the experience as an opportunity to re-evaluate their practices. CONCLUSION This study highlights midwives' resilience and adaptability during the first wave of COVID-19 pandemic. It emphasises the crucial role of face-to-face interactions in postpartum care, while recognising the value of technology when direct access is limited. By shedding light on midwives' experiences, this research contributes to improving postpartum care in unforeseen circumstances. It underscores the significance of interdisciplinary integration in planning postpartum care services and the lasting influence of lessons learned on addressing future challenges. IMPLICATIONS FOR PRACTICE The valuable insights gained from lessons learned during the COVID-19 pandemic may have a lasting influence on the postpartum care system, empowering it to tackle unforeseen challenges both today and in the future. IMPACT The current study addressed midwives' experience with providing home-based postpartum care during the COVID-19 pandemic in Norway. Midwives received an opportunity to re-evaluate their own practices and valued being included when changes were implemented. The current findings should alert policy makers, leaders and clinicians in postpartum care services when planning future practice.
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Affiliation(s)
- Hanne Marie Akselsen
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Emilie Hanssen Leknes
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Tone Engen
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Eline Skirnisdottir Vik
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Anne Britt Vika Nilsen
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
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Cummins A, Sheehy A, Taylor J, DeVitry-Smith S, Nightingale H, Davis D. Association of continuity of carer and women's experiences of maternity care during the COVID-19 pandemic: A cross-sectional survey. Midwifery 2023; 124:103761. [PMID: 37327712 PMCID: PMC10257573 DOI: 10.1016/j.midw.2023.103761] [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: 09/22/2021] [Revised: 03/19/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Recent research highlights the impact of the COVID-19 pandemic on maternity services, although none to date have analysed the association between continuity of carer and how women felt about the changes to pregnancy care and birth plans. AIM To describe pregnant women's self-reported changes to their planned pregnancy care and associations between continuity of carer and how women feel about changes to their planned care. METHODS A cross-sectional online survey of pregnant women aged over 18 years in their final trimester of pregnancy in Australia. FINDINGS 1668 women completed the survey. Most women reported at least one change to pregnancy care and birthing plans. Women receiving full continuity of carer were more likely to rate the changes to care as neutral/positive (p<.001) when compared with women who received partial or no continuity. DISCUSSION Pregnant women experienced many changes to their planned pregnancy and birth care during the COVID-19 pandemic. Women who received full continuity of carer experienced fewer changes to care and were more likely to feel neutral/positive about the changes than women who did not receive full continuity of carer.
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Affiliation(s)
- Allison Cummins
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia.
| | - Annabel Sheehy
- Centre for Midwifery, Child and Family Health - University of Technology Sydney, 235 Jones St, Ultimo, NSW 2007, Australia
| | - Jan Taylor
- University of Canberra and ACT Government, Health Directorate, Australia
| | | | - Helen Nightingale
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo 3552, Australia
| | - Deborah Davis
- University of Canberra and ACT Government, Health Directorate, Australia
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Cross H, Krahé C, Spiby H, Slade P. Do antenatal preparation and obstetric complications and procedures interact to affect birth experience and postnatal mental health? BMC Pregnancy Childbirth 2023; 23:543. [PMID: 37501081 PMCID: PMC10375777 DOI: 10.1186/s12884-023-05846-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Antenatal preparation is commonly offered to women in pregnancy in the United Kingdom, but the content is highly variable, with some programmes orientated towards 'normal birth', whilst others may incorporate information about complications and procedures (broader focus). However, the impact of this variability on birth experience has not been explored. We examined the relationship between the content of antenatal preparation received and birth experience, taking into account obstetric complications and procedures. As birth experience can have a profound impact on a mother's postnatal well-being, we also investigated associations with mothers' postnatal mood and anxiety. METHODS N = 253 first-time mothers completed a cross-sectional survey measuring demographic and clinical factors, antenatal preparation content (categorised as normality-focused or broader-focused), obstetric complications and procedures experienced, birth experience (measured using three separate indices; the Childbirth Experience Questionnaire, emotional experiences, and presence/absence of birth trauma), postnatal depression and anxiety, and qualitative information on how the COVID-19 pandemic had affected birth experience. RESULTS Regarding birth experience, receiving more broader-focused preparation was associated with a more positive birth experience irrespective of complications/procedures experienced, while receiving only normality-focused preparation was beneficial in the context of fewer complications/procedures. Regarding birth trauma, receiving more broader-focused preparation was associated with lower likelihood of reporting birth as traumatic only in the context of more complications/procedures. Degree of normality-focused preparation was unrelated to experience of birth trauma. Lastly, while more complications/procedures were associated with greater anxiety and low mood, only greater normality-focused preparation was linked with better postnatal mental health. CONCLUSIONS Antenatal preparation including both normality- and broader-focused information is positively related to women's birth experience. While normality-focused preparation seems most beneficial if fewer complications/procedures are experienced, broader-focused preparation may be most beneficial in the context of a greater number of complications/procedures. As complications/procedures are often unpredictable, offering broader-focused preparation routinely is likely to benefit women's birth experience. This antenatal preparation should be freely available and easily accessible.
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Affiliation(s)
- Hannah Cross
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
- Lancashire and South Cumbria NHS Foundation Trust, Blackpool, UK
| | - Charlotte Krahé
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Pauline Slade
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK.
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Heaney S, Galeotti M, Aventin Á. Pregnancy loss following miscarriage and termination of pregnancy for medical reasons during the COVID-19 pandemic: a thematic analysis of women's experiences of healthcare on the island of Ireland. BMC Pregnancy Childbirth 2023; 23:529. [PMID: 37480006 PMCID: PMC10360341 DOI: 10.1186/s12884-023-05839-4] [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: 04/17/2023] [Accepted: 07/09/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Losing a baby during pregnancy can be a devastating experience for expectant parents. Many report dedicated, compassionate healthcare provision as a facilitator of positive mental health outcomes, however, healthcare services have been severely impacted during the COVID-19 pandemic. AIM To explore women's experiences of healthcare service provision for miscarriage and termination of pregnancy for medical reasons (TFMR) on the island of Ireland during the COVID-19 pandemic. METHODS Findings combine data from elements of two separate studies. Study 1 used a mixed methods approach with women who experienced miscarriage and attended a hospital in Northern Ireland. Study 2 was qualitative and examined experiences of TFMR in Northern Ireland and Ireland. Data analysed for this paper includes open-ended responses from 145 women to one survey question from Study 1, and semi-structured interview data with 12 women from Study 2. Data were analysed separately using Thematic Analysis and combined for presentation in this paper. RESULTS Combined analysis of results indicated three themes, (1) Lonely and anxiety-provoking experiences; (2) Waiting for inadequate healthcare; and (3) The comfort of compassionate healthcare professionals. CONCLUSIONS Women's experiences of healthcare provision were negatively impacted by COVID-19, with the exclusion of their partner in hospital, and delayed services highlighted as particularly distressing. Limited in-person interactions with health professionals appeared to compound difficulties. The lived experience of service users will be helpful in developing policies, guidelines, and training that balance both the need to minimise the risk of infection spread, with the emotional, psychological, and physical needs and wishes of parents. Further research is needed to explore the long-term impact of pregnancy loss during a pandemic on both parents and health professionals delivering care.
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Affiliation(s)
- Suzanne Heaney
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Martina Galeotti
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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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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Mari F, Capasso M, Caso D. Exploring the psychosocial impact of the Covid-19 pandemic on women's perinatal experiences and wellbeing: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100805. [PMID: 36502624 PMCID: PMC9712141 DOI: 10.1016/j.srhc.2022.100805] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/03/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE While many studies have investigated the clinical impact of the Covid-19 pandemic on pregnant women's mental health, little attention has been paid to the exploration of women's experiences during the perinatal period from a psychosocial perspective in the Italian context. Thus, the present study aimed to explore the psychosocial changes associated with the pandemic in the perinatal context. METHODS Twenty-one Italian women who gave birth between March and November 2020 took part in this research by participating in semi-structured interviews, exploring their childbirth experiences. Our data were analysed using a Grounded Theory approach. RESULTS Our findings revealed the enhanced importance of social support as a protective factor against uncertainties, which strongly characterised all phases of the perinatal period during the pandemic. Such uncertainties were mainly linked to the discontinuity in intrapartum care, as well as to concerns of being infected with Covid-19 combined with other pregnancy-specific worries. The main sources of social support were represented by loved ones - most of all partners - along with health care staff and peer networks. CONCLUSIONS Our results suggest the importance of implementing evidence-based policies and interventions to improve women's wellbeing in the perinatal period during the pandemic, as well as of guaranteeing intrapartum care continuity and the presence of social support.
