Women's experiences of maternity service reconfiguration during the COVID-19 pandemic: A qualitative investigation

Oscillating autonomy: a grounded theory study of women's experiences of COVID-19 infection during pregnancy, labour and birth, and the early postnatal period

BACKGROUND

Testing positive for COVID-19 was associated with higher rates of detrimental psycho-social and physical health outcomes. The COVID-19 pandemic caused unprecedented disruption to everyday life. This included major reconfiguration of maternal, child, and perinatal mental health and care services and provision. This study aimed to investigate the experiences of those who tested positive for COVID-19 during pregnancy, labour and birth, or the early postnatal period.

METHODS

National on-line recruitment from across the United Kingdom resulted in sixteen mothers being invited to qualitative semi-structured interviews to understand the experiences of mothers who had been infected by COVID-19 during pregnancy, labour and birth, or the early postnatal period. Interviews were conducted, recorded, and transcribed using video-conferencing software. A Grounded Theory approach was used to analyse the data gathered pertaining to women's experiences of their positive COVID-19 diagnosis during pregnancy, labour and birth, or the early postnatal period.

RESULTS

The theory of 'Oscillating Autonomy - Losing and Seeking to Regain Control by Striving for Agency' was developed, comprising three main themes: 'Anxious Anticipation: The fear of infection was worse than COVID-19 itself'; 'Fluctuating Agency: What changed when COVID-19 took control'; and 'Reclaiming Control: Seeking reassurance during COVID-19 positivity'. Testing positive for COVID-19 whilst pregnant, during labour or birth, or in the early postnatal period was associated with a perceived loss of control. Those who were able to regain that control felt more secure in their situation.

CONCLUSIONS

Support was paramount to manage increased vulnerability, as was reassurance achieved by information seeking and positive action including increased health monitoring and COVID-19 vaccination.

Women's experiences of maternity care in the United Kingdom during the COVID-19 pandemic: A follow-up systematic review and qualitative evidence synthesis

BACKGROUND

Maternity care services in the United Kingdom have undergone drastic changes due to pandemic-related restrictions. Prior research has shown maternity care during the pandemic was negatively experienced by women and led to poor physical and mental health outcomes in pregnancy. A synthesis is required of published research on women's experiences of maternity care during the latter half of the COVID-19 pandemic.

AIM

To update a previous systematic review of maternity care experiences during the pandemic to June 2021, exploring experiences of maternity care specifically within the United Kingdom and how they may have changed, in order to inform future maternity services.

METHODS

A systematic review of qualitative literature was conducted using comprehensive searches of five electronic databases and the Cochrane COVID Study Register, published between 1 June 2021 and 13 October 2022, and further updated to 30 September 2023. Thematic Synthesis was utilised for data synthesis.

FINDINGS

Of 21,860 records identified, 27 studies were identified for inclusion. Findings included 14 descriptive themes across the five core concepts: (1)Care-seeking and experience; (2)Virtual care; (3)Self-monitoring; (4)COVID-19 vaccination; (5)Ethical future of maternity care.

DISCUSSION

Our findings in the UK are consistent with those globally, and extend those of the previous systematic review, particularly about women's perceptions of the COVID-19 vaccine during pregnancy.

CONCLUSION

Our findings suggest the following are important to women for future maternity care: personalisation and inclusiveness; clear and evidence-based communication to facilitate informed decision-making; and achieving balance between social commitments and time spent settling into motherhood.

Lived experiences of women with spontaneous abortion at a district hospital, South Africa

BACKGROUND

 Spontaneous abortions occur in 12.5% of pregnancies and have a significant impact on the well-being of women. Dissatisfaction with health services is well-documented, but no studies have been conducted in district health services of the Western Cape. The aim was to explore the lived experiences of women presenting with spontaneous abortions to the emergency department at Helderberg Hospital.

METHODS

 A descriptive phenomenological qualitative study used criterion-based purposive sampling to identify suitable participants. Data were collected through semi-structured individual interviews. Atlas-ti (version 22) software assisted with data analysis using the framework method.

RESULTS

 A total of nine participants were interviewed. There were four main themes: a supportive environment, staff attitudes and behaviour, the impact of time, and sharing of information. The comfort, cleanliness and privacy of the environment were important. COVID-19 had also impacted on this. Showing interest, demonstrating empathy and being nonjudgemental were important, as well as the waiting time for definitive treatment and the time needed to assimilate and accept the diagnosis. In addition, the ability to give relevant information, explain the diagnosis and help patients share in decision-making were key issues.

CONCLUSION

 This study highlighted the need for a more person-centred approach and managers should focus on changes to organisational culture through training and clinical governance activities. Attention should be paid to the physical environment, availability of patient information materials and sequential coordination of care with primary care services.Contribution: This study identifies issues that can improve person-centredness and women's satisfaction with care for spontaneous abortion.

Pregnant and postpartum women's experiences of the indirect impacts of the COVID-19 pandemic in high-income countries: a qualitative evidence synthesis

BACKGROUND

Pregnant and postpartum women's experiences of the COVID-19 pandemic, as well as the emotional and psychosocial impact of COVID-19 on perinatal health, has been well-documented across high-income countries. Increased anxiety and fear, isolation, as well as a disrupted pregnancy and postnatal period are widely described in many studies. The aim of this study was to explore, describe and synthesise studies that addressed the experiences of pregnant and postpartum women in high-income countries during the first two years of the pandemic.

METHODS

A qualitative evidence synthesis of studies relating to women's experiences in high-income countries during the pandemic were included. Two reviewers extracted the data using a thematic synthesis approach and NVivo 20 software. The GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was used to assess confidence in review findings.

RESULTS

Sixty-eight studies were eligible and subjected to a sampling framework to ensure data richness. In total, 36 sampled studies contributed to the development of themes, sub-themes and review findings. There were six over-arching themes: (1) dealing with public health restrictions; (2) navigating changing health policies; (3) adapting to alternative ways of receiving social support; (4) dealing with impacts on their own mental health; (5) managing the new and changing information; and (6) being resilient and optimistic. Seventeen review findings were developed under these themes with high to moderate confidence according to the GRADE-CERQual assessment.

CONCLUSIONS

The findings from this synthesis offer different strategies for practice and policy makers to better support women, babies and their families in future emergency responses. These strategies include optimising care delivery, enhancing communication, and supporting social and mental wellbeing.

Experiences of postpartum anxiety during the COVID-19 pandemic: A mixed methods study and demographic analysis

INTRODUCTION

The first wave of the COVID-19 pandemic saw the reconfiguration of perinatal and maternity services, national lockdowns, and social distancing measures which affected the perinatal experiences of new and expectant parents. This study aimed to explore the occurrence of postpartum anxieties in people who gave birth during the pandemic.

METHODS

An exploratory concurrent mixed-methods design was chosen to collect and analyse the quantitative and qualitative data of an online survey during the first UK lockdown. The survey included the Postpartum Specific Anxiety Scale-Research Short Form-for use in global Crises [PSAS-RSF-C] psychometric tool, and open-ended questions in relation to changes in birth plans and feelings about those changes and giving birth in a pandemic. Differences in measured scores were analysed for the participant's ethnicity, sexual orientation and disability using independent Student's t-tests, and for age, the analysis was completed using Pearson's correlation. Qualitative data from open-ended questions were analysed using a template analysis.

RESULTS

A total of 1,754 new and expectant parents completed the survey between 10th and 24th April 2020, and 381 eligible postnatal women completed the psychometric test. We found 52.5% of participants reported symptoms consistent with a diagnosis of postnatal anxiety-significantly higher than the rates usually reported. Younger women and sexual minority women were more likely to score highly on the PSAS-RSF-C than their older or heterosexual counterparts (p<0.001). Younger participants reported anxieties in the 'infant safety and welfare' category, whilst lesbian, gay, bisexual, and pansexual participants scored highly in the 'psychosocial adjustment to motherhood' category.

DISCUSSION

Postpartum anxiety is under-reported, and demographic differences in the rates of postpartum anxiety are under-researched. This research demonstrates for the first time a difference in postpartum anxiety rates amongst sexual minority women.

Impact of COVID-19 on access to and delivery of sexual and reproductive healthcare services in countries with universal healthcare systems: A systematic review

OBJECTIVES

The COVID-19 pandemic has caused unforeseen impacts on sexual and reproductive healthcare (SRH) services worldwide, and the nature and prevalence of these changes have not been extensively synthesized. We sought to synthesise reported outcomes on the impact of COVID-19 on SRH access and delivery in comparable countries with universal healthcare systems.

METHODS

Following PRISMA guidelines, we searched MEDLINE, Embase, PsycInfo, and CINAHL from January 1st, 2020 to June 6th, 2023. Original research was eligible for inclusion if the study reported on COVID-19 and SRH access and/or delivery. Twenty-eight OECD countries with comparable economies and universal healthcare systems were included. We extracted study characteristics, participant characteristics, study design, and outcome variables. The methodological quality of each article was assessed using the Quality Assessment with Diverse Studies (QuADS) tool. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for reporting the results. This study was registered on PROSPERO (#CRD42021245596).

