Born in Captivity: The Experiences of Puerto Rican Birth Workers and Their Clients in Quarantine

Mistreatment, Abuse, and Gender-Based Violence During Childbirth: A Longitudinal Analysis of Obstetric Violence in México (2011-2021)

This longitudinal retrospective study of mistreatment, abuse, and gender-based violence during childbirth uses two population representative samples of Mexican women to analyze the incidence of obstetric violence in Mexico from 2011 to 2021. Our assessment is that there are more continuities than changes in the phenomenon and our study does not find evidence to support the claims of increases in obstetric violence during the 2020-2021 COVID-19 pandemic. Conceptually it differentiates between acts of violence, disrespect, and abuse, based on socially constructed gender differences (gender-based violence), and those more generally related to medical authoritarianism and the biomedical model that confers medical professionals a more powerful and higher status relative to that of their patients.

Midwives' adaptation of their practice, role, and scope to ensure access to sexual and reproductive services during humanitarian crises: A scoping review

PROBLEM

Limited research has examined and synthesized the adaptation of midwives and midwife-led interventions during crises.

BACKGROUND

Evidence suggests that midwives are essential to respond to sexual and reproductive health care needs during disruptive times, and that they adapt to continue to provide their services during those circumstances.

AIM

To map the adaptations of midwives when providing care during crises globally. Secondary objectives include identifying which midwives adapted, what services were adapted and how, and the demographic receiving care.

STUDY METHODS

Scoping review using Levac's modifications of Arksey and O'Malley's methods. Publications and grey literature, in English and Spanish, with no limitations based on study design or date were included. Data was extracted and mapped using Wheaton and Maciver's Adaptation framework.

FINDINGS

We identified 3329 records, of which forty-two were included. Midwives' prior training impacted adaptation. Midwives adapted to the COVID-19 pandemic, epidemics, natural disasters, and World War II. They adapted in hospital and community settings around the provision of antenatal, labor and birth, postpartum, and contraceptive care. However, no specific data identified population demographics. Midwifery adaptations related to their practice, role, and scope of practice.

CONCLUSION

The limited available evidence identified the challenges, creativity, and mutual aid activities midwives have undertaken to ensure the provision of their services. Evidence is highly concentrated around maternal health services. Further high-quality research is needed to provide a deeper understanding of how midwifery-led care can adapt to guide sustainable responses to ensure access to sexual and reproductive health services during crises.

Explaining Iranian midwives' experiences of providing healthcare services during the COVID-19 pandemic: a qualitative study

BACKGROUND

COVID-19 has changed and challenged the way health and maternity care is provided. Midwives are among the first and most influential maternity care providers during the COVID-19 pandemic; however, there is inadequate information about their experiences in providing healthcare services, particularly in Iran. The present study was conducted to explain the midwives' experiences of providing healthcare services during the COVID-19 pandemic in Gorgan.

METHODS

The present study was conducted qualitatively through the inductive content analysis method in 2022. Data were collected through semi-structured interviews. A total of 21 individuals were selected as participants using a purposeful method and the maximum diversity strategy.

RESULTS

Data analysis led to the emergence of 377 codes, 12 subcategories, and 3 main categories, including, the laborious occupational challenges for midwives during the pandemic, identifying and creating new opportunities for the development of the midwifery profession, and the lack of perceived organizational and social support.

CONCLUSIONS

During the COVID-19 pandemic, midwives experienced various challenges in providing healthcare services, yet sacrificed themselves to perform their duties and provide quality care incessantly. The COVID-19 pandemic was a combination of laborious occupational challenges and individual and professional growth opportunities for midwives in Iran. Strong and managed organizational support is essential to overcome the crisis, maintain the workforce, and empower them to deal with future crises.

The role of doulas in providing breastfeeding support during the COVID-19 pandemic

BACKGROUND

Doulas have been instrumental in providing breastfeeding support to nursing mothers before and during the COVID-19 pandemic, as they can significantly impact a mother's ability to initiate and maintain breastfeeding. However, the COVID-19 pandemic, subsequent lockdowns, and social isolation created challenges for nursing mothers to access doulas' services, usually provided in person. In this study, we examined the role of doulas in providing breastfeeding support during the COVID-19 pandemic, exploring adaptation to COVID-19 guidelines and the challenges doulas face in providing breastfeeding support during the pandemic.

METHODS

A systematic review was conducted following the PRISMA guidelines. Thirteen scientific databases and twenty peer-reviewed journals were searched for journal articles published in English between January 2020 and March 2022 using key search terms (e.g., Doula, Breastfeeding, COVID-19). Studies evaluating the role of doulas in providing breastfeeding support during COVID-19, and the impact of COVID-19 Guidelines on doula services, were included. Two reviewers independently performed the risk of bias assessment and data extraction. Summative content analysis was used to analyze the data.