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Affiliation(s)
- Federica Mari
- Department of Humanities, University of Naples Federico II, Italy
| | - Miriam Capasso
- Department of Humanities, University of Naples Federico II, Italy.
| | - Daniela Caso
- Department of Humanities, University of Naples Federico II, Italy
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15
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Bozkurt MA, Cesur B. The effect of the Ebe Evimde application on the self-efficacy and anxiety levels of mothers: Randomized controlled trial. Digit Health 2023; 9:20552076231169840. [PMID: 37124329 PMCID: PMC10134124 DOI: 10.1177/20552076231169840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Objective Family health can be improved by making home visits with mobile applications. This study was carried out to evaluate the effect of a mobile application and web-based software called Ebe Evimde (My Home Midwife), which was designed by the researchers for use in the postpartum period, on mothers' self-efficacy and anxiety levels. Methods Home visits to 60 mothers in the intervention group, who are over 18 years of age, who have given birth at term, who have no complications in mother and baby, and who are in the second to fifth postpartum days, were made with the online home visits mobile support application Midwifery Home software and their self-efficacy and anxiety levels were evaluated. Mothers were divided into two groups as intervention (60) and control group (60) using a random number table. Results While there was a significant difference between the pretest and posttest self-efficacy levels of the intervention group, there was no difference between the pretest and posttest self-efficacy levels of the control group. When the groups obtained from the Postpartum Specific Anxiety Scale were examined, it was seen that there was a negative and very strong significant relationship between the pretest and posttest scores of the mothers in the intervention group, while when the relationship between the pretest and posttest scores of the mothers in the control group was examined; no significant relationship was observed. Conclusion The practice of Ebe Evimde (My Home Midwife) had a positive effect on mothers' self-efficacy and postpartum anxiety levels.
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Affiliation(s)
- Merve Ayşe Bozkurt
- Merve Ayşe Bozkurt, Department of Midwifery, Faculty of Health Sciences, Cumhuriyet University, 58000 Sivas, Turkiye.
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Midwives speaking out on COVID-19: The international confederation of midwives global survey. PLoS One 2022; 17:e0276459. [PMID: 36322517 PMCID: PMC9629587 DOI: 10.1371/journal.pone.0276459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Background Maternity services around the world have been disrupted since the outbreak of the COVID-19 pandemic. The International Confederation of Midwives (ICM) representing one hundred and forty-three professional midwifery associations across the world sought to understand the impact of the pandemic on women and midwives. Aim The aim of this study was to understand the global impact of COVID-19 from the point of view of midwives’ associations. Methods A descriptive cross-sectional survey using an on-line questionnaire was sent via email to every midwives’ association member of ICM. Survey instrument The survey was developed and tested by a small global team of midwife researchers and clinicians. It consisted of 106 questions divided into seven discreet sections. Each member association was invited to make one response in either English, French or Spanish. Results Data were collected between July 2020 and April 2021. All respondents fulfilling the inclusion criteria irrespective of whether they completed all questions in the survey were eligible for analysis. All data collected was anonymous. There were 101 surveys returned from the 143 member associations across the world. Many countries reported being caught unaware of the severity of the infection and in some places, midwives were forced to make their own PPE, or reuse single use PPE. Disruption to maternity services meant women had to change their plans for place of birth; and in many countries maternity facilities were closed to become COVID-19 centres. Half of all respondents stated that women were afraid to give birth in hospitals during the pandemic resulting in increased demand for home birth and community midwifery. Midwifery students were denied access to practical or clinical placements and their registration as midwives has been delayed in many countries. More than 50% of the associations reported that governments did not consult them, and they have little or no say in policy at government levels. These poor outcomes were not exclusive to high-, middle- or low-income countries. Conclusions Strong recommendations that stem from this research include the need to include midwifery representation on key government committees and a need to increase the support for planned out of hospital birth. Both these recommendations stand to enhance the effectiveness of midwives in a world that continues to face and may face future catastrophic pandemics.
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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
BackgroundFindings 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.MethodsThis 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.ResultsMothers 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.ConclusionThis 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)
- Mikhayl A. von Rieben
- School of Psychology, Deakin University, Burwood, VIC, Australia
- *Correspondence: Mikhayl A. von Rieben,
| | - Leanne Boyd
- Monash University, Eastern Health, Melbourne, VIC, Australia
| | - Jade Sheen
- School of Psychology, Deakin University, Burwood, VIC, Australia
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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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Evans C, Evans K, Booth A, Timmons S, Jones N, Nazmeen B, Sunney C, Clowes M, Clancy G, Spiby H. Realist inquiry into Maternity care @ a Distance (ARM@DA): realist review protocol. BMJ Open 2022; 12:e062106. [PMID: 36127105 PMCID: PMC9490633 DOI: 10.1136/bmjopen-2022-062106] [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 One of the most commonly reported COVID-19-related changes to all maternity services has been an increase in the use of digital clinical consultations such as telephone or video calling; however, the ways in which they can be optimally used along maternity care pathways remain unclear. It is imperative that digital service innovations do not further exacerbate (and, ideally, should tackle) existing inequalities in service access and clinical outcomes. Using a realist approach, this project aims to synthesise the evidence around implementation of digital clinical consultations, seeking to illuminate how they can work to support safe, personalised and appropriate maternity care and to clarify when they might be most appropriately used, for whom, when, and in what contexts? METHODS AND ANALYSIS The review will be conducted in four iterative phases, with embedded stakeholder involvement: (1) refining the review focus and generating initial programme theories, (2) exploring and developing the programme theories in light of evidence, (3) testing/refining the programme theories and (4) constructing actionable recommendations. The review will draw on four sources of evidence: (1) published literature (searching nine bibliographic databases), (2) unpublished (grey) literature, including research, audit, evaluation and policy documents (derived from Google Scholar, website searches and e-thesis databases), (3) expertise contributed by service user and health professional stakeholder groups (n=20-35) and (4) key informant interviews (n=12). Included papers will consist of any study design, in English and from 2010 onwards. The review will follow the Realist and Meta-narrative Evidence Synthesis Evolving Standards quality procedures and reporting guidance. ETHICS AND DISSEMINATION Ethical approval has been obtained from the University of Nottingham, Faculty of Medicine and Health Sciences Ethics Committee (FMHS 426-1221). Informed consent will be obtained for all key informant interviews. Findings will be disseminated in a range of formats relevant to different audiences. PROSPERO REGISTRATION NUMBER CRD42021288702.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Kerry Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Andrew Booth
- ScHARR, The University of Sheffield, Sheffield, UK
| | | | - Nia Jones
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Benash Nazmeen
- School of Allied Health Professionals and Midwifery, University of Bradford, Bradford, UK
| | | | - Mark Clowes
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Georgia Clancy
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK
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MacDorman MF, Barnard-Mayers R, Declercq E. United States community births increased by 20% from 2019 to 2020. Birth 2022; 49:559-568. [PMID: 35218065 DOI: 10.1111/birt.12627] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anecdotal and emerging evidence suggested that the 2020 COVID-19 pandemic may have influenced women's attitudes toward community birth. Our purpose was to examine trends in community births from 2019 to 2020, and the risk profile of these births. METHODS Recently released 2020 birth certificate data were compared with prior years' data to analyze trends in community births by socio-demographic and medical characteristics. RESULTS In 2020, there were 71 870 community births in the United States, including 45 646 home births and 21 884 birth center births. Community births increased by 19.5% from 2019 to 2020. Planned home births increased by 23.3%, while birth center births increased by 13.2%. Increases occurred in every US state, and for all racial and ethnic groups, particularly non-Hispanic Black mothers (29.7%), although not all increases were statistically significant. In 2020, 1 of every 50 births in the United States was a community birth (2.0%). Women with planned home and birth center births were less likely than women with hospital births to have several characteristics associated with poor pregnancy outcomes, including teen births, smoking during pregnancy, obesity, and preterm, low birthweight, and multiple births. More than two-thirds of planned home births were self-paid, compared with one-third of birth center and just 3% of hospital births. CONCLUSIONS It is to the great credit of United States midwives working in home and birth center settings that they were able to substantially expand their services during a worldwide pandemic without compromising standards in triaging women to optimal settings for safe birth.
