Mixed-Methods Study of the Experience of Pregnancy During the COVID-19 Pandemic

ObjectiveTo understand the experiences of women who were pregnant during the initial stage of the COVID-19 pandemic, March 2020 to May 2020, and how they coped with stress.DesignA convergent mixed-methods design.SettingOnline survey that launched in April 2020.ParticipantsA total of 185 pregnant women.MethodsFor the quantitative strand, we measured adaptation to coping with stress using the Brief Resilient Coping Scale. For the qualitative strand, we asked participants to describe the experience of being pregnant during the pandemic.ResultsThe mean score on the Brief Resilient Coping Scale was 14.7, which indicated a medium-level resilient coper. Using Krippendorff’s content analysis, we identified four themes: Robbed of Enjoying the Expected Pregnancy Experiences, Anxiety and Fear in the Face of a Pandemic Pregnancy, Heightened Source of Worry With Birth on the Horizon, and Choosing Hope.ConclusionTo meet the needs of pregnant women, perinatal nurses and other maternity care providers must understand the experience of pregnancy during times of upheaval, such as the onset of a global pandemic. Health care providers and nurses can help ensure ideal outcomes for pregnant women by recognizing the loss of the expected pregnancy experience, providing support through creative social outlets, and fostering hopeful optimism.     

Psychological Distress and Behavioural Changes in Pregnant and Postpartum Individuals During the COVID-19 Pandemic

ObjectivesTo determine the psychological and behavioural effects of the COVID-19 pandemic on a Canadian cohort of individuals during pregnancy and the postpartum period.MethodsIn 2020, individuals between 20 weeks gestation and 3 months postpartum receiving maternity care from an urban Canadian clinic were invited to complete a questionnaire. The purpose-built questionnaire used validated scales including the Medical Outcomes Study Social Support Survey (MOS), Depression, Anxiety, and Stress Scale (DASS-21), Edinburgh Postnatal Depression Scale (EPDS), and questions from a SARS study.ResultsOne hundred nine people completed the questionnaire (response rate, 55%) of whom 57% (n = 62) were postpartum. Most respondents (107, 98%) were married and had completed post-secondary education (104, 95%). Despite these protective factors, moderate to severe levels of depression (22%), anxiety (19%) and stress (27%), were recorded using the DASS-21, and 25% of participants (26) had depression (score ≥11) using the EPDS. Despite high social support in all MOS domains (median scores 84–100), a majority of participants reported loneliness (69, 67%) and were nearly or totally housebound (65, 64%). About half of participants worried about themselves (50, 46.3%) or their baby (59, 54%) contracting COVID-19, while the majority postponed (80, 74.1%) and cancelled (79, 73.2%) prenatal appointments. Being homebound or feeling lonely / lacking support were significant risk factors for psychological distress (P = 0.02) whereas exercise and strong social support were protective (P < 0.05).ConclusionPregnant and postpartum individuals experienced moderate to severe depression, anxiety, and stress during the COVID-19 pandemic. Exercise and strong social support were protective. Health care provider enquiry of home circumstances and activity may identify individuals needing enhanced supports.     

Preeclampsia and Severe Maternal Morbidity During the COVID-19 Pandemic: A Population-Based Cohort Study in Ontario,Canada

ObjectiveSignificant changes to the delivery of obstetrical care that occurred with the onset of the COVID-19 pandemic may be associated with higher risks of adverse maternal outcomes. We evaluated preeclampsia/HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome and composite severe maternal morbidity (SMM) among pregnant people who gave birth during the COVID-19 pandemic and compared these data with those of people who gave birth before the pandemic in Ontario, Canada.MethodsThis was a population-based, retrospective cohort study using linked administrative data sets from ICES. Data on pregnant people at ≥20 weeks gestation who gave birth between March 15, 2020, and September 30, 2021, were compared with those of pregnant people who gave birth within the same date range for the years 2015–2019. We used multivariable logistic regression to assess the effect of the pandemic period on the odds of preeclampsia/HELLP syndrome and composite SMM, adjusting for maternal baseline characteristics and comorbidities.ResultsThere were no differences between the study periods in the adjusted odds ratios (aORs) for preeclampsia/HELLP syndrome among primiparous (aOR 1.00; 95% CI 0.91–1.11) and multiparous (aOR 0.94; 95% CI 0.81–1.09) patients and no differences for composite SMM (primiparous, aOR 1.00; 95% CI 0.95–1.05; multiparous, aOR 1.01; 95% CI 0.95–1.08).ConclusionAdverse maternal outcomes were not higher among pregnant people who gave birth during the first 18 months of the COVID-19 pandemic in Ontario, Canada, when compared with those who gave birth before the pandemic.     

