Experiences of receiving or providing maternity care during COVID-19 pandemicQuality and Patient Safety
Capturing the experiences and responses of women and care providers to the radical maternity service re-design during COVID-19
Update: May 2021
The purpose of this study was to address the identified gap in evidence around stakeholders’ experiences (women, partners/support persons, midwives, doctors and midwifery students) of receiving and providing maternity care during the first wave of the COVID-19 Pandemic in Australia. The study is now complete and papers relating to the outcomes from key stakeholder groups are in varying stages of publication.
The findings of the study suggest that changes to maternity care have had substantial impacts on women, partners/support persons, midwives, doctors and midwifery students. Women, partners and support persons had a great sense of ‘missing out’ on health professional and social support. This had psychological impacts on those receiving care and caused concern for those providing care. Inconsistent and constantly changing information and guidelines during the pandemic was associated with uncertainty among those receiving and providing care, leading to stress and frustration. Midwifery students on placement described feeling expendable and not being treated as a part of the maternity care team.
Despite these challenges, each of the groups included in the study noted positive outcomes as a result of the changes in maternity care provision. The increased time for women to bond and establish breastfeeding with their babies due to limited visitors on hospital wards was seen as a benefit, as too were the increased hygiene measures implemented by maternity services.
The study demonstrates the significance of having a model of care that is resilient in the face of pandemics and other public health crises and that:
- incorporates essential aspects of care
- is inclusive of women and their partners/support persons
- is covered by consistent guidelines, policies and processes
- effectively communicates information
It also highlights the potential for making permanent changes to services that were seen to be positive, such as having hospital policies that limit the number of visitors on postnatal wards.
The findings have been shared at a number of health professional conferences and seminars, and are likely to have impact on current and future decision making in the design and provision of maternity care in Australia.
With the arrival of the COVID-19 vaccine in Australia and limited available evidence on the impacts of vaccination on pregnant and breastfeeding women, we are currently planning the extension of this research to examine perspectives on vaccination from the same cohorts covered in the original study. This will determine whether there are any information gaps that need to be addressed to ensure families and other maternity care stakeholders are able to make informed choices and/or provide appropriate guidance regarding vaccination.
The advent of the 2020 COVID-19 pandemic declared by the World Health Organisation (WHO) on 12 March 2020 (1) has seen rapid and significant changes to maternity service delivery in Australia at previously unprecedented levels. These changes have impacted all stakeholders of maternity services including, women, their partners, midwives, medical staff and midwifery students.
Social distancing requirements have meant that many appointments previously held face to face between women receiving maternity care and their midwives or doctors have changed. Antenatal assessments have moved to telehealth appointments using phone interviewing; with minimal contact appointments reserved for pregnancy care in later gestations (2). Antenatal classes have long provided a source of evidence based-education that have allowed women and their support partners to prepare for a healthy pregnancy, labour, birth and early parenting. Across Australia, all classes have been discontinued until further notice, with some health services making plans to move education to the online environment (3).
Women have had significant limitations placed on the amount of visitors allowed during their labour and the birth of their child (4), with reports that some women are fearful that they will be denied any family support during labour at all (5). In the postnatal period, support usually provided by the woman’s partner or family has been limited by significantly restricted visiting periods to only one hour at a time with one nominated person permitted to visit during the entire admission. In some Australian sites, the woman is allowed no visitors, not even her partner during her postnatal stay. Despite the evidence and policy advice that supports and promotes breastfeeding and maternal care of newborns, even if mothers are diagnosed as positive to CoVID-19, some health services are requiring the separation of these mothers and infants until both mother and baby test negative (6).
Once discharged home in the postnatal period, many follow up health checks are being conducted via a phone interview and midwives are limited to 15 minute appointments in the woman’s home, and only if necessary (2).