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Affiliation(s)
- Marian F MacDorman
- Maryland Population Research Center, University of Maryland, College Park, Maryland, USA
| | | | - Eugene Declercq
- Boston University School of Public Health, Boston, Massachusetts, USA
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Jefford E, Charmer L, Stulz V, Jomeen J, Hawley G, Davis D. Pandemic Changes to Maternity Services—Short- and Long-Term Consequences. INTERNATIONAL JOURNAL OF CHILDBIRTH 2022. [DOI: 10.1891/ijc-2022-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Power A, Atkinson S, Noonan M. "Stranger in a mask" midwives' experiences of providing perinatal bereavement care to parents during the COVID-19 pandemic in Ireland: A qualitative descriptive study. Midwifery 2022; 111:103356. [PMID: 35576867 PMCID: PMC9046145 DOI: 10.1016/j.midw.2022.103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/16/2022] [Accepted: 04/26/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To explore the experiences and perceptions of midwives providing perinatal bereavement care during the COVID-19 pandemic and to identify the barriers and facilitators to providing compassionate bereavement care. DESIGN A qualitative descriptive design was utilized to address the research question. Following ethical approval, in depth, semi structured interviews were undertaken to explore midwives' experiences of providing care to parents following perinatal bereavement. Narrative data was analyzed using thematic analysis. SETTING A standalone regional maternity hospital located in a large metropolitan center in the Republic of Ireland. PARTICIPANTS A purposeful sample of eleven midwives, who cared for bereaved parents during the COVID-19 pandemic volunteered to participate in the study. FINDINGS Two main themes were identified, each with associated subthemes (1) Challenges of providing compassionate bereavement care during a pandemic (2) Psychological effect and coping strategies utilised by midwives during a pandemic. CONCLUSION The COVID-19 pandemic brought unprecedented challenges when providing perinatal bereavement care. The mandatory infection prevention and control measures significantly disrupted human communication and connections. Participants in the study utilized techniques to optimize care while adhering to COVID-19 guidelines, and simultaneously putting their own fear and anxieties aside.
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Affiliation(s)
- Annmarie Power
- Health Service Executive, University Maternity Hospital, Ennis Road, Limerick, Ireland.
| | - Sandra Atkinson
- Department of Nursing and Midwifery, Health Science Building, North Bank Campus, University of Limerick, Castletroy, Limerick, Ireland
| | - Maria Noonan
- Department of Nursing and Midwifery, Health Science Building, North Bank Campus, University of Limerick, Castletroy, Limerick, Ireland
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Memmott C, Smith J, Korzuchowski A, Tan HL, Oveisi N, Hawkins K, Morgan R. 'Forgotten as first line providers': The experiences of midwives during the COVID-19 pandemic in British Columbia, Canada. Midwifery 2022; 113:103437. [PMID: 35908443 PMCID: PMC9303060 DOI: 10.1016/j.midw.2022.103437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore midwives' experiences working on the frontlines of the COVID-19 pandemic in British Columbia, Canada. DESIGN Qualitative study involving three semi-structured focus groups and four in-depth interviews with midwives. SETTING The COVID-19 pandemic in British Columbia, Canada from 2020-2021. PARTICIPANTS 13 midwives working during the first year of the COVID-19 pandemic in British Columbia. FINDINGS Qualitative analysis surfaced four key themes. First, midwives faced a substantial lack of support during the pandemic. Second, insufficient support was compounded by a lack of recognition. Third, participants felt a strong duty to continue providing high-quality care despite COVID-19 related restrictions and challenges. Lastly, lack of support, increased workloads, and moral distress exacerbated burnout among midwives and raised concerns around the sustainability of their profession. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Lack of effective support for midwives during the initial months of the COVID-19 pandemic exacerbated staffing shortages that existed prior to the pandemic, creating detrimental gaps in essential care for pregnant people, especially with increasing demands for homebirths. Measures to support midwives should combat inequities in the healthcare system, mitigating the risks of disease exposure, burnout, and professional and financial impacts that may have long-lasting implications on the profession. Given the crucial role of midwives in women- and people-centred care and advocacy, protecting midwives and the communities they serve should be prioritized and integrated into pandemic preparedness and response planning to preserve women's health and rights around the world.
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Affiliation(s)
- Christina Memmott
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD, 21205, USA
| | - Julia Smith
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr, Burnaby, British Columbia, V5A 1S6, USA.
| | - Alexander Korzuchowski
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr, Burnaby, British Columbia, V5A 1S6, USA
| | - Heang-Lee Tan
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD, 21205, USA
| | - Niki Oveisi
- University of British Columbia, Pharmaceutical Sciences Building, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, USA
| | - Kate Hawkins
- Pamoja Communications, 20-22 Wenlock Road, London, N1 7GU, England
| | - Rosemary Morgan
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD, 21205, USA
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Hosseini MS, Jahanshahlou F, Mahmoodpoor A, Sanaie S, Naseri A, Kuchaki Rafsanjani M, Seyedi-Sahebari S, Vaez-Gharamaleki Y, ZehiSaadat M, Rahmanpour D. Pregnancy, peripartum, and COVID-19: An updated literature review. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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White J, Cavenagh D, Byles J, Mishra G, Tooth L, Loxton D. The experience of delayed health care access during the COVID 19 pandemic in Australian women: A mixed methods exploration. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1384-e1395. [PMID: 34423499 PMCID: PMC8653352 DOI: 10.1111/hsc.13546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
Delayed health care access is a potential collateral effect of pandemic conditions, health rationing strategies and social distancing responses. We investigated experiences of delayed health care access in Australian women during COVID-19. A mixed methods study used quantitative and free-text data from the Australian Longitudinal Study on Women's Health COVID-19 survey 4 (health care access or delay). Logistic regression models were used to estimate factors associated with delaying access to general practitioners (GPs), specialists and allied health services. Free-text comments were analysed thematically, employing a process of constant comparison. COVID-19 survey 4 was completed by 8,200 women and 2,727 provided free-text comments. Of the women who needed the health service, 25% (1,268/5,071) delayed seeing their GP, 23.6% (570/1,695) delayed seeing a specialist and 45% (791/1,757) delayed use of an allied health service. Younger age was most significantly associated with delaying attendance. Women born 1989-95 were significantly more likely to delay compared to women born 1946-51 (OR (95% CI): GP = 0.28 (0.22, 0.35)); Specialist = 0.65 (0.45, 0.92; Allied Health = 0.59 (0.42, 0.82)). Women born 1973-78 were also likely to delay GP visits (0.69, (0.58, 0.83)). Four qualitative themes emerged including: (1) Challenges negotiating care during a pandemic; (2) Ongoing uncertainty towards accessing health care when a specialist delays an appointment; (3) Accessing health care (or not) using Telehealth and (4) Managing complex care needs. COVID-19 has had a significant effect on access to health care. Women delayed seeking help for cancer screening, mental health, and other health conditions involving chronic and complex needs for health and social care. While there is a need to rationalise and optimise health access during a pandemic, our outcomes suggest a need for public health campaigns that clarify how to access care, engage with telehealth and respond to missed appointments.
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Affiliation(s)
- Jennifer White
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
| | - Dominic Cavenagh
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
| | - Julie Byles
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
| | - Gita Mishra
- School of Public HealthFaculty of MedicineThe University of QueenslandHerstonAustralia
| | - Leigh Tooth
- School of Public HealthFaculty of MedicineThe University of QueenslandHerstonAustralia
| | - Deborah Loxton
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
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Mohammadi S, Shojaei K, Maraghi E, Motaghi Z. Quality of perinatal care for women with high-risk pregnancies during the COVID-19 pandemic in Iran. J Int Med Res 2022; 50:3000605221106723. [PMID: 35850546 PMCID: PMC9309783 DOI: 10.1177/03000605221106723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background COVID-19 has had a catastrophic effect on the healthcare system. Healthcare
quality assessment measures the difference between expected and actual
performances to identify gaps in the healthcare system. This study aimed to
evaluate the quality of perinatal care for women with high-risk pregnancies
(HPR) during the COVID-19 pandemic. Materials and Methods This cross-sectional study enrolled 450 women with HPR from health centers in
Ahvaz, Iran, from December 2020 to May 2021, using a multi-stage sampling
method. Quality of care was assessed using an observational checklist
adapted from Ministry of Health guidelines. Data were analyzed using
descriptive and statistical methods. Results The quality of the assessed aspect in comprehensive health centers and in
peripartum, perinatal, and postpartum wards was moderate. The overall score
for peripartum care was significantly positively correlated with the length
of the retraining period, and the quality of perinatal care was
significantly related to the proportion of elective cesarean sections and
preterm delivery. Conclusion The development of care practices in health centers in Iran should focus on
education and counseling. Practices in peripartum wards should emphasize the
use of partographs, physical/mental support, and privacy for mothers, while
perinatal wards should focus on timely counseling.
