Impact of the COVID-19 pandemic on expectant and new parents' experience of pregnancy, childbirth, breast feeding, parental responsiveness and sensitivity, and bonding and attunement in high-income countries: a systematic review of the evidence

Women's views and experiences of breastfeeding during the coronavirus disease 2019 pandemic: A systematic review of qualitative evidence

The coronavirus disease 2019 pandemic affected breastfeeding women in various ways. Understanding their experiences during the pandemic is crucial for informing actionable recommendations, evidence-based strategies and future policies to support breastfeeding during global pandemics. This review aimed to synthesise qualitative evidence on women's breastfeeding perceptions, experiences and support needs during the pandemic. The Joanna Briggs Institute's (JBI) guidelines on systematic reviews of qualitative evidence were followed. MEDLINE, Embase, CINAHL and Web of Science Core Collection databases were searched. Methodological quality of included papers was assessed using JBI's checklist for qualitative research. The synthesised findings were generated using JBI's meta-aggregation approach. The JBI ConQual process was used to rank each synthesised finding. Fifty-two papers were included. The synthesised findings included: (1) women's awareness and commitment to breastfeeding during the pandemic, (2) the multifaceted breastfeeding experiences of women during the pandemic, (3) breastfeeding practices and challenges for working women, (4) professional support during the pandemic: navigating breastfeeding in an evolving health care context and (5) family and peer support groups during the challenging times of the pandemic. Breastfeeding women require clear information, accessible in-person lactation support, family emotional support, food security and protection of psychological well-being. The review reported diverse breastfeeding experiences, from social support challenges to positive aspects like remote work. Breastfeeding support and lactation consultants should be considered as essential services in future pandemics. Food security is crucial for breastfeeding households. Lactation services could prioritise face-to-face consultations for physical challenges and providing online informational support. Future research could explore innovative breastfeeding education strategies.

Does parental mental health mediate the association between parents' perceived stress and parent-infant bonding during the early COVID-19 pandemic?

BACKGROUND

The spread of the COVID-19 virus was declared a pandemic in March 2020. New restrictions such as 'lockdowns' and 'social distancing' created challenges for individuals' work-life balance, financial situation, family life, and physical and mental health. The global population's stress levels rose in response to these changes, leading to a widespread deterioration of mental health. One group particularly affected was parents of infants and very young children. Poor parental mental health may disrupt parent-infant bonding, with negative consequences for infant well-being and development.

AIMS

To consider parent-infant bonding in relation to parents' perceived stress and psychological distress during the first lockdown, and to examine whether associations of stress with parent-infant bonding were mediated by parental mental health.

METHODS

DREAMCORONA (n = 738: 471 mothers and 267 partners) is a sub-study of the prospective German cohort study 'DREAM'. The SPSS modelling tool PROCESS was used to assess whether parental mental health mediated the relationship between parents' perceived stress response to the COVID-19 pandemic and parent-infant bonding, while controlling for covariates.

RESULTS

Higher levels of parental stress were strongly associated with higher levels of depression, anxiety, and aggression symptoms for both parents. In addition, there was a significant relationship between parents' self-reported stress levels and parent-infant bonding. This relationship was mediated by symptoms of depression and anxiety for fathers and by symptoms of anger-hostility for both parents.

CONCLUSION

Increased parental stress during the early pandemic was associated with poorer parent-infant bonding. This has important implications for the management of any future public health crises.

Perinatal care in SARS-CoV-2 infected women: the lesson learnt from a national prospective cohort study during the pandemic in Italy

BACKGROUND

Despite the growing importance given to ensuring high-quality childbirth, perinatal good practices have been rapidly disrupted by SARS-CoV-2 pandemic. This study aimed at describing the childbirth care provided to infected women during two years of COVID-19 emergency in Italy.

METHODS

A prospective cohort study enrolling all women who gave birth with a confirmed SARS-CoV-2 infection within 7 days from hospital admission in the 218 maternity units active in Italy during the periods February 25, 2020-June 30, 2021, and January 1-May 31, 2022. Perinatal care was assessed by evaluating the prevalence of the following indicators during the pandemic: presence of a labour companion; skin-to-skin; no mother-child separation at birth; rooming-in; breastfeeding. Logistic regression models including women' socio-demographic, obstetric and medical characteristics, were used to assess the association between the adherence to perinatal practices and different pandemic phases.

RESULTS

During the study period, 5,360 SARS-CoV-2 positive women were enrolled. Overall, among those who had a vaginal delivery (n = 3,574; 66.8%), 37.5% had a labour companion, 70.5% of newborns were not separated from their mothers at birth, 88.1% were roomed-in, and 88.0% breastfed. These four indicators showed similar variations in the study period with a negative peak between September 2020 and January 2021 and a gradual increase during the Alpha and Omicron waves. Skin-to-skin (mean value 66.2%) had its lowest level at the beginning of the pandemic and gradually increased throughout the study period. Among women who had a caesarean section (n = 1,777; 33.2%), all the indicators showed notably worse outcomes with similar variations in the study period. Multiple logistic regression analyses confirm the observed variations during the pandemic and show a lower adherence to good practices in southern regions and in maternity units with a higher annual number of births.

CONCLUSIONS

Despite the rising trend in the studied indicators, we observed concerning substandard childbirth care during the SARS-CoV-2 pandemic. Continued efforts are necessary to underscore the significance of the experience of care as a vital component in enhancing the quality of family-centred care policies.