RESULTS

The majority of studies were conducted in developed nations. This systematic review includes eight articles, four qualitative, one survey, two mixed-methods studies, and one prospective research study. Seven of the eight studies were conducted in the United States, and the eighth was conducted in multiple countries. These studies have three main themes: (1) virtual breastfeeding support provided by doulas during the pandemic; (2) remote social support provided by doulas to breastfeeding mothers during the pandemic; and (3) barriers to doula service delivery due to COVID-19 restrictions, primarily the exclusion of doulas as essential workers. The eight studies showed that doulas found innovative ways to serve the needs of birthing and nursing mothers during the difficulties brought on by the pandemic.

CONCLUSION

Doulas provided breastfeeding support during the COVID-19 pandemic by utilizing innovative service delivery methods while navigating changes in COVID-19 guidance. However, system-level integration of doulas' work and the acknowledgment of doulas as essential healthcare providers are needed to enhance doula service delivery capacity, especially during a pandemic, to help improve maternal health outcomes.

"Doulas shouldn't be considered visitors, we should be considered a part of [the] team": doula care in Georgia, USA during the COVID-19 pandemic

Doula support improves maternal-child health outcomes. However, during the COVID-19 pandemic, hospitals restricted the number of support people allowed during childbirth. An academic-community research team conducted 17 in-depth interviews and structured surveys with doulas in metro-Atlanta, Georgia, USA from November 2020 to January 2021. Surveys were analysed for descriptive statistics in Stata v. 14, and interviews were analysed in Dedoose using a codebook and memo-ing for thematic analysis. All 17 doulas reported COVID-19 changed their practices: most were unable to accompany clients to delivery (14), started using personal protective equipment (13), used virtual services (12), and had to limit the number of in-person prenatal/postpartum visits (11). Several attended more home births (6) because birthing people were afraid to have their babies in the hospital. Some stopped seeing clients altogether due to safety concerns (2). Many lost clientele who could no longer afford doula services, and some offered pro bono services. Most doulas pointed to restrictive hospital policies that excluded doulas and disallowed virtual support as they felt doulas should be considered a part of the team and clients should not be forced to decide between having their doula or their partner in the room. COVID-19 has severely impacted access to and provision of doula care, mostly due to economic hardship for clients and restrictive hospital policies. At the same time, doulas and their clients have been resourceful - using virtual technology, innovative payment models, and home births.

Maternity care during COVID-19: a qualitative evidence synthesis of women's and maternity care providers' views and experiences

Background

As COVID-19 continued to impact society and health, maternity care, as with many other healthcare sectors across the globe, experienced tumultuous changes. These changes have the potential to considerably impact on the experience of maternity care. To gain insight and understanding of the experience of maternity care during COVID-19, from the perspectives of women and maternity care providers, we undertook a qualitative evidence synthesis (QES).

Methods

The population of interest for the QES were pregnant and postpartum women, and maternity care providers, who provided qualitative data on their experiences of maternity care during COVID-19. The electronic databases of MEDLINE, CINAHL, EMBASE, PsycINFO and the Cochrane COVID study register were systematically searched from 01 Jan 2020 to 13 June 2021. The methodological quality of the included studies was appraised using a modified version of the quality assessment tool, based on 12-criteria, designed by the Evidence for Policy and Practice Information coordinating Centre (EPPI-Centre). Data were extracted by two reviewers independently and synthesised using the Thomas and Harden framework. Confidence in the findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual).

Results

Fifty records relating to 48 studies, involving 9,348 women and 2,538 maternity care providers, were included in the QES. The methodological quality of the studies varied from four studies meeting all 12 quality criteria to two studies meeting one quality criterion only. The synthesis revealed eight prominent themes. Five of these reflected women’s experiences: 1) Altered maternity care (women), 2) COVID-related restrictions, 3) Infection prevention and risk, 4) ‘the lived reality’ – navigating support systems, and 5) Interactions with maternity services. Three themes reflected maternity care providers’ experiences: 6) Altered maternity care (providers), 7) Professional and personal impact, and 8) Broader structural impact. Confidence in the findings was high or moderate.

Conclusion

Although some positive experiences were identified, overall, this QES reveals that maternity care during COVID-19 was negatively experienced by both women and maternity care providers. The pandemic and associated changes evoked an array of emotive states for both populations, many of which have the potential to impact on future health and wellbeing. Resource and care planning to mitigate medium- and longer-term adverse sequelae are required.

PROSPERO registration

CRD42021232684.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04724-w.