SYNTHESIS

Eighty-two studies met inclusion criteria. Findings were qualitatively synthesised into the domains of: antepartum care, intrapartum care, postpartum care, assisted reproductive technologies, abortion access, gynaecological care, sexual health services, and HIV care. Research was concentrated in relatively few countries. Access and delivery were negatively impacted by a variety of factors, including service disruptions, unclear communication regarding policy decisions, decreased timeliness of care, and fear of COVID-19 exposure. Across outpatient services, providers favoured models of care that avoided in-person appointments. Hospitals prioritized models of care that reduced time and number of people in hospital and aerosol-generating environments.

CONCLUSIONS

Overall, studies demonstrated reduced access and delivery across most domains of SRH services during COVID-19. Variations in service restrictions and accommodations were heterogeneous within countries and between institutions. Future work should examine long-term impacts of COVID-19, underserved populations, and underrepresented countries.

Factors associated with negative birth experience in Peruvian Quechua-speaking indigenous women in a context of contagion due to COVID-19

OBJECTIVE

The aim of this study was to determine the factors associated with negative birth experience in Peruvian Quechua-speaking indigenous women in the context of contagion due to COVID-19.

METHODS

This was a cross-sectional study, with 142 women from the Olleros community (Huaraz-Peru, 3336 m a.s.l.), whose birth occurred between November 2020 and December 2021. Two questionnaires were applied between January and June 2022, prior voluntary informed consent and approval by an ethics committee. The SPSS program version 24 and the odds ratio (OR) were used with 95% confidence interval (CI).

RESULTS

A total of 62.7% of women (89/142) had a negative birth experience. The main factors associated were hospital and biosafety factors, highlighting the restriction to choose the position during birth (OR = 15.64, CI: 1.89-128.99, P = 0.001), care of women in a language other than Quechua (OR = 5.86, CI: 1.51-22.76, P = 0.005) and fear of health personnel when approaching women due to COVID-19 (OR = 10.61, CI: 3.94-28.56, P < 0.001).

CONCLUSION

Hospital and biosafety factors are associated with negative birth experience in Peruvian Quechua-speaking indigenous women, with less emphasis on sociodemographic and obstetric factors. The results found show that, in the case of this research, the negative birth experience is not only due to the restrictions imposed by COVID-19 pandemic, but also to the limited application of the intercultural approach in Peru, where the opinion of women is not taken into account. In this sense, intervention actions are required through health policies with an intercultural approach that involve the active participation of women.

Community postnatal care delivery in England since Covid-19: A qualitative study of midwifery leaders' perspectives and strategies

PROBLEM

COVID-19 impacted negatively on maternity care experiences of women and staff. Understanding the emergency response is key to inform future plans.

BACKGROUND

Before the COVID-19 pandemic, experts highlighted concerns about UK community postnatal care, and its impact on long-term health, wellbeing, and inequalities. These appear to have been exacerbated by the pandemic.

AIM

To explore community postnatal care provision during and since the pandemic across a large diverse UK region.

METHODS

A descriptive qualitative approach. Virtual semi-structured interviews conducted November 2022-February 2023. All regional midwifery community postnatal care leaders were invited to participate.

FINDINGS

11/13 midwifery leaders participated. Three main themes were identified: Changes to postnatal care (strategic response, care on the ground); Impact of postnatal care changes (staff and women's experiences); and Drivers of postnatal care changes (COVID-19, workforce issues).

DISCUSSION

Changes to postnatal care during the pandemic included introduction of virtual care, increased role of Maternity Support Workers, and moving away from home visits to clinic appointments. This has largely continued without evaluation. The number of care episodes provided for low and high-risk families appears to have changed little. Those requiring additional support but not deemed highest risk appear to have been most impacted. Staffing levels influenced amount and type of care provided. There was little inter-organisation collaboration in the postnatal pandemic response.

CONCLUSION

Changes to postnatal care provision introduced more efficient working practices. However, evaluation is needed to ensure ongoing safe, equitable and individualised care provision post pandemic within limited resources.

The impact of maternity service restrictions related to COVID-19 on women's experiences of giving birth in England: A qualitative study

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.

Accessing health information during the COVID-19 pandemic: the experience of NHS maternity service users

BACKGROUND

The COVID-19 pandemic caused various disruptions to NHS maternity services in England. Changes were made to antenatal and postnatal care and the way that information was shared with maternity service users during these times. Fewer face-to-face appointments, increased virtual appointments and changes in guidance about the suitability of the COVID-19 vaccine without appropriate information sharing and evidence caused concern.

METHODS

This study took a blended inductive-deductive approach to secondary data analysis using a population subset of 16 from a wider study that sought to understand the impact of COVID-19 on maternity services in England. Participants of this study were aged 28-44 and gave birth using NHS maternity services in England. The data were collected and coded using Rapid Analysis Procedure sheets, which generated key themes, which are used here to structure the results.

RESULTS

Four main themes were generated from the analysis: 1) service restrictions to antenatal and postnatal appointments 2) access to information and changes to antenatal and postnatal care 3) inconsistencies in the implementation of government and NHS policy and 4) limited information about COVID-19 vaccine provided by NHS trusts and hesitancy in vaccine acceptance.

CONCLUSION

Participants experienced poor communication that affected their understanding of maternity service changes and there was limited general and maternal health information provided. Vaccine information was also inadequate, and participants expressed a desire for clearer guidance. The UK Government, Royal College of Obstetricians and Gynaecologists, and NHS must collaborate with maternity service users to ensure that there are evidence-based guidelines and policies that can be understood and standardised across all NHS maternity trusts.

Midwives' experiences with providing home-based postpartum care during the COVID-19 pandemic: A qualitative study

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.

Health anxiety, death anxiety and coronaphobia: Predictors of postpartum depression symptomatology during the COVID-19 pandemic

OBJECTIVE

To determine levels of postpartum depression symptoms and possible relevant predictors, such as death anxiety, health anxiety, and coronavirus-related anxiety.

DESIGN

Cross-sectional web-based survey using quantitative methods.

SETTING

Exclusively online recruiting via social media and unpaid cross-posting conducted during the third wave of the COVID-19 pandemic in Romania.

PARTICIPANTS

Women were eligible to take part in the study if they were mothers over the age of 18 and had a baby aged between 4 weeks - 12 months of age; 1024 women were included in the final sample.

MEASUREMENTS AND FINDINGS

Health anxiety, death anxiety, coronavirus-related anxiety, and postpartum depression symptoms were measured using validated instruments. Current depression symptomatology was 67.6%, 26.7% scored above the cut-off for high health anxiety, 1% for coronavirus-related anxiety, and 62.7% for death anxiety. Significant predictors for depressive symptomatology were breastfeeding, history of depression, family income, number of children, health anxiety, death anxiety, and coronavirus anxiety. Further, hierarchical multiple regression analysis indicated that death anxiety, health anxiety, and coronavirus anxiety predicted postpartum depression symptoms over and above socio-demographic factors.

KEY CONCLUSIONS

Supported by previous studies, our results suggest that postpartum depression symptomatology levels during the COVID-19 pandemic are high and that they are predicted by health and death anxiety, which are also increased during the pandemic.

IMPLICATION FOR PRACTICE

The findings provide information to identify the risk for depression symptoms in postpartum mothers during acute public health situations.

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

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.

Maternal mental health concerns during the COVID-19 pandemic in Iran: a content analysis study

BACKGROUND

As crises occur, attention to physical health usually becomes more than mental health, neglecting mental health, especially in some vulnerable groups such as pregnant women and new mothers, can have adverse consequences. Therefore, it is imperative to recognize and comprehend their mental health needs, particularly during critical situations such as the recent COVID-19 pandemic. The aim of this study was to explain the understanding and experience of mental health concerns faced by pregnant and postpartum women during this pandemic.

METHODS

This qualitative study was conducted from March 2021 to November 2021 in Iran. Data were collected using semi-structured in-depth interviews to understand mental health concerns in pregnancy and the postpartum period during the COVID-19 pandemic. Twenty-five purposefully retrieved and participated in the study. Due to the prevalence of coronavirus, most of the participants preferred tele interviews. When data saturation was achieved, the data were codified manually and analyzed using Graneheim and Lundman's approach 2004.

RESULTS

Based on the content analysis of the interviews, 2 main themes, 8 categories 23 subcategories were identified. The identified themes were as follows: (1) Maternal mental health threats and (2) Inadequate access to the required information.

CONCLUSION

The results of this study showed that the main concern and fear of pregnant and postpartum women in the COVID-19 pandemic was the fear of the possibility of death for themselves and/or their fetus/infant. The knowledge that was obtained from the understanding of pregnant women and new mothers about the mental health concerns during the COVID-19 pandemic can help managers in planning to improve and promote women's mental health, especially in critical situations.