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Affiliation(s)
- Solmaz Mohammadi
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Kobra Shojaei
- Fertility, Infertility and Perinatology Research Center, Department of Obstetrics and Gynecology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elham Maraghi
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Motaghi
- Reproductive Health Department, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Breastfeeding, Complementary Feeding, Physical Activity, Screen Use, and Hours of Sleep in Children under 2 Years during Lockdown by the COVID-19 Pandemic in Chile. CHILDREN 2022; 9:children9060819. [PMID: 35740756 PMCID: PMC9221584 DOI: 10.3390/children9060819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
Infants and children are a risk group in terms of developing healthy habits, an important aspect if we consider that many of them were born during the COVID-19 pandemic. Our objective was to evaluate compliance with lifestyle recommendations proposed at the national and international levels in children aged 0 to 23 months during confinement due to the COVID-19 pandemic in Chile. A cross-sectional study was conducted, and 211 online questionnaires were completed with sociodemographic and lifestyle information of children. Our results show high compliance with the recommendations on breastfeeding intake (78.3% and 69.5% in 0–5-month-old and 6–23-month-old children, respectively); age of starting complementary feeding (87.4%); non-consumption of salt and sugar (80.1%), non-caloric sweeteners (90.7%), and sweet and salty snacks (68.9%); and hours of physical activity (66.8%) and sleep (65.4%). However, we observed low compliance with the recommendations on the age of introduction of dinner (58.0%), eggs (23.0%), legumes (39.2%), and fish (35.1%); low consumption of legumes (43.4%) and fish (20.5%); and low compliance with the recommendations on screen use during meals (59.2%) and daily screen hours (41.2%). In conclusion, feeding behavior, physical activity, use of screens, and hours of sleep in children were altered by confinement during the pandemic, harming the development of healthy lifestyles.
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Flaherty SJ, Delaney H, Matvienko-Sikar K, Smith V. Maternity care during COVID-19: a qualitative evidence synthesis of women's and maternity care providers' views and experiences. BMC Pregnancy Childbirth 2022; 22:438. [PMID: 35619069 PMCID: PMC9132752 DOI: 10.1186/s12884-022-04724-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/03/2022] [Indexed: 01/16/2023] Open
Abstract
Background As COVID-19 continued to impact society and health, maternity care, as with many other healthcare sectors across the globe, experienced tumultuous changes. These changes have the potential to considerably impact on the experience of maternity care. To gain insight and understanding of the experience of maternity care during COVID-19, from the perspectives of women and maternity care providers, we undertook a qualitative evidence synthesis (QES). Methods The population of interest for the QES were pregnant and postpartum women, and maternity care providers, who provided qualitative data on their experiences of maternity care during COVID-19. The electronic databases of MEDLINE, CINAHL, EMBASE, PsycINFO and the Cochrane COVID study register were systematically searched from 01 Jan 2020 to 13 June 2021. The methodological quality of the included studies was appraised using a modified version of the quality assessment tool, based on 12-criteria, designed by the Evidence for Policy and Practice Information coordinating Centre (EPPI-Centre). Data were extracted by two reviewers independently and synthesised using the Thomas and Harden framework. Confidence in the findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual). Results Fifty records relating to 48 studies, involving 9,348 women and 2,538 maternity care providers, were included in the QES. The methodological quality of the studies varied from four studies meeting all 12 quality criteria to two studies meeting one quality criterion only. The synthesis revealed eight prominent themes. Five of these reflected women’s experiences: 1) Altered maternity care (women), 2) COVID-related restrictions, 3) Infection prevention and risk, 4) ‘the lived reality’ – navigating support systems, and 5) Interactions with maternity services. Three themes reflected maternity care providers’ experiences: 6) Altered maternity care (providers), 7) Professional and personal impact, and 8) Broader structural impact. Confidence in the findings was high or moderate. Conclusion Although some positive experiences were identified, overall, this QES reveals that maternity care during COVID-19 was negatively experienced by both women and maternity care providers. The pandemic and associated changes evoked an array of emotive states for both populations, many of which have the potential to impact on future health and wellbeing. Resource and care planning to mitigate medium- and longer-term adverse sequelae are required. PROSPERO registration CRD42021232684. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04724-w.
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Affiliation(s)
| | - Hannah Delaney
- School of Nursing and Midwifery, University of Dublin Trinity College Dublin, Dublin, Ireland.,Health Research Board-Trials Methodology Research Network (HRB-TMRN), National University of Ireland, Galway, Ireland
| | | | - Valerie Smith
- School of Nursing and Midwifery, University of Dublin Trinity College Dublin, Dublin, Ireland.
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Assfaw HM, Abuhay M, Asratie MH. Desire for Birth Companionship Among Pregnant Women Attending Antenatal Care in Debremarkos City, Northwest Ethiopia: Magnitude and Associated Factors. Front Glob Womens Health 2022; 3:823020. [PMID: 35464775 PMCID: PMC9021547 DOI: 10.3389/fgwh.2022.823020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Birth companionship is one of the components of the respectful maternity continuum of care recommended by the World Health Organization (WHO). Women's desire for birth companionship needs to be given attention during the antenatal care period to make them ready during labor and delivery. There is a dearth of study about the status of women's desire for birth companionship and associated factors. Objective This study aimed to assess the prevalence of desire for birth companionship and associated factors among pregnant women in Debremarkos city, northwest Ethiopia. Methods Institution-based cross-sectional study was conducted from February 1, 2021 to March 30, 2021 in Debremarkos city, northwest Ethiopia. A total of 423 participants were accessed by systematic random sampling. A face-to-face interviewer-administered questionnaire was employed. The data were entered into Epi data version 4.6 and transformed to SPSS version 25. Binary logistic regression analysis was done, and variables with a p-value ≤ 0.2 on bivariable analysis were taken for multivariable analysis. Adjusted odds ratio with a 95% confidence interval was used to detect the association, and a p-value of <0.05 in the multivariable analysis was used to declare statistical significance. Results The prevalence of desire for birth companionship was 57.45% (52.6–62.2%). Women who were the primary decision-maker for maternal health care services [adjusted odds ratio (AOR) =3.0; 95% CI 1.7–5.6], women with planned pregnancy (AOR = 2.0; 95% CI 1.0–3.9), women who have no bad obstetric history (AOR = 2.3; 95% CI 1.2–4.4), and women whose 1st antenatal care visit starts within the second trimester (AOR = 2.6; 1.6–4.4) were statistically significant with desire on birth companionship. Conclusions Desire of pregnant women for birth companionship was high in this study. Improving women's decision-making power, emphasis on the type of pregnancy, obstetrical history, and early initiation of antenatal care visit were the suggested areas to increase the desire of women for birth companionship.
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Affiliation(s)
- Hussien Mohammed Assfaw
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulunesh Abuhay
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- *Correspondence: Melaku Hunie Asratie
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Almeida RAAS, Carvalho RHDSBFD, Lamy ZC, Alves MTSSDBE, Poty NARDC, Thomaz EBAF. DO PRÉ-NATAL AO PUERPÉRIO: MUDANÇAS NOS SERVIÇOS DE SAÚDE OBSTÉTRICOS DURANTE A PANDEMIA DA COVID-19. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0206pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
RESUMO Objetivo: analisar mudanças na assistência à saúde materna durante a pandemia da Covid-19, segundo relatos dos profissionais de saúde. Método: pesquisa qualitativa, realizada com gestores, médicos, enfermeiros, residentes e técnicos de enfermagem atuantes nos setores de ambulatório de pré-natal, emergência obstétrica, hospitalização obstétrica e centro de parto de um hospital público federal de alta complexidade no Nordeste do Brasil. Os dados foram coletados de no período de dezembro de 2020 a agosto de 2021. A amostra, escolhida intencionalmente, buscou a diversidade de características e situações, foi encerrada pelo critério da saturação de sentidos. Questionário estruturado e roteiro semiestruturado de entrevista foram utilizados para coleta dos dados. As entrevistas foram gravadas e transcritas. Empregou-se a análise de conteúdo, na modalidade temática. Resultados: entrevistaram-se 28 profissionais. Foram identificadas mudanças na dinâmica da assistência obstétrica categorizadas em: pré-natal; e parto/puerpério. No pré-natal, houve diminuição das consultas eletivas; aumento do tempo entre consultas; a paramentação atrasava o atendimento; implantação de novos protocolos de higienização; limitação do número de acompanhantes; criação de novos ambientes como a sala Covid-19 para gestantes sintomáticas; teleatendimento e sobrecarga de trabalho pelo aumento da demanda vinda da Atenção Primária à Saúde. No parto/puerpério, os relatos apontaram redução do número de leitos; testagem e isolamento das pacientes sintomáticas; limitação da deambulação, restrição de acompanhantes e obrigatoriedade do uso de máscara pela parturiente. Conclusão: a reestruturação dos serviços e a criação de novos espaços para atendimento de pacientes com Covid-19 ocasionaram redução na oferta de vagas para consultas de pré-natal e pós-parto. As mudanças foram acompanhadas por novas regras de atendimento, com retrocessos quanto à garantia de direitos previamente conquistados.
