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

Pregnancy and neonatal outcomes of SARS-CoV-2 infection discovered at the time of delivery: a tertiary center experience in North Italy

OBJECTIVES

Although the knowledge on SARS-CoV-2 infection in pregnancy has greatly improved, there is still a lack of information on its role in the later stages of gestation. The aim of this study is to investigate whether SARS-CoV-2 discovered at delivery is associated with any obstetric or neonatal complications.

METHODS

A retrospective case-control study was conducted at Department of Obstetrics, University Hospital Maggiore della Carità, Novara, Italy, from March 2020 to March 2023. Pregnant women admitted were tested for SARS-CoV-2. 168 women resulted positive at the time of delivery; the women were asymptomatic or paucisymptomatic. 170 negative women were selected as controls, selecting, for each SARS-CoV-2 positive patient, the patient who gave birth right before, if negative. Demographic and anamnestic characteristics, pregnancy, labor, and neonatal outcomes were evaluated.

RESULTS

SARS-CoV-2 positive patients were more likely to have gestational diabetes (13.7 vs. 5.3 %) and required less frequently intrapartum analgesia (11.3 vs. 27 %) and labor augmentation (7.3 vs. 16.5 %). Post-partum hemorrhage rate was lower (13.7 vs. 22.9 %) and a shorter length of first and second stage of labor occurred. There were no statistically significant differences between the two groups regarding the mode of delivery and neonatal outcomes.

CONCLUSIONS

SARS-CoV-2 positive patients have shorter labor length and a lower incidence of postpartum hemorrhage. Fewer obstetric interventions, as well as less use of intrapartum analgesia and oxytocin, could explain these findings. Moreover, gestational diabetes could increase susceptibility to infection. SARS-CoV-2 infection discovered at the time of delivery in asymptomatic or paucisymptomatic patients does not appear to increase the rate of cesarean delivery or other obstetric complications, and neonatal outcomes have not worsened.

Longitudinal impact of an online interdisciplinary perinatal mental health module on Healthcare Professionals' knowledge, skills, attitudes and confidence: A qualitative evaluation

AIM/OBJECTIVE

The current study aimed to explore the following research question; 'What is the longitudinal impact, if any, of an online interdisciplinary perinatal mental health module on HCP knowledge, skills, attitudes and confidence'.

BACKGROUND

Research suggests that one in five women/people will experience a mental health issue during the perinatal period. Healthcare Professionals (HCPs) play a critical role in identifying, supporting and referring those who disclose health or psychosocial concerns in pregnancy or after birth and consistent research findings highlight the need for appropriate targeted perinatal mental health education among this cohort. To address this need, a thirteen-week (Masters Level) interdisciplinary online module in perinatal mental health was collaboratively developed between one Irish Higher Education Institution and national mental healthcare specialists. The module aims to develop HCP knowledge, skills, attitude and confidence in sustainably supporting women/people and families experiencing perinatal mental health issues. However, a recent scoping review concluded that there was insufficient evidence with respect to the longitudinal impact of such courses on HCP practice.

DESIGN/METHODS

The study design adopted a qualitative descriptive design that used online individual interviews for data collection. The evaluation was informed by the Kirkpatrick and Kirkpatrick Evaluation Model. The study group consisted of six voluntarily self-selected perinatal mental health module participants. Longitudinal impacts of the module were explored 8-10 months following module completion. Thematic Analysis was undertaken using Braun and Clarkes Framework. Ethical approval for the study was obtained from the author's Higher Education Institution (HEI).

RESULTS

Findings revealed several interrelated and reinforcing themes that had an impact on the longer-term application of enhanced knowledge, skills, attitude and confidence in practice. These were; pedagogical features of the interdisciplinary perinatal mental health education module, sociocultural and professional influences, persistent enthusiasm and commitment to improve care in spite of systemic obstacles and, ongoing need for perinatal mental health education.

CONCLUSIONS

Provision of targeted, agile and manageable professional education courses on perinatal mental health care will continue to be required. However, despite sustained commitment and enthusiasm to implement enhanced knowledge and skills, systemic obstacles continue to exist and these may have an impact on the efficacy of such courses in the longer term.

A Qualitative Investigation of the Experiences of Women with Perinatal Depression and Anxiety during the COVID-19 Pandemic

OBJECTIVES

The COVID-19 pandemic has had significant impacts on maternal mental health. We explored the lived experiences of women with perinatal depression and anxiety to elucidate their perceptions of how the pandemic influenced their mental health and access to care.

METHODS

We conducted a qualitative descriptive study using semi-structured interviews. From March to October 2021, purposive sampling was used to recruit a socio-demographically diverse sample of women with self-reported perinatal depression or anxiety who were pregnant or within one year postpartum between March 2020 and October 2021. Interviews were conducted remotely and thematically analyzed.

RESULTS

Fourteen women were interviewed. Three major themes arose. Theme 1, Negative impacts of COVID-19 on symptoms of depression and anxiety, described how the pandemic magnified underlying symptoms of depression and anxiety, increased social isolation, generated anxiety due to fears of COVID-19 infection, and caused economic stress. In theme 2, Negative impacts of COVID-19 on access to and quality of health care, women described stressful and isolating delivery experiences, negative psychological impact of partners not being able to participate in their perinatal health care, interruptions and barriers to mental health treatment, and challenges in using telehealth services for mental health care. Theme 3, Positive impacts of COVID-19 on mental health, identified advantages of increased telehealth access and ability to work and study from home.

