Routine health care suffered severe setbacks in most parts of the world with the onset of the coronavirus disease 2019 (COVID-19) pandemic. This was mainly due to the measures taken in health facilities to prevent transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of the pandemic.
A new pre-print sent to medRxiv* server shows how this situation could be avoided in maternity and neonatal care after childbirth.
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 admitted to medical offices at one time, visitation restrictions and restrictions on the presence of doulas, partners and others during the birth itself were some of the the sudden changes that markedly affected women’s lives during pregnancy and after childbirth.
Previous studies from several countries showed that many women reported increased fear and sadness due to the lack of their preferred birth companions, the fear that the infection would be transmitted to their babies during childbirth, and having to give up the possibility of water birth, in some cases on due to the perceived risk of virus transmission.
Of course, other reports show no difference in the level of satisfaction experienced before and during the pandemic when it came to childbirth.
The current pre-print describes both the kinds of perceptions women had about their pandemic pregnancies and birth experiences, compared to pre-pandemic studies, as well as the reasons for such perceptions. The raw data came from the responses to the international Babies Born Better survey version 3 (B3 survey). This was analyzed as part of the ASPIRE-COVID-19 study.
There were over 2,200 studies in the analysis, with around 60% being from the UK and the rest from the Netherlands. About a third of these came from women who had given birth during the pandemic, namely about 40% of them from the UK and a quarter of them from the Netherlands. The median age was in the early thirties for both cohorts.
When birth experiences were examined, several women in the Netherlands reported a vaginal birth regardless of the time period. In the UK, more women had a birth in the hospital during the pandemic than pre-pandemics. Overall, about 45% of the women in the Dutch cohort gave birth at home, but this was less than a fifth for the British cohort.
Interestingly, two out of three women in the Dutch cohort were very satisfied with their birth experience compared to half of the British cohort regardless of the time period. In the former, women with a higher standard of living were more likely to have a better birth experience, but not in the latter.
The reasons for the dissatisfaction with the birth experience could be summarized in two themes: Either the woman felt unsupported or 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 of the medical and support staff to provide the care that was appropriate for each patient helped to mitigate the negative effects of other restrictions in force.
These factors proved to be a more influential theme during the pandemic than before it.
The lack of support was due to the insufficient number of employees, due to quarantine or illness, due to the enforcement of social distancing or both. Preferred partners were also often barred from being present at birth or visiting subsequently due to COVID-19 restrictions, causing significant stress on the new mother.
The closure of some home birth services in the UK during the pandemic limited the freedom of some, but by no means all, women during childbirth, while this was not a factor in the Dutch cohort. The availability of home births was related to their positive evaluation of the birth experience in the latter.
On the other hand, some bending of the rules by the treating staff was seen positively by the patients as an attempt to improve the quality of their care and was reported to have made the experience good. This was also the case when women apparently expected a lower standard of care than there would be normal pre-pandemic, thus appreciating even the basic care they eventually received.
This study used data from two different countries covering two time periods to evaluate the standard of pregnancy and postpartum care during COVID-19 in relation to the patient experience. The results show that knowledge, empathy and competence on the part of the healthcare staff was highly valued by the patients during this challenging period while they were going through the birth.
The Dutch cohort was mostly complimentary about their experiences compared to the British cohort, where the standard of living and the birth environment played a major role in shaping these perceptions. Interestingly, this was not related to the pandemic. In fact, women in the Netherlands, who had a better standard of living, seemed even more positive about their birth experiences during the pandemic than before it, even though they had less support, less freedom of choice, and less control over their birth process. than before.
The reasons for this seem to be that many women did not expect the care to reach the pre-pandemic levels and were therefore grateful when it did. Second, they admired the efforts made by healthcare providers to compensate for the difficulties their patients face due to COVID-19 restrictions or other rules, to the extent that they are more flexible than expected for the benefit of their patients.
The results of this study confirm similar results from other studies that emphasize the importance of giving pregnant women more control and support during childbirth. In addition, the results show that when healthcare professionals went the extra mile for their patients, the overall experience counteracted the negativity of the pandemic situation and restrictions.
The researchers also noted that
There are growing signs of moral distress and fatigue with compassion among staff trying to maintain services by constantly having to go “beyond” their shift hours, or from the stress of breaking rules that they feel are harmful to women, women giving birth and families. ”
This “unsustainable“Spending must be stopped by putting more realistic and humane rules into play.
Furthermore, the correlation between positive birth experiences with a higher standard of living points to a fundamental inequality in benefits, especially in a time of crisis. Whether this is because women with higher socioeconomic status are better equipped to ask for and get what they need at such times, or because they are generally less stressed, needs to be decided. But according to the authors,
personalization should continue to be an important part of the general maternity care policy, including guidelines and staff resources, in order to enable staff to benefit all service users on an equal footing;. “
medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be considered as crucial, guide clinical practice / health-related behavior or be treated as established information.