Being pregnant and becoming a parent during the COVID-19 pandemic: a longitudinal qualitative study with women in the Born in Bradford COVID-19 research study

BACKGROUND

Uncertainty around the risk of COVID-19 to pregnant women and their babies prompted precautionary restrictions on their health and care during the pandemic. Maternity services had to adapt to changing Government guidance. Coupled with the imposition of national lockdowns in England and restrictions on daily activities, women's experiences of pregnancy, childbirth and the postpartum period, and their access to services, changed rapidly. This study was designed to understand women's experiences of pregnancy, labour and childbirth and caring for a baby during this time.

METHODS

This was an inductive longitudinal qualitative study, using in-depth interviews by telephone with women in Bradford, UK, at three timepoints during their maternity journey (18 women at timepoint one, 13 at timepoint two and 14 at timepoint three). Key topics explored were physical and mental wellbeing, experience of healthcare services, relationships with partners and general impact of the pandemic. Data were analysed using the Framework approach. A longitudinal synthesis identified over-arching themes.

RESULTS

Three longitudinal themes captured what was important to women: (1) women feared being alone at critical points in their maternity journey, (2) the pandemic created new norms for maternity services and women's care, and (3) finding ways to navigate the COVID-19 pandemic in pregnancy and with a baby.

CONCLUSIONS

Modifications to maternity services impacted significantly on women's experiences. The findings have informed national and local decisions about how best to direct resources to reduce the impact of COVID-19 restrictions and the longer-term psychological impact on women during pregnancy and postnatally.

School closures and well-being-related topic searches on Google during the COVID-19 pandemic in Sub-Saharan Africa

BACKGROUND

Following the outbreak of the 2020 coronavirus, governments adopted non-pharmaceutical interventions (NPIs) to save lives. The NPIs have been deemed to have unintended consequences on mental health and well-being. This study aimed to estimate the impact of the COVID-19 pandemic-induced school closures on the relative search volumes (RSVs) of well-being-relevant topics in 30 low and lower- middle income countries in Sub-Saharan Africa.

METHODS

Google Trends search data, difference-in-differences and event study methods were used to evaluate the impact on the related search volume (RSV) of well-being related topic queries in Sub-Saharan Africa.

RESULTS

The results suggest positive and significant increases in the search intensity for anger, boredom, fear, sleep, exercise, and prayer. Contrary to other studies, we find no discernible effects on the relative search volumes (RSVs) on loneliness, sadness, and suicide.

CONCLUSION

Our findings suggest that the pandemic and the associated restrictions had a mixed effect on well-being-related searches. We recommend increased vigilance and proactive communication from the government and policy makers with the general population in times of emergencies when social policies that restrict lives and liberties need to be adopted.

Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework

BACKGROUND

The COVID-19 pandemic has resulted in profound and far-reaching impacts on maternal and newborn care and outcomes. As part of the ASPIRE COVID-19 project, we describe processes and outcome measures relating to safe and personalised maternity care in England which we map against a pre-developed ASPIRE framework to establish the potential impact of the COVID-19 pandemic for two UK trusts.

METHODS

We undertook a mixed-methods system-wide case study using quantitative routinely collected data and qualitative data from two Trusts and their service users from 2019 to 2021 (start and completion dates varied by available data). We mapped findings to our prior ASPIRE conceptual framework that explains pathways for the impact of COVID-19 on safe and personalised care.

RESULTS

The ASPIRE framework enabled us to develop a comprehensive, systems-level understanding of the impact of the pandemic on service delivery, user experience and staff wellbeing, and place it within the context of pre-existing challenges. Maternity services experienced some impacts on core service coverage, though not on Trust level clinical health outcomes (with the possible exception of readmissions in one Trust). Both users and staff found some pandemic-driven changes challenging such as remote or reduced antenatal and community postnatal contacts, and restrictions on companionship. Other key changes included an increased need for mental health support, changes in the availability and uptake of home birth services and changes in induction procedures. Many emergency adaptations persisted at the end of data collection. Differences between the trusts indicate complex change pathways. Staff reported some removal of bureaucracy, which allowed greater flexibility. During the first wave of COVID-19 staffing numbers increased, resolving some pre-pandemic shortages: however, by October 2021 they declined markedly. Trying to maintain the quality and availability of services had marked negative consequences for personnel. Timely routine clinical and staffing data were not always available and personalised care and user and staff experiences were poorly captured.

CONCLUSIONS

The COVID-19 crisis magnified pre-pandemic problems and in particular, poor staffing levels. Maintaining services took a significant toll on staff wellbeing. There is some evidence that these pressures are continuing. There was marked variation in Trust responses. Lack of accessible and timely data at Trust and national levels hampered rapid insights. The ASPIRE COVID-19 framework could be useful for modelling the impact of future crises on routine care.

'An extra level of kind of torment': Views and experiences of recurrent miscarriage care during the initial phases of COVID-19 in Ireland-A qualitative interview study

INTRODUCTION

Maternity services underwent much change during the COVID-19 pandemic. Research on the impact on miscarriage care and experiences during this time is sparse. Within a national evaluation of recurrent miscarriage care, we qualitatively explored stakeholder views and experiences of recurrent miscarriage services in Ireland. This study describes the impact of the COVID-19 pandemic on those experiences and perceptions of care.

METHODS

People with professional and lived experience of recurrent miscarriage and service engagement were actively involved in this qualitative study from idea generation to analysis and reporting. We recruited women and men with two or more consecutive first-trimester miscarriages, and people involved in the management/delivery of recurrent miscarriage services and supports. We used purposive sampling to ensure that perspectives across disciplinary or lived experience, geographical, and health service administrative areas, were included. We conducted semi-structured interviews, virtually all due to COVID-19 restrictions, between June 2020 and February 2021. These were audio-recorded, and data were transcribed, and subsequently analyzed using reflexive thematic analysis.

RESULTS

We interviewed 42 service providers and 13 women and 7 men with experience of recurrent miscarriage. We actively generated two central themes during data analysis. The first-'Disconnected'-describes how many women navigated miscarriage diagnosis and management and care in subsequent pregnancies alone; many felt that this resulted in increased trauma. At the same time, men struggled with not being present to support their partners and described feeling disconnected. The second theme highlighted 'The perceived dispensability of recurrent miscarriage services and supports'. Some service providers felt that service reduction and redeployment demonstrated a lack of value in the service. Virtual clinics facilitated access to services, but a preference for in-person care was highlighted.

CONCLUSION

Our analysis provides rich insights into the significant impacts that the COVID-19 pandemic has had on the way recurrent miscarriage care is provided and experienced, with important implications for early pregnancy, miscarriage and recurrent miscarriage care. Services have undergone significant changes and, while these may be temporary, how services should be delivered in the future requires consideration, particularly given the deficits in care and care experiences highlighted prepandemic.

PATIENT OR PUBLIC CONTRIBUTION

Members of the multidisciplinary RE:CURRENT Project Research Advisory Group (including four parent advocates, two of whom are co-authors on this article) were actively involved throughout the study, including the generation of topic guides and the refining of themes.

The antenatal psychological experiences of women during two phases of the COVID-19 pandemic: A recurrent, cross-sectional, thematic analysis

Initial COVID-19-related social distancing restrictions, imposed in the UK in March 2020, and the subsequent lifting of restrictions in May 2020 caused antenatal disruption and stress which exceeded expected vulnerabilities associated with this lifecourse transition. The current study aimed to explore the antenatal psychological experiences of women during different phases of pandemic-related lockdown restrictions in the UK. Semi-structured interviews were held with 24 women about their antenatal experiences: twelve were interviewed after the initial lockdown restrictions (Timepoint 1; T1), and a separate twelve women were interviewed after the subsequent lifting of those restrictions (Timepoint 2; T2). Interviews were transcribed and a recurrent, cross-sectional thematic analysis was conducted. Two themes were identified for each timepoint, and each theme contained sub-themes. T1 themes were: 'A Mindful Pregnancy' and 'It's a Grieving Process', and T2 themes were: 'Coping with Lockdown Restrictions' and 'Robbed of Our Pregnancy'. COVID-19 related social distancing restrictions had an adverse effect on women's mental health during the antenatal period. Feeling trapped, anxious, and abandoned were common at both timepoints. Actively encouraging conversations about mental wellbeing during routine care and adopting a prevention opposed to cure attitude toward implementing additional support provisions may serve to improve antenatal psychological wellbeing during health crises.

Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis

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.

The impact of the Covid-19 pandemic on postnatal depression: analysis of three population-based national maternity surveys in England (2014-2020)

Background

Few studies have evaluated postnatal depression before and during the Covid-19 pandemic using comparable data across time. We used data from three national maternity surveys in England to compare prevalence and risk factors for postnatal depression before and during the pandemic.

Methods

Analysis was conducted using population-based surveys carried out in 2014 (n = 4571), 2018 (n = 4509), and 2020 (n = 4611). Weighted prevalence estimates for postnatal depression (EPDS score ≥13) were compared across surveys. Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for the association between sociodemographic, pregnancy- and birth-related, and biopsychosocial factors, and postnatal depression.

