Improving pregnancy care during the COVID-19 pandemic

Routine health services suffered severe setbacks in most parts of the world with the onset of the coronavirus disease 2019 (COVID-19) pandemic. This is largely due to measures put in place in healthcare facilities to prevent the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of the pandemic.

Study: Personalizing Maternity and Newborn Care During the COVID-19 Pandemic: Findings from the Babies Born Better Survey in the UK and the Netherlands. Image Credit: M.M. Vieira/Shutterstock

A new preprint published on the medRxiv* server shows how this situation could be avoided in maternal and neonatal care after childbirth.

Introduction

The physical and emotional impact of pregnancy is enormous for the typical woman and her family. In fact, the experiences of this period often continue to affect their lives long after.

During the COVID-19 pandemic, non-pharmaceutical interventions such as social distancing, restrictions on the number of people allowed into doctor’s offices at one time, visitation restrictions, and limits on the attendance of doulas, partners and others during childbirth itself, are some of the sudden changes that have dramatically affected the lives of women during pregnancy and after childbirth.

Previous studies in several countries have shown that many women have reported increased apprehension and sadness due to the absence of their preferred birthing companions, fear that the infection will be transmitted to their babies during childbirth and having to forego the option of water birth, in some cases, due to the perceived risk of viral transmission.

Of course, other reports show no difference in the level of satisfaction felt before and during the pandemic when it comes to giving birth.

The current preprint describes both the type of perceptions women had of their pandemic pregnancies and childbirth experiences, compared to pre-pandemic studies, as well as the reasons for those perceptions. The raw data comes from the responses to the international survey Babies Born Better version 3 (survey B3). This was analyzed as part of the ASPIRE-COVID-19 study.

Results

There were over 2,200 surveys in the analysis, of which around 60% were from the UK and the rest from the Netherlands. Around a third of these were from women who had given birth during the pandemic, namely around 40% of those in the UK and a quarter of those in the Netherlands. The median age was in the early thirties for both cohorts.

When childbirth experiences were examined, more women in the Netherlands reported having given birth vaginally regardless of period. In the UK, more women gave birth in hospital during the pandemic than before the pandemic. Overall, around 45% of women in the Dutch cohort gave birth at home, but less than a fifth for the UK cohort.

Interestingly, two out of three women in the Dutch cohort were very satisfied with their childbirth experience, compared to half of the UK cohort, regardless of time period. In the first case, women with a higher standard of living were more likely to have a better birth experience, but not in the second.

Reasons for dissatisfaction with the birthing experience could be summarized in two themes: either the woman felt unsupported or she felt deprived of her freedom to choose the circumstances surrounding the birth.

In addition, women who did not expect as good care as before due to the pandemic situation were often pleasantly surprised, while the efforts made by medical and support staff to provide the appropriate care to each patient mitigated the negative effects of other restrictions in forcing.

These factors have proven to be a more influential theme during the pandemic than before.

The lack of support was due to insufficient staffing, quarantine or illness, enforcement of social distancing, or both. Preferred partners were also often barred from being present at the birth or visiting each other afterwards due to COVID-19 restrictions, which caused significant stress for the new mother.

The closure of some home birth services in the UK during the pandemic has restricted the freedom of some, but by no means all, women during childbirth, which was not a factor in the Dutch cohort . The availability of home birth was related to their positive assessment of the childbirth experience among the latter.

On the other hand, some rule bends by caregivers were seen positively by patients as an effort to improve the quality of their care and were reported to have made the experience enjoyable. This was also the case when women apparently expected a lower level of care than would be normal before the pandemic, and therefore valued even the basic care they eventually received.

Consequences

This study used data from two different countries spanning two time periods to assess the standard of care during pregnancy and postpartum during COVID-19, in terms of patient experience. The results show that the familiarity, empathy and competence of health care providers were highly valued by patients during this difficult period of childbirth.

The Dutch cohort was mostly complimentary about their experiences compared to the UK cohort, with standard of living and place of birth playing a major role in shaping these perceptions. Interestingly, this was unrelated to the pandemic. In fact, women in the Netherlands who had a better standard of living seemed even more positive about their birthing experiences during the pandemic than before, even though they had less support, less freedom to choose the setting. and less control over their birthing process. than before.

This appears to be because many women did not expect care to reach pre-pandemic levels and therefore appreciated it. Second, they admired the efforts made by healthcare providers to compensate for the difficulties faced by their patients due to COVID-19 restrictions or other rules, to the point of being more flexible than expected for the benefit of their patients.

The findings of this study support similar findings from other studies that highlight the importance of giving working women more control and support during childbirth. Additionally, the results show that when healthcare staff went the extra mile for their patients, the overall experience belied the negativity of the pandemic situation and restrictions.

The researchers also noted that,

There is growing evidence of moral distress and compassion fatigue among staff trying to maintain services by constantly having to go “beyond” their working hours, or by the stress of breaching rules he deems harmful to women, pregnant women and families.”

This “unsustainable“Spending must be stopped by putting in place more realistic and humane rules.

Moreover, the association of positive childbirth experiences with a higher standard of living indicates a fundamental inequality of services, especially in times of crisis. Whether this is because women with higher socioeconomic status are better equipped to ask for and get what they need at these times, or because they are less stressed, overall remains to be determined. However, according to the authors,

personalization should continue to be an important part of overall maternity care policy, including guidelines and staffing resources, to enable staff to equitably benefit all service users.”

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behaviors, or treated as established information.

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