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Gurol-Urganci I, Waite L, Webster K, Jardine J, Carroll F, Dunn G, Frémeaux A, Harris T, Hawdon J, Muller P, van der Meulen J, Khalil A. Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study. PLoS Med 2022; 19:e1003884. [PMID: 35007282 PMCID: PMC8803187 DOI: 10.1371/journal.pmed.1003884] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 01/31/2022] [Accepted: 12/07/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted maternity services worldwide and imposed restrictions on societal behaviours. This national study aimed to compare obstetric intervention and pregnancy outcome rates in England during the pandemic and corresponding pre-pandemic calendar periods, and to assess whether differences in these rates varied according to ethnic and socioeconomic background. METHODS AND FINDINGS We conducted a national study of singleton births in English National Health Service hospitals. We compared births during the COVID-19 pandemic period (23 March 2020 to 22 February 2021) with births during the corresponding calendar period 1 year earlier. The Hospital Episode Statistics database provided administrative hospital data about maternal characteristics, obstetric inventions (induction of labour, elective or emergency cesarean section, and instrumental birth), and outcomes (stillbirth, preterm birth, small for gestational age [SGA; birthweight < 10th centile], prolonged maternal length of stay (≥3 days), and maternal 42-day readmission). Multi-level logistic regression models were used to compare intervention and outcome rates between the corresponding pre-pandemic and pandemic calendar periods and to test for interactions between pandemic period and ethnic and socioeconomic background. All models were adjusted for maternal characteristics including age, obstetric history, comorbidities, and COVID-19 status at birth. The study included 948,020 singleton births (maternal characteristics: median age 30 years, 41.6% primiparous, 8.3% with gestational diabetes, 2.4% with preeclampsia, and 1.6% with pre-existing diabetes or hypertension); 451,727 births occurred during the defined pandemic period. Maternal characteristics were similar in the pre-pandemic and pandemic periods. Compared to the pre-pandemic period, stillbirth rates remained similar (0.36% pandemic versus 0.37% pre-pandemic, p = 0.16). Preterm birth and SGA birth rates were slightly lower during the pandemic (6.0% versus 6.1% for preterm births, adjusted odds ratio [aOR] 0.96, 95% CI 0.94-0.97; 5.6% versus 5.8% for SGA births, aOR 0.95, 95% CI 0.93-0.96; both p < 0.001). Slightly higher rates of obstetric intervention were observed during the pandemic (40.4% versus 39.1% for induction of labour, aOR 1.04, 95% CI 1.03-1.05; 13.9% versus 12.9% for elective cesarean section, aOR 1.13, 95% CI 1.11-1.14; 18.4% versus 17.0% for emergency cesarean section, aOR 1.07, 95% CI 1.06-1.08; all p < 0.001). Lower rates of prolonged maternal length of stay (16.7% versus 20.2%, aOR 0.77, 95% CI 0.76-0.78, p < 0.001) and maternal readmission (3.0% versus 3.3%, aOR 0.88, 95% CI 0.86-0.90, p < 0.001) were observed during the pandemic period. There was some evidence that differences in the rates of preterm birth, emergency cesarean section, and unassisted vaginal birth varied according to the mother's ethnic background but not according to her socioeconomic background. A key limitation is that multiple comparisons were made, increasing the chance of false-positive results. CONCLUSIONS In this study, we found very small decreases in preterm birth and SGA birth rates and very small increases in induction of labour and elective and emergency cesarean section during the COVID-19 pandemic, with some evidence of a slightly different pattern of results in women from ethnic minority backgrounds. These changes in obstetric intervention rates and pregnancy outcomes may be linked to women's behaviour, environmental exposure, changes in maternity practice, or reduced staffing levels.
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Affiliation(s)
- Ipek Gurol-Urganci
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Lara Waite
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Kirstin Webster
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Jennifer Jardine
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Fran Carroll
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - George Dunn
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Alissa Frémeaux
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Tina Harris
- Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Jane Hawdon
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Patrick Muller
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Jan van der Meulen
- Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, London, United Kingdom.,Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, United Kingdom.,Fetal Medicine Unit, Liverpool Women's Hospital, Liverpool, United Kingdom
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Almeida RAAS, Carvalho RHDSBFD, Lamy ZC, Alves MTSSDBE, Poty NARDC, Thomaz EBAF. FROM PRENATAL TO POSTPARTUM CARE: CHANGES IN OBSTETRIC HEALTH SERVICES DURING THE COVID-19 PANDEMIC. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0206en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
ABSTRACT Objective: to analyze changes in maternal health care during the Covid-19 pandemic, according to reports by health professionals. Method: qualitative research, conducted with managers, physicians, nurses, residents and nursing technicians working in a prenatal outpatient clinic, obstetric emergency department, delivery center and obstetric inpatient ward of a high complexity federal public hospital in the Northeast of Brazil. Data were collected from December 2020 to August 2021. The sample, chosen intentionally, sought the diversity of characteristics and situations, was closed by the criterion of saturation of meaning. A structured questionnaire and a semi-structured interview script were used for data collection. The interviews were recorded and transcribed. Content analysis was used in the thematic modality. Results: 28 professionals were interviewed. Changes in the dynamics of obstetric care were identified and categorized as: prenatal care; and childbirth/postpartum. In prenatal care, there was a decrease in elective consultations; increased time between consultations; delayed care due to paramentation; implementation of new hygiene protocols; limitation of the number of companions; creation of new environments such as the Covid-19 isolation room for symptomatic pregnant women; teleservice and work overload due to the increased demand coming from Primary Health Care. In childbirth/postparum, the reports indicated a reduction in the number of beds; testing and isolation of symptomatic patients; limitating walking, restriction of companions and mandatory use of mask by pregnant woman. Conclusion: the restructuring of services and the creation of new spaces to care for patients with Covid-19 led to a reduction in the availability of vacancies for prenatal and postpartum consultations. The changes were accompanied by new service rules, with setbacks regarding the guarantee of rights.
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Gemperle M, Grylka-Baeschlin S, Klamroth-Marganska V, Ballmer T, Gantschnig BE, Pehlke-Milde J. Midwives' perception of advantages of health care at a distance during the COVID-19 pandemic in Switzerland. Midwifery 2021; 105:103201. [PMID: 34864326 PMCID: PMC8580889 DOI: 10.1016/j.midw.2021.103201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 10/30/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore midwives' perceptions of the advantages of telemedicine during the COVID-19 pandemic in Switzerland. DESIGN Cross-sectional study based on an online survey using quantitative methods. SETTING Midwives working in Switzerland. PARTICIPANTS Self-selected convenience sample of 630 members of the Swiss Federation of Midwives. MEASUREMENT Open questions on advantages of health care at a distance and workrelated characteristics were used in the online questionnaire. The information was coded and integrative content analysis was applied. FINDINGS A good half of the respondents associated telemedicine with either an advantage beyond the pandemic ("Reduced workload", "Improved health care provision", "Greater self-care of clients"), while the others saw a pandemic-related advantage ("Protection from COVID-19", "Maintaining care/counseling in an exceptional situation"), or no advantage at all. Older, more experienced midwives were less likely to see an advantage beyond the pandemic. The motive "Reduced workload" was positively associated with professionals aged younger than 40 years and midwives with up to 14 years of professional experience, and "Protection from COVID-19" was more likely cited by midwives aged 50 and more and by midwives working solely in hospitals. Midwives who stated "Maintaining care" and "Improved health care provision" as motives to embrace telemedicine were more likely to experience health care at a distance as a positive treatment alternative. KEY CONCLUSION Midwives' perceptions of the advantages of health care at a distance vary substantially with age and years of professional experience, as well as workrelated characteristics. Further research is necessary to acquire a sound understanding of underlying reasons, including the sources of the general attitudes involved. IMPLICATION FOR PRACTICE Understanding the differences in perceptions of health care at a distance is important in order to improve the work situation of midwives and the health care they provide to women and families. Different sensitivities represent an important source in the ongoing discussion about the future use of telemedicine in health care.