Findings

Prevalence of postnatal depression increased from 10.3% in 2014 to 16.0% in 2018 (difference = +5.7% (95% CI: 4.0-7.4); RR = 1.55 (95% CI: 1.36-1.77)) and to 23.9% in 2020 (difference = +7.9% (95% CI: 5.9-9.9); RR = 1.49 (95% CI: 1.34-1.66)). Having a long-term mental health problem (aRR range = 1.48-2.02), antenatal anxiety (aRR range = 1.73-2.12) and antenatal depression (aRR range = 1.44-2.24) were associated with increased risk of postnatal depression, whereas satisfaction with birth (aRR range = 0.89-0.92) and social support (aRR range = 0.73-0.78) were associated with decreased risk before and during the pandemic.

Interpretation

This analysis indicates that Covid-19 had an important negative impact on postnatal women's mental health and may have accelerated an existing trend of increasing prevalence of postnatal depression. Risk factors for postnatal depression were consistent before and during the pandemic. Timely identification, intervention and follow-up are key to supporting women at risk, and it is essential that mechanisms to support women are strengthened during times of heightened risk such as the pandemic.

Funding

NIHR Policy Research Programme.

Perinatal mental health and women's lived experience of the COVID-19 pandemic: A scoping review of the qualitative literature 2020-2021

BACKGROUND

The COVID-19 pandemic resulted in global physical distancing restrictions and lockdown orders. Despite the clear documentation of increased mental distress amongst adult populations during the pandemic, there is limited evidence about the mental health challenges of people in the perinatal period (pregnancy, birth and postpartum). The aim of this review is to summarise the qualitative research about women's lived experience and emotional wellbeing during the COVID-19 pandemic.

METHODS

A comprehensive search strategy was developed. Twenty peer-reviewed qualitative research articles published in English from January 1, 2020, to December 15, 2021, were included. Data synthesis outlined the evidence from common themes in a narrative format.

RESULTS

Themes during pregnancy included: (1) information seeking: anxiety and fear; (2) experiencing isolation and disruptions to my social support; (3) 'Going it alone' in pregnancy care; (4) anticipatory grieving and despair; (5) finding 'silver linings' in social restrictions. One key theme during birth was "birthing in a crisis". Themes during postpartum included: (1) isolating 'Early motherhood is much like lockdown'; (2) breastfeeding: triumphs and tribulations; (3) facing disruptions during postpartum care; (4) 'Affecting us for years to come' - COVID-19 was not the only trauma; (5) 'silver linings' during postpartum care.

CONCLUSIONS

This review provides important insights into how experiences of isolation, decreased social support and adaptions to maternity services affect women's mental health. Maternity services should consider how perinatal mental health support may be integrated into the care of women who may still be required to isolate or have reduced visitors during their perinatal care.

STATEMENT OF SIGNIFICANCE

The restrictions and disruptions to maternity care due to the COVID-19 pandemic were likely to impact the mental health of women in the perinatal period (pregnancy, birth and postpartum). What is already known is that public health measures due to COVID-19 increased the prevalence of common perinatal mental disorders (CPMDs) and exacerbated common risk factors for CPMDs (i.e., poor social support).

WHAT THIS PAPER ADDS

The qualitative research with women in the perinatal period during the pandemic provides unique insights into how these events impacted perinatal mental and emotional health. In particular, the ways that global physical distancing measures and maternity care adaptations contributed to women's feelings of distress, isolation, and depression/despair. Silver linings such as more uninterrupted time with immediate family were also identified.

Childbirth experience during the COVID-19 pandemic: A qualitative thematic analysis

Introduction

Pregnancy is a period of special vulnerability for the mental health of women. The arrival of the COVID-19 pandemic altered the routines of pregnant women, its effects on this population are thus far unknown. Therefore, the objective of this study is to understand the impact of the pandemic on the birth experience of women during the state of emergency in Andalusia, Spain.

Methods

A qualitative study was conducted with 14 women, using semistructured interviews via telematics. These were recorded and later transcribed using the F4transkript software. In order to analyse the data retrieved from the interviews and identify the main patterns of meaning/responses, the thematic analysis method was applied.

Results

The main emerging themes were 'prenatal medical care', 'hospital safety', and 'postpartum with COVID-19 restrictions'. The results indicated that the reorganization of perinatal medical care, the lack of information, and the fear of contagion were the factors that most negatively influenced the participants. Instead, the security during the birth process and the tranquillity in postpartum were the positive aspects of the birth experiences during COVID-19.

Conclusion

This is the first qualitative study in Andalusia that identifies the specific aspects of the COVID-19 pandemic that have affected the mental health of pregnant women. The results contribute to a broader perception of the experience of women and the creation of health protocols for emergencies akin to the COVID-19 pandemic.

"There's very little that you can do other than refer them to the doctor if you think they've got postnatal depression": Scoping the potential for perinatal mental health care by community pharmacists

BACKGROUND

Twenty percent of women in the UK develop perinatal mental health (PMH) problems, which have widespread effects on maternal and child health. Community pharmacists are ideally placed to identify PMH problems and refer to other trained healthcare professionals.

OBJECTIVE

This study explored community pharmacists' attitudes, current counselling practices, and barriers to providing mental health advice to perinatal women.

METHODS

A qualitative focus group study was performed virtually with community pharmacists (n = 11), working in urban settings across London. A topic guide was used to cover current counselling practice, barriers to and confidence in counselling women, and thoughts on potential pharmacist-led perinatal mental health services. The focus groups were recorded, transcribed, and analysed using thematic analysis.

RESULTS

Three themes were identified: Doing Mental Health Care; Willing, but Unable; and Introspection and reflection, which were related through a central organising concept of 'Perinatal mental health care as a new frontier for community pharmacy'. It was found that while community pharmacists provide mental health advice to perinatal women and their partners, they lacked confidence, which was related to a lack of knowledge and inadequate training opportunities. Organisational barriers were identified including a lack of a formal referral pathway to existing mental health services and other trained healthcare professionals. Perceptions of opportunities and recommendations for service improvement and change were also garnered.

CONCLUSION

This study demonstrates community pharmacists have a potential role within community mental healthcare in identification of PMH problems and providing appropriate advice and support. Upskilling community pharmacists in mental health should be considered to increase knowledge and confidence while formal referral pathways to other trained healthcare professionals and existing services should be established and made available to pharmacists.

Parent organizations' experiences of the pandemic response in maternity care in thirteen European countries

We surveyed changes to maternity care services in the first 17 months of the COVID-19 pandemic in 13 different European countries, from the perspective of national maternity service (parent) organizations advocating for a human rights approach to maternity services. A qualitative study was conducted in November 2020. An open-question survey was sent to national maternity service (parent) organizations and members of COST Action 18211 in Europe, asking about COVID-19 measures in maternity services (antenatally, intrapartum, postnatally, and overall satisfaction). From the open answers, 16 core issues were extracted. Between February and August 2021, semi-structured interviews with the national representatives of 14 parent member organizations in Europe were conducted, collecting details on overall national situations and changes due to COVID-19 measures. The reported experiences of parent organizations from 13 European countries show wide variations in epidemiological containment measures during the first 17 months of the COVID-19 pandemic. Practices differed between facilities, resulting in emotional disquiet and confusion for parent-patients. Most countries maintained antenatal and postnatal care but restricted psychosocial support (antenatal and birth companions, visitors). Organizations from nine countries reported that women had to wear masks during labor, and all but two countries saw separations of mothers and babies. Most parent organizations described a need for more reliable information for new parents. During the pandemic, non-evidence-based practices were (re-) established in many settings, depriving women and families of many factors which evidence has shown to be essential for a positive birthing experience. Based on the findings, we consider the challenges in maternity services and propose a strategy for future crises.

Exploring the experiences of pregnant women in the U.S. during the first year of the Covid-19 pandemic

In this paper, we integrate the stress process model with symbolic interactionism to frame our analysis of interviews with 35 women who were pregnant and/or gave birth during the first year of the Covid-19 pandemic. We detail three stressors, highlight their variation, and discuss how they coped with these stressors. Women reported having to navigate contradictory information about the public health crisis, but Black participants simultaneously endured added strain from a heightened awareness of racialized violence. To cope with an overabundance of precarious and contradictory messages, some women sought out information (i.e., information gatherers), others eschewed information (i.e., information avoiders), and most established protective "bubbles." Next, women experienced disruptions in pregnancy rituals but coped by reframing their expectations. This stressor, however, was less acute for women with a prior birth. Third, women shared feelings of social isolation and reduced social support, which were intensified if pregnancy complications occurred. Women coped by relying on telecommunication and at-home monitoring devices. Our study shows how pregnant women experienced and coped through adversity to mitigate stressors amid pandemonium.

Making maternity and neonatal care personalised in the COVID-19 pandemic: Results from the Babies Born Better survey in the UK and the Netherlands

BACKGROUND

The COVID-19 pandemic had a severe impact on women's birth experiences. To date, there are no studies that use both quantitative and qualitative data to compare women's birth experiences before and during the pandemic, across more than one country.