Health professionals have reported longer working hours and feeling frightened for their own safety as well as that of their families (7). The changes in service delivery have left many feeling dissatisfied with the level of care that they are able to provide. There has been concern expressed about midwives’ and doctors’ ability to adequately form a working relationship with women (8), as well as anxiety about the ability to perform a thorough assessment and provide appropriate advice over the telephone. There have been confusing and mixed reports about the availability of personal protective equipment to enable midwives and medical practitioners to undertake the advised precautions which has contributed to increased stress (9).
Midwifery students around Australia have unique requirements to partner with a minimum of ten women as part of their entry to practice education as required by the national accreditation body. Students must attend a minimum of four antenatal visits, the woman’s birth and two postnatal visits for each woman (10). In response to the CoVID-19 pandemic, many students have had clinical placements cancelled (11) and have been prevented from attending visits and the births of the women they have contracted to provide continuity of care.
The most recent pandemic comparison period for Australia was during the 2009 H1N1 ‘Swine Flu pandemic. Despite the initial evidence indicating that pregnant women, babies and the elderly were the most vulnerable population, the drastic measures requiring personal distancing and subsequent maternity service redesign seen during the current pandemic were not implemented during the H1N1 outbreak (12). The different approaches to the management of the two pandemics has been alluded to in recent publications outlining the variances in transmission and replication patterns of the viruses (13).
There are no periods during living or recorded memory where such radical changes have been made to health services in response to an infectious disease on such a national and global scale. Capturing the experiences and responses of the key stakeholders to the radical maternity service re-design would fill a gap in current evidence and is an important contribution to understanding how these service changes have impacted each group and, collectively as a whole.
The purpose of this study is to address the identified gap in evidence around stakeholders’ experiences of receiving and providing maternity care during the current CoVID-19 Pandemic in Australia. We anticipate the findings of this study will have multifactorial significance and relevance encompassing maternity care consumers, maternity care providers, health service managers, public health clinicians and policy makers.
There are emerging suggestions from commentators within Australia and other similarly developed nations around the world that the significant levels of service redesign that have been necessary during the COVID-19 pandemic mean that there may be no ‘return to normal’ (14-16). The projection is that the socio-political changes that have occurred so rapidly will result in an altered landscape for the way core services such as health and education are delivered post-pandemic (17).
If these projections are upheld in the ‘post COVID-19 experience’ it is even more necessary that the experiences of stakeholders’ who have working memory of both before and after COVID-19 health service is captured. This will provide valuable data to health system managers who will be evaluating how to (re)create new health systems in light of the stakeholder experiences and considering the evidence regarding the impact of the current restrictions and service changes.
There are five main study objectives:
1. Explore and describe women’s experiences of receiving maternity care
2. Explore and describe partner’s experiences of receiving and participating in maternity care
3. Explore and describe midwives’ experiences of providing maternity care
4. Explore and describe medical practitioners’ experiences of providing maternity care
5. Explore and describe midwifery students’ experiences of providing maternity care
This will be a national online study. Prospective participants who meet the following inclusion criteria will be invited to participate in the study through completion of an online survey and offered the option of expressing interest in an interview.
- Women who are currently pregnant or who have had a baby since March 2020
- Partners of women who are pregnant or who have had a baby since March 2020
- Midwives who have provided care across the antenatal, labour and postnatal continuum to women within the last six months
- Medical staff who have provided care across the antenatal, labour and postnatal continuum to women within the last six months
- Midwifery students across the antenatal, labour and postnatal continuum to women within the last six months
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3. Childbirth and Early Parenting Education [press release]. NSW Health2020.
4. Health Service Update Maternity Responses [press release]. ACT Government2020.
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6. Information regarding changes for any COVID_19 Positive Patients [press release]. NSW: Sydney Adventist Hospital2020.
7. NSW nurses told not wear scrubs outside of hospital due to abuse over coronavirus fears [press release]. New South Wales: Australian Broadcasting Corporation2020.
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18. Shields L, Smyth W. Common Quantitative Methods. In: Schneider Z, Whitehead D, LoBiondo-Wood G, Haber J, editors. Nursing and Midwifery Research. 5th ed. NSW: Elsevier; 2016.