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Affiliation(s)
- Michael Gemperle
- ZHAW Zurich University of Applied Sciences, School of Health Professions, Research Institute for Midwifery Science, Katharina-Sulzer-Platz 9, Winterthur 8401, Switzerland; ZHAW Zurich University of Applied Sciences, ZHAW digital, Gertrudstrasse 15, Winterthur 8401, Switzerland.
| | - Susanne Grylka-Baeschlin
- ZHAW Zurich University of Applied Sciences, School of Health Professions, Research Institute for Midwifery Science, Katharina-Sulzer-Platz 9, Winterthur 8401, Switzerland
| | - Verena Klamroth-Marganska
- ZHAW Zurich University of Applied Sciences, School of Health Professions, Research Institute for Occupational Therapy, Katharina-Sulzer-Platz 9, Winterthur 8401, Switzerland
| | - Thomas Ballmer
- ZHAW Zurich University of Applied Sciences, School of Health Professions, Research Institute for Occupational Therapy, Katharina-Sulzer-Platz 9, Winterthur 8401, Switzerland
| | - Brigitte E Gantschnig
- ZHAW Zurich University of Applied Sciences, School of Health Professions, Research Institute for Occupational Therapy, Katharina-Sulzer-Platz 9, Winterthur 8401, Switzerland
| | - Jessica Pehlke-Milde
- ZHAW Zurich University of Applied Sciences, School of Health Professions, Research Institute for Midwifery Science, Katharina-Sulzer-Platz 9, Winterthur 8401, Switzerland
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Marshall J, Ross S, Buchanan P, Gavine A. Providing effective evidence based support for breastfeeding women in primary care. BMJ 2021; 375:e065927. [PMID: 34725097 DOI: 10.1136/bmj-2021-065927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Joyce Marshall
- Division of Maternal Health, University of Huddersfield, UK
| | - Sam Ross
- School of Medicine, Dentistry and Nursing, University of Glasgow and NHS Greater Glasgow and Clyde, UK
| | | | - Anna Gavine
- School of Health Sciences, University of Dundee, UK
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Making good care essential: The impact of increased obstetric interventions and decreased services during the COVID-19 pandemic. Women Birth 2021; 35:484-492. [PMID: 34774446 PMCID: PMC8559154 DOI: 10.1016/j.wombi.2021.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 11/21/2022]
Abstract
Problem & background Since the onset of the COVID-19 pandemic in Canada, policies have been implemented to limit interpersonal contact in clinical and community settings. The impacts of pandemic-related policies on experiences of pregnancy and birth are crucial to investigate and learn from. Aim To examine the impact of pandemic policy changes on experiences of pregnancy and birth, thereby identifying barriers to good care; to inform understandings of medicalization, care, pregnancy, and subjectivity during times of crisis; and to critically examine the assumptions about pregnancy and birth that are sustained and produced through policy. Methods Qualitative descriptive study drawing on 67 in-depth interviews with people who were pregnant and/or gave birth in Canada during the pandemic. The study took a social constructionist standpoint and employed thematic analysis to derive meaning from study data. Findings The pandemic has resulted in an overall scaling back of perinatal care alongside the heavy use of interventions (e.g., induction of labour, cesarian section) in response to pandemic stresses and uncertainties. Intervention use here is an outcome of negotiation and collaboration between pregnant people and their care providers as they navigate pregnancy and birth in stressful, uncertain conditions. Discussion Continuity of care throughout pregnancy and postpartum, labour support persons, and non-clinical services and interventions for pain management are all essential components of safe maternal healthcare. However, pandemic perinatal care demonstrates that they are not viewed as such. Conclusion The pandemic has provided an opportunity to restructure Canadian reproductive health care to better support and encourage out-of-hospital births – including midwife-assisted births – for low-risk pregnancies.
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Ornaghi S, Fumagalli S, Guinea Montalvo CK, Beretta G, Invernizzi F, Nespoli A, Vergani P. Indirect impact of SARS-CoV-2 pandemic on pregnancy and childbirth outcomes: A nine-month long experience from a university center in Lombardy. Int J Gynaecol Obstet 2021; 156:466-474. [PMID: 34669973 PMCID: PMC9087530 DOI: 10.1002/ijgo.13990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/19/2021] [Indexed: 01/23/2023]
Abstract
Objective To determine the impact on perinatal health of changes in social policies and obstetric care implemented to curb SARS‐CoV‐2 transmission. However, robust data on the topic are lacking since most of the studies has examined only the first few months of the outbreak. Methods A retrospective analysis of prospectively collected data on uninfected and asymptomatically infected women giving birth between March and November 2020 and in the same time frame of 2019 at our tertiary care center in Lombardy, northern Italy. Perinatal outcomes were compared according to the year (2019 versus 2020) and to the trimester (March–May, June–August, September–November) of childbirth, corresponding to the three phases of the pandemic (first wave, deceleration, second wave) and covering a 9‐month period. Results We identified increased rates of gestational diabetes mellitus, spontaneous preterm birth, and neuraxial analgesia in 2020 versus 2019, with different temporal distributions: gestational diabetes mellitus and spontaneous preterm birth were more prevalent during the deceleration and the second wave phase, whereas epidural analgesia was more prevalent during the first wave. Conclusion By assessing a prolonged time frame of the pandemic, we show that pandemic‐related control measures, as applied in Lombardy, impacted relevant perinatal outcomes of women giving birth at our center.
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Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Simona Fumagalli
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | | | - Greta Beretta
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Francesca Invernizzi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Antonella Nespoli
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
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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 2021; 35:475-483. [PMID: 34688582 PMCID: PMC8514642 DOI: 10.1016/j.wombi.2021.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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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No one asked us: Understanding the lived experiences of midwives providing care in the north west suburbs of Melbourne during the COVID-19 pandemic: An interpretive phenomenology. Women Birth 2021; 35:447-457. [PMID: 34627733 PMCID: PMC8493470 DOI: 10.1016/j.wombi.2021.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/22/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022]
Abstract
Problem Within the Victorian healthcare system, a rapid response to the COVID-19 pandemic has necessitated frequent and ongoing changes to midwifery practice. Background Midwives are a vital workforce at risk of burnout, attrition, and trauma. Emotional consequences of the pandemic for midwives remain largely unknown. Aim To understand the lived experiences of midwives providing care in the north west suburbs of Melbourne, Victoria during the pandemic. Methods Purposive and snowball sampling facilitated the recruitment of eight midwives in the north west suburbs of Melbourne, Victoria. Semi-structured interviews were audio recorded and transcribed, occurring via telephone or video between September and October 2020. Interpretive phenomenology was the methodology used, informed by the writings of Heidegger and Gadamer. Findings Insights gleaned from the data embody a range of understandings. The unknown cost of change and adaptation; waves of the virus; balancing risk; telehealth; personal protective equipment; stripping away support; the privilege of abiding by the restrictions; separation, distress, uncertainty; and, professional strength. Discussion Experiences of midwives during the pandemic are characterised by sensations of voicelessness and professional invisibility. Distinctive differences in personal wellbeing and professional satisfaction exist between midwives working with and without continuity of care. Conclusion This paper voices the lived experiences of Victorian midwives, in the midst of an extended lockdown, during the COVID-19 pandemic. Knowledge obtained from this research provides important understandings for leaders, policymakers, and healthcare systems, in planning a long-term response to the pandemic that supports the wellbeing and longevity of a vital workforce.
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The impact of COVID-19 on the provision of respectful maternity care: Findings from a global survey of health workers. Women Birth 2021; 35:378-386. [PMID: 34531166 PMCID: PMC9179099 DOI: 10.1016/j.wombi.2021.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/20/2022]
Abstract
Background Significant adjustments to maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care. Aim To explore how the COVID-19 pandemic negatively affected frontline health workers’ ability to provide respectful maternity care globally. Methods We conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected qualitative data between July and December 2020 among a subset of respondents and conducted a qualitative content analysis to explore open-ended responses. Findings Health workers (n = 1127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers’ fear of getting infected and measures taken to minimise COVID-19 transmission. Discussion Multidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term. Conclusions The measures taken during the COVID-19 pandemic had the capacity to disrupt the provision of respectful maternity care and therefore the quality of maternity care.