AIM

To examine women's birth experiences during the COVID-19 pandemic and to compare the experiences of women who gave birth in the United Kingdom (UK) or the Netherlands (NL) either before or during the pandemic.

METHOD

This study is based on analyses of quantitative and qualitative data from the online Babies Born Better survey. Responses recorded by women giving birth in the UK and the NL between June and December 2020 have been used, encompassing women who gave birth between 2017 and 2020. Quantitative data were analysed descriptively, and chi-squared tests were performed to compare women who gave birth pre- versus during pandemic and separately by country. Qualitative data was analysed by inductive thematic analysis.

FINDINGS

Respondents in both the UK and the NL who gave birth during the pandemic were as likely, or, if they had a self-reported above average standard of life, more likely to rate their labour and birth experience positively when compared to women who gave birth pre-pandemic. This was despite the fact that those labouring in the pandemic reported a lack of support and limits placed on freedom of choice. Two potential explanatory themes were identified in the qualitative data: respondents had lower expectations of care during the pandemic, and they appreciated the efforts of staff to give individualised care, despite the rules.

CONCLUSION

Our study implies that many women labouring during the COVID-19 pandemic experienced restrictions, but their experience was mitigated by staff actions. However, personalised care should not be maintained by the good will of care providers, but should be a priority in maternity care policy to benefit all service users equitably.

Learning from a crisis: a qualitative study of the impact on mothers' emotional wellbeing of changes to maternity care during the COVID-19 pandemic in England, using the National Maternity Survey 2020

BACKGROUND

Pregnancy and the postnatal period can be times of psychosocial stress and insecurity, but high quality maternity care and social support can help mothers cope with stress and feel more secure. The COVID-19 pandemic and associated social and economic disruption increased rates of antenatal and postnatal stress, anxiety and depression, and also had profound impacts on the organisation of maternity services in England.

METHODS

This was a qualitative descriptive study of the impact of pandemic-related changes to maternity care on mothers' emotional wellbeing, using inductive thematic analysis of open text responses to the National Maternity Survey (NMS) 2020 in England. A random sample of 16,050 mothers who gave birth 11-24^th May 2020 were invited to take part in the survey, and 4,611 responded, with 4,384 answering at least one open text question.

RESULTS

There were three themes: 'Chaos: impact of uncertainty', 'Abandoned: impact of reduction in care', and 'Alone: impact of loss of social support'. Mothers valued maternity care and many experienced additional stress from chaotic changes and reduction in care during the pandemic; from health professionals' own uncertainty and anxiety; and from restrictions on essential social support during pregnancy, labour and birth. Others felt that health professionals had communicated and cared for them well despite the changes and restrictions, and these mothers felt psychologically safe.

CONCLUSIONS

Planning for future crises should include considering how necessary adaptations to care can be implemented and communicated to minimise distress; ensuring that mothers are not deprived of social support at the time when they are at their most vulnerable; and supporting the psychological welfare of staff at a time of enormous pressure. There are also lessons for maternity care in 'normal' times: that care is highly valued, but trust is easily lost; that some mothers come into the maternity system with vulnerabilities that can be ameliorated or intensified by the attitudes of staff; that every effort should be made to welcome a mother's partner or chosen companion into maternity care; and that high quality postnatal care can make a real difference to mothers' wellbeing.

Project20: Maternity care mechanisms that improve (or exacerbate) health inequalities. A realist evaluation

BACKGROUND

Women with low socioeconomic status and social risk factors are at a disproportionate risk of poor birth outcomes and experiences of maternity care. Specialist models of maternity care that offer continuity are known to improve outcomes but underlying mechanisms are not well understood.

AIM

To evaluate two UK specialist models of care that provide continuity to women with social risk factors and identify specific mechanisms that reduce, or exacerbate, health inequalities.

METHODS

Realist informed interviews were undertaken throughout pregnancy and the postnatal period with 20 women with social risk factors who experienced a specialist model of care.

FINDINGS

Experiences of stigma, discrimination and paternalistic care were reported when women were not in the presence of a known midwife during care episodes. Practical and emotional support, and evidence-based information offered by a known midwife improved disclosure of social risk factors, eased perceptions of surveillance and enabled active participation. Continuity of care offered reduced women's anxiety, enabled the development of a supportive network and improved women's ability to seek timely help. Women described how specialist model midwives knew their medical and social history and how this improved safety. Care set in the community by a team of six known midwives appeared to enhance these benefits.

CONCLUSION

The identification of specific maternity care mechanisms supports current policy initiatives to scale up continuity models and will be useful in future evaluation of services for marginalised groups. However, the specialist models of care cannot overcome all inequalities without improvements in the maternity system as a whole.

Becoming a mother during the COVID-19 pandemic: The lived experience as told by birthing mothers: A qualitative study

AIMS AND OBJECTIVES

The aim of this study is to explore the lived experience of women who gave birth during the COVID-19 pandemic.

BACKGROUND

Experiencing pregnancy during the Covid-19 pandemic exacerbates the risk of the onset of psychological problems.

DESIGN

This is a descriptive, single-centre, qualitative study.

METHODS

The enrolment for data collection included childbearing mothers aged 18 years and over between November 2021 and April 2022. The researchers invited them to write about their personal experiences during the isolation period of the first pandemic wave. The descriptive phenomenological analysis of the data was carried out using the method described by Mortari.

RESULTS

A total of 50 mothers were recruited, of whom 28 were primiparous (56.0%) and 22 multiparous (44.0%). From the analysis of the interviews, five main themes emerged that enclose the experience of both primiparous and multiparous mothers: 'The negative feeling: between loneliness, sadness and fear'; 'The comfort of being cared for: between humanity and competence'; 'Family proximity: between comfort and stress'; 'Symbiotic intimacy: bonding; Managing physical pain and consciousness of being resilient women'.

CONCLUSIONS

The study showed that the discomfort associated with the absence of family support in the phase of labour and childbirth was compensated by the professionalism of the health staff and allowed new mothers to experience moments of great intimacy with the child.

IMPLICATIONS FOR NURSING MANAGEMENT

Such data could help create recommendations based on the assisted person's experiences to ensure that care is increasingly attentive and tailored to the needs of mothers and, thus, of children.

The experience of fathers during the covid-19 UK maternity care restrictions

OBJECTIVE

During the COVID-19 pandemic fathers in the UK were excluded from many aspects of maternity care to reduce escalating transmission rates. This study explores the experiences of fathers who had a baby during the pandemic to understand what effect these maternity restrictions had on them and their relationship to the baby.

DESIGN

A qualitative interview study of the experiences of fathers whose baby was born during the pandemic-related UK maternity restrictions.

PARTICIPANTS AND SETTING

Non-probability voluntary response sampling of 20 fathers: including 13 primiparous fathers and 7 multiparous fathers. Eligibility criteria were that fathers lived in the UK and had a baby born on or after the 23rd March 2020; the start of the most severe COVID-19 maternity restrictions. Participants were interviewed remotely via telephone using semi-structured interviews which were transcribed and analysed using thematic analysis.

FINDINGS

Four themes, including ten sub-themes, were identified that described fathers' experiences of the maternity restrictions and the father-baby relationship. The themes were: (1) The impact on paternal experience: this theme describes a collective negative paternal maternity experience as a result of the restrictions. Notably, father exclusion produced feelings of isolation and a sense of loss, along with a disconnection from the pregnancy. (2) The impact on the father-baby relationship: this theme discusses the adverse consequence of the restrictions on initial father-baby bonding. (3) Observed impact on mothers: the observed detrimental impact that excluding fathers had on maternal mental health and well-being. Finally, (4) Fatherhood in the 'new normal': the change of daily living during the pandemic aided profound family relationship building, improving long-term father-baby bonding, compared to pre-pandemic conditions.

KEY CONCLUSIONS

The findings provide evidence of undesirable consequences the pandemic-related UK maternity restrictions had on birth partners. With restrictions to maternity care implemented across the globe, these concerns may be applicable at an international scale.

IMPLICATIONS FOR PRACTICE

This study adds to other contemporary literature on this subject and can inform discussion among maternity services of the importance of including fathers for improved parental well-being and initial infant bonding.

Multicountry study protocol of COCOON: COntinuing Care in COVID-19 Outbreak global survey of New, expectant, and bereaved parent experiences

INTRODUCTION

Globally, the COVID-19 pandemic has significantly disrupted the provision of healthcare and efficiency of healthcare systems and is likely to have profound implications for pregnant and postpartum women and their families including those who experience the tragedy of stillbirth or neonatal death. This study aims to understand the psychosocial impact of COVID-19 and the experiences of parents who have accessed maternity, neonatal and bereavement care services during this time.

METHODS AND ANALYSIS

An international, cross-sectional, online and/or telephone-based/face-to-face survey is being administered across 15 countries and available in 11 languages. New, expectant and bereaved parents during the COVID-19 pandemic will be recruited. Validated psychometric scales will be used to measure psychosocial well-being. Data will be analysed descriptively and by assessing multivariable associations of the outcomes with explanatory factors. In seven of these countries, bereaved parents will be recruited to a nested, qualitative interview study. The data will be analysed using a grounded theory analysis (for each country) and thematic framework analysis (for intercountry comparison) to gain further insights into their experiences.