CONCLUSIONS FOR PRACTICE

The COVID-19 pandemic negatively affected women with perinatal depression and anxiety by magnifying underlying symptoms, increasing stress and social isolation, and disrupting access to mental health care. Findings provide support for policies and interventions to prevent and address social isolation, as well as optimization of telehealth services to prevent and address gaps in perinatal mental health treatment.

Lesson Learned During a Pandemic: A Phenomenological Study of Pregnant Women's Experience in Resource-Limited Setting

Introduction

Pandemics like COVID-19 has strained healthcare systems globally, particularly in resource-limited settings where pre-existing healthcare gaps and constraints amplify the challenges faced by pregnant women. Having this lesson on pregnant women's experiences during COVID-19 offers invaluable insights into potential strategies and interventions needed to mitigate the impact of similar outbreaks in the future. Therefore, this phenomenological study aimed to uncover the experiences of pregnant women during the COVID-19 pandemic in Dilla town, Gedeo zone, southern Ethiopia.

Method and Materials

A descriptive phenomenological design was employed at Dilla University teaching hospital. A Purposive sampling technique was used and point of data saturation was declared at participant 16th. An in-depth interview was conducted in a private room after they received antenatal care services. The interviews were audiotaped, transcribed, and analysed using the open code software version 4.03. The interviews were transcribed verbatim to provide tick descriptions of data. Thematic analysis was employed using an inductive approach. Direct quotes from participants were included without any grammar editing to preserve their intended meaning.

Results

Our study found five predominant themes: mental health consequences of the COVID-19 pandemic, health impact of COVID-19, concerns over the economic impact of the COVID-19 pandemic, COVID-19 influence on social engagements, and challenge on getting reliable information.

Conclusion and Recommendation

This study identified that pregnant women experienced various challenges during the pandemic which includes psychological problems, health impact of COVID-19, economic problems, lack of reliable information and limited social support. Hence, implementing a customized approach by integrating psychosocial interventions with prenatal care services and conducting intensive health education sessions and economic empowerment are beneficial as mitigation strategies to better prepare for future pandemics.

Management of neonates with maternal prenatal coronavirus infection and influencing factors

The coronavirus disease 2019 (COVID-19) in pregnancy causes adverse outcomes for both the mother and the fetus. Neonates are at risk of vertical transmission and in-utero infection. Additionally, intensive care unit (ICU) admission and impairment in the organ systems of the mother are associated with neonatal outcomes, including impaired intrauterine growth, prematurity, and neonatal ICU admission. The management of neonates born from infected mothers has changed over the progress of the pandemic. At the beginning of the pandemic, cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoiding of skin-to-skin contact, breast milk, and breastfeeding were the main practices to reduce vertical and horizontal transmission risk in the era of insufficient knowledge. The effects of antenatal steroids and delayed cord clamping on COVID-19 were also not known. As the pandemic progressed, data showed that prenatal, delivery room, and postnatal care of neonates can be performed as pre-pandemic practices. Variants and vaccines that affect clinical course and outcomes have emerged during the pandemic. The severity of the disease and the timing of infection in pregnancy also influence maternal and neonatal outcomes. The knowledge and lessons from COVID-19 will be helpful for the next pandemic if it happens. IMPACT: Prenatal infection with COVID-19 is associated with adverse maternal and neonatal outcomes. Our review includes the management of neonates with prenatal COVID-19 infection exposure, maternal-fetal, delivery room, and postnatal care of neonates, clinical features, treatment of neonates, and influencing factors such as variants, vaccination, severity of maternal disease, and timing of infection during pregnancy. There is a growing body of data and evidence about the COVID-19 pandemic. The knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.

The pandemic experiences of Ontario perinatal providers: a qualitative study

BACKGROUND

The COVID-19 pandemic has produced widespread disruptions for healthcare systems across Canada. Perinatal care in Ontario, Canada was subject to province-wide public health restrictions, reallocation of hospital beds and human health resources. To better understand the impacts of the pandemic on Ontario perinatal care, this study explored the perspectives of perinatal care providers about their clinical COVID-19 pandemic experiences.

METHODS

Semi-structured key informant virtual interviews were conducted between August 2021 and January 2022 with 15 Ontario-based perinatal care providers. Recorded interviews were transcribed, and thematic content analysis used to identify major themes and subthemes.

RESULTS

Participants were mainly women, practicing in Eastern and Central Ontario as health providers (obstetricians, nurses, midwives), allied regulated health professionals (social worker, massage therapist), and perinatal support workers (doula, lactation consultant). Major themes and subthemes were identified inductively as follows: (1) Impacts of COVID-19 on providers (psychosocial stress, healthcare system barriers, healthcare system opportunities); (2) Perceived impacts of COVID-19 on pregnant people (psychosocial stress, amplification of existing healthcare barriers, influences on reproductive decision making; minor theme- social and emotional support roles); (3) Vaccine discourse (provider empathy, vaccines and patient family dynamics, minor themes- patient vaccine hesitancy, COVID-19 misinformation); and (4) Virtual pregnancy care (benefits, disadvantages, adaptation of standard care practices).

CONCLUSIONS

Perinatal care providers reported significant stress and uncertainty caused by the COVID-19 pandemic and evolving hospital protocols. Providers perceived that their patients were distressed by both the pandemic and related reductions in pregnancy healthcare services including hospital limits to support companion(s). Although virtual pregnancy care impaired patient-provider rapport, most providers believed that the workflow efficiencies and patient convenience of virtual care is beneficial to perinatal healthcare.

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.