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Aşcı Ö, Demirgöz Bal M, Ergin A. The breastfeeding experiences of COVID-19-positive women: A qualitative study in Turkey. Jpn J Nurs Sci 2021; 19:e12453. [PMID: 34476899 PMCID: PMC8646522 DOI: 10.1111/jjns.12453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/13/2021] [Accepted: 07/29/2021] [Indexed: 01/04/2023]
Abstract
Aim The aim of the study was to determine the breastfeeding experiences of COVID‐19‐positive women. Methods This was a qualitative study of 14 women diagnosed with COVID‐19. One‐to‐one telephone interviews were conducted and recorded. The data were analyzed thematically. Results Three main themes were identified. Theme 1 was “increased emotional load,” outlining the emotional effects of the disease in the women, such as feeling sad and inadequate, in addition to anxiety and fear. Theme 2 was “breastfeeding during the disease,” which illustrated the effects of the treatment process on the women, the disease‐related symptoms, their influence on breastfeeding attitudes and behavior, and the effects of social media and television. Theme 3 was “perceived social support and need,” defining the social support perceived and expected by the women during isolation with needs. Conclusion Women who could not get the professional support they expected had to face the difficult choice between taking medical treatment and breastfeeding. Many women refused drug treatment for COVID‐19 and continued to breastfeed with all the resultant emotional and physical difficulties, as they believed in the benefits of mother's milk. The experiences of the women were discussed with an approach that enabled developing health care services further. It was concluded that Turkish health care professionals need to develop an evidence‐based and female‐centered approach for COVID‐19 management in breastfeeding women.
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Affiliation(s)
- Özlem Aşcı
- Division of Midwifery, Niğde Ömer Halisdemir University, Niğde Zübeyde Hanım School of Health, Niğde, Turkey
| | - Meltem Demirgöz Bal
- Faculty of Health Sciences, Division of Midwifery, Marmara University, Istanbul, Turkey
| | - Ayla Ergin
- Faculty of Health Sciences, Division of Midwifery, Kocaeli University, Kocaeli, Turkey
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Adnani QES, O'Connell MA, Homer CSE. Advocating for midwives in low-to-middle income countries in the COVID-19 pandemic. Women Birth 2021; 34:501-502. [PMID: 34429269 PMCID: PMC8372516 DOI: 10.1016/j.wombi.2021.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Indexed: 02/06/2023]
Affiliation(s)
| | - Maeve Anne O'Connell
- School of Health Sciences, College of Biomedical and Life Sciences, Cardiff University, United Kingdom
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Piankusol C, Sirikul W, Ongprasert K, Siviroj P. Factors Affecting Breastfeeding Practices under Lockdown during the COVID-19 Pandemic in Thailand: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168729. [PMID: 34444479 PMCID: PMC8391455 DOI: 10.3390/ijerph18168729] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
A COVID-19 lockdown and restrictive order has had a large impact on the lives of people. This cross-sectional study was conducted to identify factors affecting breastfeeding among mothers living in Thailand during the lockdown. Data were collected from 903 mothers with infants ages 0–12 months from 17 July 2020 to 17 October 2020 after the first nationwide COVID-19 lockdown period by an online platform and interview questionnaire survey. Multivariable logistic regression analysis was used to investigate the association between the effect of lockdown and breastfeeding practices with potential confounder adjustment including maternal age, ethnicity, newborn age <6 months, family income below $16,130 per annum, education below undergraduate level, and working status. Mothers changed breastfeeding practices in this period (n = 39, 4.32%) including having changed from exclusive breastfeeding to combined breastfeeding with formula milk (n = 22, 2.44%), and having reduced the frequency when compared to before the pandemic (n = 13, 1.44%). The associated factors of changing breastfeeding practices were “contact with healthcare services” (aOR = 0.46, 95% CI 0.22 to 0.96, p = 0.04), “infant feeding support from health personnel” (aOR = 0.39, 95% CI 0.16 to 1.94, p = 0.035), and “lack family support and help with feeding your baby after lockdown” (aOR = 7.04, 95% CI 1.92 to 25.84, p = 0.003). In conclusion, this study showed a slight decrease in breastfeeding in the sampled mothers during the COVID-19 lockdown in Thailand. A long-term national surveillance system for maintenance of breastfeeding should be established. Health care service interventions and additional information are needed to support mothers and families for breastfeeding during pandemics.
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Panda S, O'Malley D, Barry P, Vallejo N, Smith V. Women's views and experiences of maternity care during COVID-19 in Ireland: A qualitative descriptive study. Midwifery 2021; 103:103092. [PMID: 34325384 PMCID: PMC8582075 DOI: 10.1016/j.midw.2021.103092] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/25/2021] [Accepted: 07/03/2021] [Indexed: 11/30/2022]
Abstract
Objective To gain insight and understanding of women's views and experiences of maternity care during the COVID-19 pandemic in Ireland. Design A qualitative descriptive study using semi-structured interviews. Due to social distancing and associated COVID-19 restrictions at the time of the study, the interviews were held remotely via telephone. The interviews were digitally recorded and transcribed verbatim. Thematic analysis was used to analyse the interview data. Setting & participants A large urban tertiary referral maternity unit (greater than 8000 births per year) in the Republic of Ireland. Women of low and high obstetric risk, primiparous and multiparous, who gave birth in April or May of 2020 were eligible for inclusion. Women were invited to take part via a hospital-based gatekeeper who had no other involvement in the study. Findings Nineteen women consented to take part and were interviewed. Four dominant themes reflective of women's views and experiences emerged during data analysis. These were: ‘navigating the system’, ‘at the end of the day it's just you’, ‘preparing for and adapting to uncertainty’ and ‘blessing in disguise’. Key conclusions and implications for practice Women experienced added challenges as a result of COVID-19 associated altered care structures and processes. Some changes implemented in response to the pandemic were positively experienced by women. The findings will contribute to and assist in planning future services for women and their partners, and in tailoring care to meet women's expectations and needs as the COVID-19 pandemic continues and beyond.
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Affiliation(s)
- Sunita Panda
- School of Nursing and Midwifery, University of Dublin Trinity College, 24 D'Olier Street, Dublin, Ireland.
| | - Deirdre O'Malley
- School of Nursing and Midwifery, University of Dublin Trinity College, 24 D'Olier Street, Dublin, Ireland
| | - Paula Barry
- The Coombe Women and Infants University Hospital, Dolphins Barn, Dublin, Ireland
| | - Nora Vallejo
- The Coombe Women and Infants University Hospital, Dolphins Barn, Dublin, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, University of Dublin Trinity College, 24 D'Olier Street, Dublin, Ireland
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Davis-Floyd R, Gutschow K. Editorial: The Global Impacts of COVID-19 on Maternity Care Practices and Childbearing Experiences. FRONTIERS IN SOCIOLOGY 2021; 6:721782. [PMID: 34291107 PMCID: PMC8287247 DOI: 10.3389/fsoc.2021.721782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - Kim Gutschow
- Department of Anthropology, Williams, College, Williamstown, MA, United States
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Takemoto MLS, McKay G, Amorim M, Gbomosa CN, Tengbeh AF, Wenham C. How can countries create outbreak response policies that are sensitive to maternal health? BMJ 2021; 373:n1271. [PMID: 34183332 PMCID: PMC8237156 DOI: 10.1136/bmj.n1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Ensuring women’s need for sexual and reproductive healthcare are met should be a priority during disease outbreaks, say Maira L S Takemoto and colleagues
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Affiliation(s)
- Maira L S Takemoto
- Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil
| | - Gillian McKay
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Melania Amorim
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | - Cady N Gbomosa
- University of Ottawa Faculty of Health Sciences, Ottawa, Ontario, Canada
| | - Angus F Tengbeh
- Institute for Global Health and Development, Queen Margaret University, School of Health Sciences, Edinburgh, UK
| | - Clare Wenham
- London School of Economics and Political Science, London, UK
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Miranda AR, Scotta AV, Cortez MV, Soria EA. Triggering of postpartum depression and insomnia with cognitive impairment in Argentinian women during the pandemic COVID-19 social isolation in relation to reproductive and health factors. Midwifery 2021; 102:103072. [PMID: 34218023 PMCID: PMC8437687 DOI: 10.1016/j.midw.2021.103072] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/10/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
Objective The 2019 coronavirus disease pandemic (COVID-19) required strict confinement measures that differentially impacted the individual's daily life. Thus, this work aimed to study postpartum women's mental health in Argentina during mandatory social isolation. Design A cross-sectional survey was conducted from May to July 2020, which included five validated questionnaires to assess postpartum depression (Postpartum Depression Screening Scale‐Short Form), insomnia (Insomnia Severity Index), memory complaints (Memory Complaint Scale), metacognition (Brief Metamemory and Metaconcentration Scale), and breastfeeding self-efficacy (Breastfeeding Self-Efficacy Scale-Short Form). Sociodemographic variables, social isolation characteristics, and breastfeeding practices were also collected. This study was conducted in accordance with the Declaration of Helsinki. Statistical analysis included zero-order correlations, multiple logistic regressions, and a set of structural equation models (SEM) to test direct and indirect effects. Goodness-of-fit indices were calculated for SEM. Setting Postpartum women were recruited from public hospitals, private health clinics, and online community recruitment in the Cordoba province (Argentina). Participants 305 postpartum women from Argentina. Measurements and findings 37% of women reported postpartum depression, 46% insomnia, 42% memory impairment, 60% low metaconcentration, 50% low metamemory, and 23% low breastfeeding efficacy. Also, significant associations were found demonstrating that social isolation promoted postpartum depression and insomnia were reciprocally related, which compromised female cognition and efficacy. This situation was aggravated in women during late postpartum, with previous children, and by low social support (e.g., family, health professionals), with non-exclusive breastfeeding being increased. Key conclusions This is the first study addressing postpartum women's mental status during social isolation in Argentina, which was a promoting factor for postpartum depression and insomnia that were reciprocally related. This situation was also aggravated by reproductive factors, such as late postpartum, multiparity, breastfeeding frequency, and non-exclusive breastfeeding. Additionally, breastfeeding self-efficacy depended on mental health status, and euthymia therefore favoured the practice of exclusive breastfeeding.