ETHICS AND DISSEMINATION

Ethics approval for the multicountry online survey, COCOON, has been granted by the Mater Misericordiae Human Research Ethics Committee in Australia (reference number: AM/MML/63526). Ethics approval for the nested qualitative interview study, PUDDLES, has been granted by the King's College London Biomedical & Health Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Subcommittee (reference number: HR-19/20-19455) in the UK. Local ethics committee approvals were granted in participating countries where required. Results of the study will be published in international peer-reviewed journals and through parent support organisations. Findings will contribute to our understanding of delivering maternity care services, particularly bereavement care, in high-income, lower middle-income and low-income countries during this or future health crises.

Predictors and impact of women's breastfeeding self-efficacy and postnatal care in the context of a pandemic in Australia and Aotearoa New Zealand

OBJECTIVE

To investigate predictors of breastfeeding self-efficacy, postnatal care experiences, and there subsequent impact on breastfeeding outcomes in Australia and Aotearoa New Zealand in the context of the COVID-19 pandemic.

DESIGN

A cross-sectional online survey collected data between August and October 2020 with recruitment via social media. Quantitative data were analyzed using descriptive analyses, and linear and logistic regression analysis related to the Breastfeeding Self-Efficacy Scale-Short Form findings. Open text responses were analyzed using content analysis.

FINDINGS

There were 1001 complete responses. Visitor restrictions impacted the woman's early parenting experience in both positive and negative ways. One third of participants stated their postnatal needs were not met with 82 stating that they had no postnatal care at all. During the first six weeks postnatal, 48.1% felt not very or not at all confident caring for their baby. Despite 94.3% of participants initiating breastfeeding, only 70% were exclusively breastfeeding at six weeks. The mean self-efficacy score was 49.98 suggesting the need for additional help, with first time mothers having a statistically significant lower score.

DISCUSSION/CONCLUSION

Sub-optimal postnatal care and support negatively influence breastfeeding self-efficacy. Women desired additional help during the COVID-19 pandemic inclusive of support and education to meet their postnatal needs and exclusively breastfeed.

IMPLICATIONS FOR PRACTICE

Women require appropriate and timely postnatal care and support to promote confidence in caring for baby and achieve their breastfeeding goals. Preferably this care should be provided face-to-face.

Precarity and preparedness during the SARS-CoV-2 pandemic: A qualitative service evaluation of maternity healthcare professionals

Introduction

The SARS‐CoV‐2 pandemic has devastated populations, posing unprecedented challenges for healthcare services, staff and service‐users. In the UK, rapid reconfiguration of maternity healthcare service provision changed the landscape of antenatal, intrapartum and postnatal care. This study aimed to explore the experiences of maternity services staff who provided maternity care during the SARS‐CoV‐2 pandemic to inform future improvements in care.

Material and methods

A qualitative interview service evaluation was undertaken at a single maternity service in an NHS Trust, South London. Respondents (n = 29) were recruited using a critical case purposeful sample of maternity services staff. Interviews were conducted using video‐conferencing software, and were transcribed and analyzed using Grounded Theory Analysis appropriate for cross‐disciplinary health research. The focus of analysis was on staff experiences of delivering maternity services and care during the SARS‐CoV‐2 pandemic.

Results

A theory of “Precarity and Preparedness” was developed, comprising three main emergent themes: “Endemic precarity: A health system under pressure”; “A top‐down approach to managing the health system shock”; and “From un(der)‐prepared to future flourishing”.

Conclusions

Maternity services in the UK were under significant strain and were inherently precarious. This was exacerbated by the SARS‐CoV‐2 pandemic, which saw further disruption to service provision, fragmentation of care and pre‐existing staff shortages. Positive changes are required to improve staff retention and team cohesion, and ensure patient‐centered care remains at the heart of maternity care.

A qualitative analysis of feelings and experiences associated with perinatal distress during the COVID-19 pandemic

Background

Rates of perinatal mental health difficulties (experienced during pregnancy and the 12-months postpartum) increased worldwide during the COVID-19 pandemic. In the UK, anxiety and depression were estimated to affect more than half of perinatal women during the first national lockdown. However, little is known about women’s qualitative experiences of distress. This study aimed to extend published quantitative findings resulting from the same data set (Harrison et al., Women Birth xxxx, 2021;  Harrison et al., J Reprod Infant Psychol 1–16, 2021) to qualitatively explore: 1) the feelings and symptoms associated with maternal perinatal distress during the COVID-19 pandemic; and 2) the associated sources of distress.

Methods

As part of an online survey during May 2020, 424 perinatal women responded to an open-ended question regarding a recent experience of distress. Qualitative data were analysed using an initial content analysis, followed by an inductive thematic analysis adopting a realist approach. Data were explored in the context of self-reported perinatal anxiety and depression symptoms.

Results

Initial content analysis of the data identified twelve distinct categories depicting participants’ feelings and symptoms associated with psychological distress. Despite the high rates of probable depression in the sample, women’s descriptions were more indicative of anxiety and general distress, than of symptoms traditionally related to depression. In terms of the associated psychosocial stressors, a thematic analysis identified five themes: Family wellbeing; Lack of support; Mothering challenges; Loss of control due to COVID-19; and Work and finances. Unsurprisingly given the context, isolation was a common challenge. Additionally, psychological conflict between maternal expectations and the reality of pregnancy and motherhood, loss of autonomy and control, and fears surrounding family health, safety, and wellbeing underlay many of the themes.

Conclusions

This study presents an array of feelings and symptoms expressed by perinatal mothers which may be useful to consider in relation to perinatal wellbeing. Furthermore, our data highlights several common sources of distress, including multiple COVID-19 specific factors. However, many were related to more general perinatal/maternal experiences. Our findings also point to considerations that may be useful in alleviating distress in pregnancy and early motherhood, including social support, realistic perinatal/maternal expectations, and support for those with perceived perinatal trauma.

Fear of childbirth in pregnancy was not increased during the COVID ‐19 pandemic in the Netherlands: a cross‐sectional study

Introduction

Fear of childbirth is a well‐known problem during pregnancy and can have implications for childbirth, including prolonged labor, use of epidural analgesia, obstetric complications, presence of traumatic stress symptoms, or request for an elective cesarean section. The coronavirus disease 2019 (COVID‐19) pandemic has affected mental health and therefore could have increased fear of childbirth during the pandemic. The aim of this study was to investigate fear of childbirth during the pandemic in the Netherlands compared with a reference group from before the pandemic.

Material and methods

We conducted a cross‐sectional study to evaluate pregnant women during the first and second waves of COVID‐19 compared with both each other and with pregnant women from before the pandemic. Participants were recruited through social media platforms, hospitals, and midwifery practices. Pregnant women aged ≥18 years who had mastered the Dutch language were eligible to participate. Fear of childbirth was measured with the Wijma Delivery Expectancy Questionnaire online using a cut‐off score of ≥85 to indicate clinically relevant fear of childbirth. The primary outcome was the prevalence of fear of childbirth. We undertook additional analyses to specifically look at possible effect modification.

Results

In total, 1102 pregnant women completed the questionnaire during the first wave of the pandemic, 731 during the second wave, and 364 before the pandemic. Fear of childbirth was present in 10.6%, 11.4%, and 18.4%, respectively. We considered possible effect modification, which indicated that age and parity had a significant influence. In participants during the first wave of COVID‐19, nulliparous women had significantly lower odds (odds ratio [OR] 0.50; 95% confidence interval [CI] 0.34–0.73; p < 0.01) of having a fear of childbirth than did the reference group. Both younger participants in the first wave (OR 0.59; 95% CI 0.37–0.93; p < 0.05) and older participants in the first wave (OR 0.44; 95% CI 0.28–0.71; p < 0.01) and the second wave (OR 0.36; 95% CI 0.21–0.62; p < 0.01) of COVID‐19 had lower odds of fear of childbirth than the reference group.

Conclusions

Pregnant women during the first and second waves of COVID‐19 had lower fear of childbirth scores than pregnant women before the pandemic, indicating less fear of childbirth during the pandemic. This could be explained by an increased level of information, more time to consume information, and better work–life balance with more people working at home during the pandemic.

Impact of the COVID-19 pandemic on midwifery-led service provision in the United Kingdom in 2020-21: findings of three national surveys

Background

The COVID-19 pandemic required all healthcare systems to adapt quickly. There is some evidence about the impact of the pandemic on United Kingdom maternity services overall, but little is known about the impact on midwifery-led services, including midwifery units and home birth services.

Objective

To describe changes to midwifery-led service provision in the United Kingdom and the Channel Islands during the COVID-19 pandemic.

Design

Three national surveys were circulated using the United Kingdom Midwifery Study System (UKMidSS) and the Royal College of Midwives (RCM) Heads and Directors of Midwifery Network. The UKMidSS surveys took place in wave 1 (April to June 2020) and in wave 2 (February to March 2021). The RCM survey was conducted in April 2020.

