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Jackson C, Brawner J, Ball M, Crossley K, Dickerson J, Dharni N, Rodriguez DG, Turner E, Sheard L, Smith H. 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. BMC Pregnancy Childbirth 2023; 23:494. [PMID: 37403018 PMCID: PMC10320984 DOI: 10.1186/s12884-023-05774-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/10/2023] [Indexed: 07/06/2023] Open
Abstract
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.
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Affiliation(s)
- Cath Jackson
- Valid Research Ltd, Sandown House, Sandbeck Way, Wetherby, LS22 7DN, UK.
| | | | - Matthew Ball
- Justice Studio, 10 Portfleet Place, De Beauvoir Road, London, N1 5SZ, UK
| | - Kirsty Crossley
- Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Josie Dickerson
- Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Nimarta Dharni
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | | | - Ella Turner
- Justice Studio, 10 Portfleet Place, De Beauvoir Road, London, N1 5SZ, UK
| | - Laura Sheard
- York Trials Unit, Department of Health Sciences, University of York, Heslington, YO10 5DD, York, UK
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Implementation of Public Health England Infection Prevention and Control Guidance in Maternity Units in response to the COVID-19 pandemic. J Hosp Infect 2022; 129:219-226. [PMID: 35588996 PMCID: PMC9109966 DOI: 10.1016/j.jhin.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/20/2022]
Abstract
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.
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Macdonald D, Snelgrove-Clarke E, Ross-White A, Bigelow-Talbert K. Experiences of birthing care during COVID-19: a systematic review protocol. JBI Evid Synth 2022; 20:1353-1360. [PMID: 35184100 DOI: 10.11124/jbies-21-00300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to explore and understand the birthing care experiences of midwives, nurses, women, and birthing people during COVID-19. INTRODUCTION The COVID-19 pandemic has had implications for providing and receiving birthing care globally. In addition to navigating fears of contracting COVID-19, health care providers and families have had to adapt to changing policies and clinical practices in response to varying recommendations and evidence. These changes, including restrictive visitor policies and mandated mask-wearing, influenced the experience of birthing care. Synthesizing qualitative evidence about the birthing experiences of midwives, nurses, women, and birthing people (people who give birth but who do not identify as women) during COVID-19 can provide important information for policies and decision-making for future global pandemics. INCLUSION CRITERIA Studies including licensed midwives, licensed nurses, women, and birthing people who provided or received birthing care during the COVID-19 pandemic will be considered. Studies published from January 2020 onward will be included. The review will consider all studies that present qualitative data, including, but not limited to, research designs such as phenomenology, ethnography, grounded theory, feminist research, and action research. METHODS The following databases will be searched: MEDLINE, Embase, CINAHL, PsycINFO, and LitCovid. MedArchiv, PsyArXiv, and Google Scholar will be searched for gray literature. Studies will be assessed independently by two reviewers. Any disagreements will be resolved through discussion or with a third reviewer. Data extraction will be completed by two reviewers. The JBI tools and resources will be used for meta-aggregation, including the creation of categories and synthesized findings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021292832.
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Affiliation(s)
- Danielle Macdonald
- School of Nursing, Queen's University, Kingston, ON, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, ON, Canada
| | - Erna Snelgrove-Clarke
- School of Nursing, Queen's University, Kingston, ON, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, ON, Canada
| | - Amanda Ross-White
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, ON, Canada
- Queen's University Libraries, Queen's University, Kingston, ON, Canada
| | - Kristen Bigelow-Talbert
- School of Nursing, Queen's University, Kingston, ON, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, ON, Canada
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Aydin E, Glasgow KA, Weiss SM, Khan Z, Austin T, Johnson MH, Barlow J, Lloyd-Fox S. Giving birth in a pandemic: women's birth experiences in England during COVID-19. BMC Pregnancy Childbirth 2022; 22:304. [PMID: 35399066 PMCID: PMC8994823 DOI: 10.1186/s12884-022-04637-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/17/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Expectant parents worldwide have experienced changes in the way they give birth as a result of COVID-19, including restrictions relating to access to birthing units and the presence of birthing partners during the birth, and changes to birth plans. This paper reports the experiences of women in England. METHODS Data were obtained from both closed- and open-ended responses collected as part of the national COVID in Context of Pregnancy, Infancy and Parenting (CoCoPIP) Study online survey (n = 477 families) between 15th July 2020 - 29th March 2021. Frequency data are presented alongside the results of a sentiment analysis; the open-ended data was analysed thematically. RESULTS Two-thirds of expectant women reported giving birth via spontaneous vaginal delivery (SVD) (66.1%) and a third via caesarean section (CS) (32.6%) or 'other' (1.3%). Just under half (49.7%) of the CS were reported to have been elective/planned, with 47.7% being emergencies. A third (37.4%) of participants reported having no changes to their birth (as set out in their birthing plan), with a further 25% reporting COVID-related changes, and 37.4% reporting non-COVID related changes (e.g., changes as a result of birthing complications). One quarter of the sample reported COVID-related changes to their birth plan, including limited birthing options and reduced feelings of control; difficulties accessing pain-relief and assistance, and feelings of distress and anxiety. Under half of the respondents reported not knowing whether there could be someone present at the birth (44.8%), with 2.3% of respondents reporting no birthing partner being present due to COVID-related restrictions. Parental experiences of communication and advice provided by the hospital prior to delivery were mixed, with significant stress and anxiety being reported in relation to both the fluctuating guidance and lack of certainty regarding the presence of birthing partners at the birth. The sentiment analysis revealed that participant experiences of giving birth during the pandemic were predominately negative (46.9%) particularly in relation to the first national lockdown, with a smaller proportion of positive (33.2%) and neutral responses (19.9%). CONCLUSION The proportion of parents reporting birthing interventions (i.e., emergency CS) was higher than previously reported, as were uncertainties related to the birth, and poor communication, leading to increased feelings of anxiety and high levels of negative emotions. The implications of these findings are discussed.