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Affiliation(s)
- Agustín Ramiro Miranda
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Escuela de Fonoaudiología. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
| | - Ana Veronica Scotta
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Escuela de Fonoaudiología. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
| | - Mariela Valentina Cortez
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Escuela de Fonoaudiología. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
| | - Elio Andrés Soria
- Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina; Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Cátedra de Biología Celular, Histología y Embriología, Instituto de Biología Celular. Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina.
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Sanders J, Blaylock R. "Anxious and traumatised": Users' experiences of maternity care in the UK during the COVID-19 pandemic. Midwifery 2021; 102:103069. [PMID: 34186334 PMCID: PMC8437682 DOI: 10.1016/j.midw.2021.103069] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/24/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022]
Abstract
Objective The COVID-19 pandemic saw universal, radical, and ultra-rapid changes to UK National Health Services (NHS) maternity care. At the onset of the pandemic, NHS maternity services were stripped of many of the features which support woman and family centred care. In anticipation of unknown numbers of pregnant women and maternity staff potentially sick with COVID-19, services were pared back to the minimum level considered to be required to keep women and their babies safe. The aim of this survey was to understand the impact of COVID-19 public health messaging and pandemic-related service changes on users of maternity care in the UK during the pandemic. Methods We conducted an online survey to explore user's experiences of COVID-19 public health messaging and ‘socially-distanced’ maternity care across the UK. The study population consisted of women who had experienced pregnancy after the 11th March 2020 (when the WHO declared a pandemic), whether or not they were still pregnant. We collected data between June and September 2020. We used framework analysis for the free-text data and generated descriptive statistics. Findings Women were generally happy to adopt a precautionary approach and stringently social distance in the context of a relatively unknown pathogen and in an environment of extreme anxiety and uncertainty, but were acutely aware of the negative impacts. The survey found that the widespread changes to services caused unintended negative consequences including essential clinical care being missed, confusion over advice, and distress and emotional trauma for women. COVID-19 restrictions have resulted in women feeling their antenatal and postnatal care to be inadequate and has also come at great emotional cost to users. Women reported feeling isolated and sad in the postnatal period, but also frustrated and upset by a lack of staff to help them care for their new baby. Key conclusions With growing evidence of the impact of the virus on pregnant women and an increased understanding of the unintended consequences of unclear public health messaging and overly precautious services, a more nuanced, evidence-based approach to caring for women during a pandemic must be prioritised. Implications for practice All maternity services should ensure they have clear lines of communication with women to keep them updated on changing care and visiting arrangements. Services should ensure that opportunities to provide safe face-to-face care and access for birth partners and visitors are maximised.
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Affiliation(s)
- Julia Sanders
- School of Healthcare Sciences, Cardiff University, UK.
| | - Rebecca Blaylock
- Centre for Reproductive Research and Communication, British Pregnancy Advisory Service (BPAS), 30-31 Furnival Street, London, EC4A 1JQ.
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Chiumento A, Baines P, Redhead C, Fovargue S, Draper H, Frith L. Which ethical values underpin England's National Health Service reset of paediatric and maternity services following COVID-19: a rapid review. BMJ Open 2021; 11:e049214. [PMID: 34103322 PMCID: PMC8189755 DOI: 10.1136/bmjopen-2021-049214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To identify ethical values guiding decision making in resetting non-COVID-19 paediatric surgery and maternity services in the National Health Service (NHS). DESIGN A rapid review of academic and grey literature sources from 29 April to 31 December 2020, covering non-urgent, non-COVID-19 healthcare. Sources were thematically synthesised against an adapted version of the UK Government's Pandemic Flu Ethical Framework to identify underpinning ethical principles. The strength of normative engagement and the quality of the sources were also assessed. SETTING NHS maternity and paediatric surgery services in England. RESULTS Searches conducted 8 September-12 October 2020, and updated in March 2021, identified 48 sources meeting the inclusion criteria. Themes that arose include: staff safety; collaborative working - including mutual dependencies across the healthcare system; reciprocity; and inclusivity in service recovery, for example, by addressing inequalities in service access. Embedded in the theme of staff and patient safety is embracing new ways of working, such as the rapid roll out of telemedicine. On assessment, many sources did not explicitly consider how ethical principles might be applied or balanced against one another. Weaknesses in the policy sources included a lack of public and user involvement and the absence of monitoring and evaluation criteria. CONCLUSIONS Our findings suggest that relationality is a prominent ethical principle informing resetting NHS non-COVID-19 paediatric surgery and maternity services. Sources explicitly highlight the ethical importance of seeking to minimise disruption to caring and dependent relationships, while simultaneously attending to public safety. Engagement with ethical principles was ethics-lite, with sources mentioning principles in passing rather than explicitly applying them. This leaves decision makers and healthcare professionals without an operationalisable ethical framework to apply to difficult reset decisions and risks inconsistencies in decision making. We recommend further research to confirm or refine the usefulness of the reset phase ethical framework developed through our analysis.
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Affiliation(s)
- Anna Chiumento
- Institute of Population Health Sciences, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | - Paul Baines
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Caroline Redhead
- Liverpool Law School, Faculty of Humanities and Social Sciences, University of Liverpool, Liverpool, UK
| | | | - Heather Draper
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Lucy Frith
- Law and Philosophy, Faculty of Humanities and Social Sciences, University of Liverpool, Liverpool, UK
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Morse H, Brown A. Accessing local support online: Mothers' experiences of local Breastfeeding Support Facebook groups. MATERNAL & CHILD NUTRITION 2021; 17:e13227. [PMID: 34060716 PMCID: PMC8476430 DOI: 10.1111/mcn.13227] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/26/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
The importance of support to breastfeeding success is well established, as are the difficulties many mothers face in accessing the support they need. With the majority of UK mothers now accessing social media for support, Breastfeeding Support Facebook (BSF) groups have increased exponentially. BSF groups vary in type (local or national/international) and in moderation-overseen by breastfeeding mothers and by midwives or trained lactation specialists. Some groups aimed at supporting mothers in a specific geographical area also have associated face-to-face groups, facilitated as either professional or peer support. Little is currently known about these specific local groups, their prevalence, impact or value to mothers. This paper examines mothers' experiences of using local BSF groups and why they value them as part of a larger study exploring the impact of midwife moderation on these groups. An online survey consisting of open and closed questions was completed by 2028 mothers. Findings identified that local BSF groups are widely used and highly valued for their connection with local face-to-face services and other mothers. They offer access to expertise and shared experience in a format mothers find convenient and timely, improving confidence and self-efficacy. Local BSF groups enable the formation of support networks and development of breastfeeding knowledge that mothers credit with increased well-being, motivation and breastfeeding duration. As such, they have the potential to add value to local face-to-face services and improve breastfeeding experiences and knowledge in communities. The findings have important implications to support the development of integrated online interventions to improve public health.
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Affiliation(s)
- Holly Morse
- Department of Public Health, Policy and Social SciencesSwansea UniversitySwanseaUK,Centre for Lactation, Infant Feeding and Translation Research (LIFT)Swansea UniversitySwanseaUK
| | - Amy Brown
- Department of Public Health, Policy and Social SciencesSwansea UniversitySwanseaUK,Centre for Lactation, Infant Feeding and Translation Research (LIFT)Swansea UniversitySwanseaUK
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50
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‘Watchful attendance’ during labour and birth. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 28:100617. [DOI: 10.1016/j.srhc.2021.100617] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 11/22/2022]
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