Findings

The response rate to the UKMidSS surveys was 84% in wave 1 and 70% in wave 2, while 48% of Heads and Directors of Midwifery responded to the RCM survey. Around 60% of midwifery units reported being open as usual in wave 1, with the remainder affected by closures. Fewer unit closures (15%) were reported in the wave 2 survey. Around 40% of services reported some reduction in home birth services in wave 1, compared with 15% in wave 2. The apparent impact of the pandemic varied widely across the four nations of the United Kingdom and within the English regions.

Conclusions

The pandemic led to increased centralisation of maternity care and the disruption of midwifery-led services, especially in the first wave. Further research should focus on the reasons behind closures, the regional variation and the impact on maternity care experience and outcomes.

On race and ethnicity during a global pandemic: An 'imperfect mosaic' of maternal and child health services in ethnically-diverse South London, United Kingdom

Background

The SARS-CoV-2 pandemic has brought racial and ethnic inequity into sharp focus, as Black, Asian, and Minority Ethnic people were reported to have greater clinical vulnerability. During the pandemic, priority was given to ongoing, reconfigured maternity and children's healthcare. This study aimed to understand the intersection between race and ethnicity, and healthcare provision amongst maternity and children's healthcare professionals, during the SARS-CoV-2 pandemic.

Methods

A qualitative study consisting of semi-structured interviews (N = 53) was undertaken with maternity (n = 29; August-November 2020) and children's (n = 24; June-July 2021) healthcare professionals from an NHS Trust in ethnically-diverse South London, UK. Data pertinent to ethnicity and race were subject to Grounded Theory Analysis, whereby data was subjected to iterative coding and interpretive analysis. Using this methodology, data are compared between transcripts to generate lower and higher order codes, before super-categories are formed, which are finally worked into themes. The inter-relationship between these themes is interpreted as a final theory.

Findings

Grounded Theory Analysis led to the theory: An 'Imperfect Mosaic', comprising four themes: (1) 'A System Set in Plaster'; (2) 'The Marginalised Majority'; (3) 'Self-Discharging Responsibility for Change-Making'; and (4) 'Slow Progress, Not No Progress'. The NHS was observed to be brittle, lacking plasticity to deliver change at pace. Overt racism based on skin colour has been replaced by micro-aggressions between in-groups and out-groups, defined not just by ethnicity, but by other social determinants. Contemporaneously, responsibility for health, wellbeing, and psychological safety in the workplace is discharged to, and accepted by, the individual.

Interpretation

Our findings suggest three practicable solutions: (1) Representation of marginalised groups at all NHS levels; (2) Engagement in cultural humility which extends to other social factors; and (3) Collective action at system and individual levels, including prioritising equity over simplistic notions of equality.

Funding

This service evaluation was supported by the King's College London King's Together Rapid COVID-19 Call, successfully awarded to Laura A. Magee, Sergio A. Silverio, Abigail Easter, & colleagues (reference:- 204823/Z/16/Z), as part of a rapid response call for research proposals. The King's Together Fund is a Wellcome Trust funded initiative.

Implementation of Public Health England Infection Prevention and Control Guidance in Maternity Units in response to the COVID-19 pandemic

Background

This study aimed to explore the successes and barriers to the implementation of Public Health England (PHE) infection prevention and control guidance in English maternity units during the COVID-19 pandemic.

Methods

Qualitative semi-structured interviews with obstetricians, midwives and neonatologists who worked in a maternity unit in England, UK, between March 2020 and July 2021. A thematic analysis was performed.

Results

Successes to the implementation of PHE guidance were related to existing infrastructure, training satisfaction, and organisational culture where subthemes considered the importance of a multidisciplinary approach, COVID-19 dedicated roles and hospital-wide communication. Barriers to implementation related to the applicability of the guidance with subthemes highlighting contradictions between updates, specialties and hospitals, undesirable timings and frequency of guidance updates, reductions in staff compliance and delayed implementation. Finally, the layout of some units made it difficult to implement various aspects of the guidance (e.g., social distancing), and many detailed issues related to information technology compatibility, a lack of availability and accessibility to appropriate personal protective equipment (PPE), and variations in testing arrangements between units.

Conclusions

This research provides information on the experiences of healthcare professionals working on maternity units during the COVID-19 pandemic. Findings illustrate the importance of effective hospital-wide communication and the need for consistent, easily understood guidance. These results will be used to inform the content of an expert panel consensus meeting.

“Never let a good crisis go to waste”: Positives from disrupted maternity care in Australia during COVID-19

Objective

Due to the COVID-19 pandemic, a number of changes to maternity care were rapidly introduced in all countries, including Australia, to reduce the risk of infection for pregnant women and their care providers. While many studies have reported on the negative effects of these changes, there is a paucity of evidence on factors which women and their providers perceived as positive and useful for future maternity care.

Design

Data was analysed from the Birth in the time of COVID-19 (BITTOC 2020) study survey. Conventional content analysis and descriptive statistics were used to analyse the data and examine which aspects of COVID-amended care women experienced as positive. Data from women were compared to data from midwives.

Setting

This project took place in Australia in 2020-2021.

Participants

The survey was distributed to women who gave birth and midwives who worked in Australia during the COVID-19 pandemic (March 2020 onwards).

Measurements and findings

Women reported a variety of positives from their maternity care during COVID-19. These included both care-related factors as well as contextual factors. The most commonly mentioned positives for pregnant and postnatal women were care-related, namely fewer visitors in hospital, having increased access to telehealth services. These were also the most commonly reported positives by midwives. Having midwifery continuity of care models, giving birth at home and having their partner work from home were also highlighted by women as positives.

Key conclusions

Despite the negative effect of COVID-19-related restrictions on maternity care, a variety of changes were viewed as positive by both women and midwives, with strong agreement between the two groups.

Implications for practice

These findings provide evidence to support the inclusion of these positive elements of care and ensure that the lessons learned from the pandemic are utilised to improve maternity care in Australia going forward.

Physical and Psychological Childbirth Experiences and Early Infant Temperament

Objective

To examine how physical and psychological childbirth experiences affect maternal perceptions and experiences of early infant behavioural style (temperament).

Background

Unnecessary interventions may disturb the normal progression of physiological childbirth and instinctive neonatal behaviours that facilitate mother-infant bonding and breastfeeding. While little is known about how a medicalised birth may influence developing infant temperament, high impact interventions which affect neonatal crying and cortisol levels could have longer term consequences for infant behaviour and functioning.

Methods

A retrospective Internet survey was designed to fully explore maternal experiences of childbirth and her postnatal perceptions of infant behaviour. Data collected from 999 mother-infant dyads were analysed using Pearson's correlations and multiple analyses of covariance, employing the Bonferroni method of correction to establish initially significant variables. Multiple linear regressions were conducted to determine major perinatal contributors to perceived early infant temperament.

Results

Multiple regression analyses on each of the eight Mother and Baby Scales outcome variables indicated that early infant behavioural style (0-6 months) was largely predicted by subjective maternal states during and post-childbirth, postnatal depression scores, maternal personality traits and infant age. For example, infant age (Beta = 0.440, p = 0.000) was the most significant predictor of Alert-Responsive infant behaviour, followed by maternal Postnatal Positive experience (Beta = 0.181, p = 0.000). In contrast, depression (EPDS) scores (Beta = 0.370, p = 0.000) were the most significant predictor of Unsettled-Irregular infant behaviour, followed by Anxious-Afraid Birth Emotions (Beta = 0.171, p = 0.000) and infant age (Beta = -0.196, p = 0.000). Mothers also perceived their infants as more Alert-Responsive (Beta = 0.080, p = 0.010) and Easier overall (Beta = 0.085, p = 0.008) after a Supported birth experience.

Conclusion

Maternal and infant outcomes were influenced by multiple physical and psychological perinatal variables. The mother's subjective experience appeared to be of equal significance to more objective factors (e.g. birthplace/mode). Social support enhanced the mother's childbirth experience, benefitting her perceptions of her baby's early temperament. These findings provide further support for current World Health Organisation intrapartum guidelines (2018) on the importance of making childbirth a 'positive experience' for women.

Supporting Perinatal Mental Health and Wellbeing during COVID-19

Mental health is especially important as women transition into parenthood. The COVID-19 pandemic has necessitated the rapid reconfiguration of maternity services, including perinatal mental healthcare, as offered by Specialist Perinatal Mental Health Midwives, in NHS Trusts in the United Kingdom. This article represents work undertaken in rapid response to the COVID-19 pandemic and aims to document the findings from March 2020 up until May 2021 in literature published on perinatal mental health through the pandemic, as well as to engage in a knowledge mapping exercise across five NHS Trusts in London. In this research, we utilised a critical review methodology which purposefully selects and synthesises materials after extensive literature searching to provide a broad and informed narrative around an issue. For our knowledge mapping exercise, we utilised an inclusive stance to gather, pool, and synthesise data from five NHS Trusts regarding the provisions and reconfigurations of their perinatal mental health services, creating a comparable and translatable snapshot in time. Our rapid, critical review highlighted two themes: ‘Increased Perinatal Distress’ and ‘Inaccessible Services and Support’. Our knowledge mapping exercise produced four themes: ‘Retention of Existing Service Provision’; ‘Additional Services Provided’; ‘Reconfiguration of Service Provision’; ‘Additional Provision to Support Staff Wellbeing’. We conclude by offering best practice guidance in order to provide shared learning to aid the transition through para-pandemic circumstances to service delivery in a post-pandemic ‘new normal’.