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Affiliation(s)
- Ezra Aydin
- Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK.
- Department of Psychiatry, Columbia University, New York City, USA.
| | - Kevin A Glasgow
- Department of Education, University of Cambridge, Cambridge, UK
| | - Staci M Weiss
- Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
| | - Zahra Khan
- Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
| | - Topun Austin
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Mark H Johnson
- Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Jane Barlow
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Sarah Lloyd-Fox
- Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
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Eri TS, Blix E, Downe S, Vedeler C, Nilsen ABV. Giving birth and becoming a parent during the COVID-19 pandemic: a qualitative analysis of 806 women's responses to three open-ended questions in an online survey. Midwifery 2022; 109:103321. [PMID: 35349790 PMCID: PMC8935971 DOI: 10.1016/j.midw.2022.103321] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 03/03/2022] [Accepted: 03/20/2022] [Indexed: 11/27/2022]
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Linden K, Domgren N, Zaigham M, Sengpiel V, Andersson ME, Wessberg A. Being in the shadow of the unknown - Swedish women's lived experiences of pregnancy during the COVID-19 pandemic, a phenomenological study. Women Birth 2021; 35:440-446. [PMID: 34602340 PMCID: PMC9364685 DOI: 10.1016/j.wombi.2021.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
Background The COVID-19 pandemic has had a profound effect on the emotional well-being of expecting mothers. Sweden’s unique strategy for managing COVID-19 involved no national lockdown. Emphasis was instead placed on limiting crowding and asking citizens to practice social distancing measures. Aim To gain a deeper understanding of how women not infected by SARS-CoV-2 experienced pregnancy during the COVID-19 pandemic in Sweden. Methods This was a qualitative study with a reflective lifeworld approach. Fourteen women that had not contracted COVID-19 and who were pregnant during the first and second wave of the pandemic were interviewed. Data were analysed with a phenomenological reflective lifeworld approach. Findings The essence of the women’s experiences of being pregnant during the COVID-19 pandemic was best described as being in the shadow of the unknown, where the COVID-19 pandemic could at times totally overshadow the experience of being pregnant, while at other times, rays of sunlight pierced through the clouds. The experience was characterised by having to deal with the uncertainties caused by the pandemic and feelings of being in an information echo. Women felt socially isolated and had to face maternal check-ups without the support of their partners. There was, however, a strong trust in maternal health-care services despite the lack of information available. Conclusion Being in the shadow of the unknown represents the uncertainties posed by the COVID-19 pandemic on the experience of pregnancy. Sufficient information, a companion of choice and screening for emotional well-being are important factors in maternity care during pandemics.
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Affiliation(s)
- Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Nimmi Domgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mehreen Zaigham
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Sweden; Skåne University Hospital, Lund, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria E Andersson
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Sweden; Skåne University Hospital, Lund, Sweden
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Morniroli D, Consales A, Colombo L, Bezze EN, Zanotta L, Plevani L, Fumagalli M, Mosca F, Giannì ML. Exploring the Impact of Restricted Partners' Visiting Policies on Non-Infected Mothers' Mental Health and Breastfeeding Rates during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126347. [PMID: 34208247 PMCID: PMC8296174 DOI: 10.3390/ijerph18126347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
Changes in perinatal care occurring during the coronavirus disease 2019 (COVID-19) pandemic may negatively affect mothers' mental health and breastfeeding. This study, performed between April and May 2020, aimed to investigate the effect of restricted partners' visiting policies on non-infected mother's anxiety symptoms, the perceived postpartum support, and the breastfeeding outcomes at discharge. A cross-sectional study was conducted in a neonatal tertiary referral center in northern Italy during Italy's lockdown. We enrolled mothers with a negative nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), adequate oral and written comprehension of the Italian language, and absence of underlying maternal or neonatal clinical conditions. Maternal anxiety levels were assessed through the State-Trait Anxiety Inventory-Form Y (STAI-Y). Maternal perception of staff's support was evaluated by the Nurse Parent Support Tool (NPST). A STATE-A (concurrent emotional state after a specific situation) score ≥ 40 was considered indicative of clinically significant symptoms of anxiety. A total of 109 mothers completed the study. Mean STATE-A score was ≥40 in 42% of mothers, and median NPST score was 4.23. Mothers separated from their partner had a mean STATE-A score ≥ 40 in a higher percentage of cases than those who were not (51% vs. 30%, p = 0.03) and a lower perception of caregiver support. A NPST score ≤4.23, partner 's absence during the hospital stay and primiparity were independently associated with a STATE-A score ≥ 40. Breastfeeding rates at discharge were not influenced by maternal anxiety levels and partner's restricted policies. Instead, they were influenced by mode of delivery, a well-known risk factor, and pre-pandemic intention to breastfeed. Our study demonstrates the positive impact of a partner's presence on maternal mental health and perception of caregiver support.
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Affiliation(s)
- Daniela Morniroli
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
| | - Alessandra Consales
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-025503-2907
| | - Lorenzo Colombo
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
| | - Elena Nicoletta Bezze
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
| | - Lidia Zanotta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
| | - Laura Plevani
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
| | - Monica Fumagalli
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Maria Lorella Giannì
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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