Health visiting in England: The impact of the COVID-19 pandemic

This focused review of evidence considers the impact of the pandemic in 2020 on families with children under 5 years in England, and the health visiting (HV) service that supports them. . Data were drawn from national surveys of health visitors (HVs) and parents, a freedom of information request of employers, published research, and national data. Framework analysis and triangulation, using the Key Elements of an effective HV service, were used to categorize the key findings. The findings from the review indicate that the impacts of the pandemic were wide-ranging and disproportionately affected the most disadvantaged families, increasing demand for HV support. HVs' ability to respond was compromised due to national policy decisions to partially stop the service and variations in local implementation including the redeployment of HVs, pre-existing workforce capacity issues, and the effectiveness of innovations to identify and support vulnerable families. The pandemic exacerbated factors that can lead to poorer outcomes for families. Key learning from the pandemic response, including the need to prioritize the HV service, must be acted upon to reduce ongoing impacts now and ensure that the service is equipped for future emergencies.

Midwives' Knowledge and Preparedness in Providing Maternity Care During COVID-19 Pandemic in Dodoma Region, Tanzania: A Cross-Sectional Study

Background

COVID-19 pandemic has a high impact on the health of pregnant women and healthcare providers worldwide.

Objective

This study aims to assess midwives' knowledge and preparedness in providing maternity care during COVID-19 pandemic.

Methods

A cross-sectional analytical hospital-based study that included 116 midwives, who were working in labor ward, was conducted in the Dodoma region of Tanzania from March to June 2021. The Chi-square test and Fisher's exact test were used to assess the association between the categorical variables. The predictors of midwives' knowledge and preparedness were determined using binary logistic regression analysis. Statistical analysis was performed using SPSS version 23.0; p < .05 was considered to be significant.

Results

Of the midwives studied, 63 (54.3%) had adequate knowledge about COVID-19 and only 30 (25.9%) were adequately prepared on provision of maternal care. Having diploma/bachelor level of education (AOR  =  2.62, 95%CI  =  1.08-6.36, p  =  .033), being trained on COVID-19 (AOR  =  3.65, 95%CI  =  1.11-12.00, p  =  .033) and working in urban health facilities (AOR = 3.65, 95%CI  =  1.17-13.98, p  =  .002) were the significant determinants of midwives' knowledge on COVID-19. Working at a health center (AOR  =  0.19, 95%CI  =  0.03-1.32. p  =  .033), being trained on COVID-19 (AOR  =  0.04, 95%CI  =  0.01-0.14, p  =  .000 and having adequate knowledge on COVID-19 (AOR  =  0.20, 95%CI  =  0.03-1.32, p  =  .032) were determinants of midwives' preparedness on provision of maternal care.

Conclusion

Knowledge and preparedness in the provision of maternity care during the COVID-19 pandemic were low. Emphasis should be put on training midwives on IPC when providing maternity care. This may help in preventing the spread of infectious diseases including COVID-19 as we observed in the present study.

Preliminary findings on the experiences of care for parents who suffered perinatal bereavement during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic poses an unprecedented risk to the global population. Maternity care in the UK was subject to many iterations of guidance on how best to reconfigure services to keep women, their families and babies, and healthcare professionals safe. Parents who experience a pregnancy loss or perinatal death require particular care and support. PUDDLES is an international collaboration investigating the experiences of recently bereaved parents who suffered a late miscarriage, stillbirth, or neonatal death during the global COVID-19 pandemic, in seven countries. In this study, we aim to present early findings from qualitative work undertaken with recently bereaved parents in the United Kingdom about how access to healthcare and support services was negotiated during the pandemic.

METHODS

In-depth semi-structured interviews were undertaken with parents (N = 24) who had suffered a late miscarriage (n = 5; all mothers), stillbirth (n = 16; 13 mothers, 1 father, 1 joint interview involving both parents), or neonatal death (n = 3; all mothers). Data were analysed using a template analysis with the aim of investigating bereaved parents' access to services, care, and networks of support, during the pandemic after their bereavement.

RESULTS

All parents had experience of utilising reconfigured maternity and/or neonatal, and bereavement care services during the pandemic. The themes utilised in the template analysis were: 1) The Shock & Confusion Associated with Necessary Restrictions to Daily Life; 2) Fragmented Care and Far Away Families; 3) Keeping Safe by Staying Away; and 4) Impersonal Care and Support Through a Screen. Results suggest access to maternity, neonatal, and bereavement care services were all significantly reduced, and parents' experiences were notably affected by service reconfigurations.

CONCLUSIONS

Our findings, whilst preliminary, are important to document now, to help inform care and service provision as the pandemic continues and to provide learning for ongoing and future health system shocks. We draw conclusions on how to enable development of safe and appropriate services during this pandemic and any future health crises, to best support parents who experience a pregnancy loss or whose babies die.

Postpartum women's experiences of social and healthcare professional support during the COVID-19 pandemic: A recurrent cross-sectional thematic analysis

Problem

Disrupted access to social and healthcare professional support during the COVID-19 pandemic have had an adverse effect on maternal mental health.

Background

Motherhood is a key life transition which increases vulnerability to experience negative affect.

Aim

Explore UK women’s postnatal experiences of social and healthcare professional support during the COVID-19 pandemic.

Methods

Semi-structured interviews were conducted with 12 women, approximately 30 days after initial social distancing guidelines were imposed (T1), and a separate 12 women were interviewed approximately 30 days after the initial easing of social distancing restrictions (T2). Recurrent cross-sectional thematic analysis was conducted in NVivo 12.

Findings

T1 themes were, ‘Motherhood has been an isolating experience’ (exacerbated loneliness due to diminished support accessibility) and ‘Everything is under lock and key’ (confusion, alienation, and anxiety regarding disrupted face-to-face healthcare checks). T2 themes were, ‘Disrupted healthcare professional support’ (feeling burdensome, abandoned, and frustrated by virtual healthcare) and ‘Easing restrictions are bittersweet’ (conflict between enhanced emotional wellbeing, and sadness regarding lost postnatal time).

Discussion

Respondents at both timepoints were adversely affected by restricted access to informal (family and friends) and formal (healthcare professional) support, which were not sufficiently bridged virtually. Additionally, the prospect of attending face-to-face appointments was anxiety-provoking and perceived as being contradictory to social distancing guidance. Prohibition of family from maternity wards was also salient and distressing for T2, but not T1 respondents.

Conclusion

Healthcare professionals should encourage maternal help-seeking and provide timely access to mental health services. Improving access to informal and formal face-to-face support are essential in protecting maternal and infant wellbeing.

Postpartum women's psychological experiences during the COVID-19 pandemic: a modified recurrent cross-sectional thematic analysis

BACKGROUND

COVID-19 has placed additional stressors on mothers during an already vulnerable lifecourse transition. Initial social distancing restrictions (Timepoint 1; T1) and initial changes to those social distancing restrictions (Timepoint 2; T2) have disrupted postpartum access to practical and emotional support. This qualitative study explores the postpartum psychological experiences of UK women during different phases of the COVID-19 pandemic and associated 'lockdowns'.

METHODS

Semi-structured interviews were conducted with 12 women, approximately 30 days after initial social distancing guidelines were imposed in the UK (22 April 2020). A separate 12 women were interviewed approximately 30 days after the initial easing of social distancing restrictions (10 June 2020). Data were transcribed verbatim, uploaded into NVivo for management and analysis, which followed a recurrent cross-sectional approach to thematic analysis.

RESULTS

Two main themes were identified for T1: 'Motherhood is Much Like Lockdown' and 'A Self-Contained Family Unit'. Each main T1 theme contained two sub-themes. Two main themes were also identified for T2: 'Incongruously Held Views of COVID-19' and 'Mothering Amidst the Pandemic'. Each main T2 theme contained three sub-themes. Comparisons between data gathered at each timepoint identified increased emotional distress over time. Current findings call for the improvement of postpartum care by improving accessibility to social support, and prioritising the re-opening of schools, and face-to-face healthcare appointments and visitation.

CONCLUSION

Social distancing restrictions associated with COVID-19 have had a cumulative, negative effect on postpartum mental health. Recommendations such as: Allowing mothers to 'bubble' with a primary support provider even at their healthcare appointments; allowing one support partner to attend all necessary healthcare appointments; and providing tailored informational resources, may help to support postpartum emotional wellbeing during this, and similar health crises in the future.