Negative Emotions,Triggers, and Coping Strategies Among Postpartum Indian Women During Second Wave of COVID-19 Pandemic: Lessons for the Subsequent Waves and Beyond

IntroductionThe study aimed to evaluate COVID-19 associated psychological distress among pregnant and postpartum women during the second wave of COVID-19 in India.MethodsA cross-sectional survey was done using a pre-validated tool involving 491 participants attending a tertiary-care hospital during the second wave of COVID-19 in India.ResultsThree-fourths of participants experienced negative emotions such as fear and various features of depression. Participants (75%) reported COVID-related news on TV/Radio/Newspapers including social media as the major trigger for these negative emotions. Loss of social support mainly affected postpartum women (p < 0.001) and working women (p < 0.001). Inability to access healthcare services had negative associations with age (p < 0.001), education (p < 0.001), and socioeconomic class (p < 0.001). Various coping strategies being followed by participants included watching TV/Videos or reading books (93%), resorting to social media (77%), spending more time praying and meditating (86%), and engaging in hobbies (56%).ConclusionDuring the second wave, the COVID-19 pandemic had a significantly high negative impact on the psychological and social well-being of pregnant and postpartum women. Hence, it is important to initiate appropriate preventive and corrective steps by the policymakers for any future waves of the pandemic.     

Scoping Review of Racial and Ethnic Representation of Participants in Mental Health Research Conducted in the Perinatal Period During the COVID-19 Pandemic

ObjectiveTo identify the racial and ethnic representation of participants in mental health research conducted in the perinatal period during the COVID-19 pandemic.Data SourcesMEDLINE, CINAHL, Cochrane Library, PsycINFO, Scopus, Web of Science.Study SelectionWe included peer-reviewed research articles in which researchers reported mental health outcomes of women during the perinatal period who were living in the United States or Canada during the COVID-19 pandemic. We included 25 articles in the final review.Data ExtractionWe extracted the citation, publication date, design, aim, country of origin, participant characteristics, sampling method, method of measurement of race and ethnicity, and mental health outcome(s).Data SynthesisThe combined racial and ethnic representation of the 16,841 participants in the included studies was White (76.5%), Black (9.8%), other/multiracial (6.2%), Asian (3.9%), Hispanic/Latina (2.6%), Indigenous or Ethnic Minority Canadian (0.9%), and Native American or Alaska Native (0.1%). Most studies were conducted in the United States, used a cross-sectional design, and incorporated social media platforms to recruit participants. Depression, anxiety, and stress were the most frequently assessed mental health outcomes.ConclusionRelatively few women of color who were pregnant or in the postpartum period during the pandemic participated in mental health research studies. Future studies should develop intentional recruitment strategies to increase participation of women of color. Researchers should use updated guidance on reporting race and ethnicity to accurately represent every participant, minimize misclassification of women of color, and report meaningful results.     

Perinatal Behavioral Health,the COVID-19 Pandemic,and a Social Determinants of Health Framework

The United States has greater prevalence of mental illness and substance use disorders than other developed countries, and pregnant women are disproportionately affected. The current global COVID-19 pandemic, through the exacerbation of psychological distress, unevenly affects the vulnerable population of pregnant women. Social distancing measures and widespread closures of businesses secondary to COVID-19 are likely to continue for the foreseeable future and to further magnify psychosocial risk factors. We propose the use of a social determinants of health framework to integrate behavioral health considerations into prenatal care and to guide the implementation of universal and comprehensive psychosocial assessment in pregnancy. As the most numerous and well-trusted health care professionals, nurses are ideally positioned to influence program and policy decisions at the community and regional levels and to advocate for the full integration of psychosocial screening and behavioral health into prenatal and postpartum care as core components.     

Impact of Protocol Adjustments Due to the COVID-19 Pandemic on Infertility Treatment Outcomes

As a result of the COVID-19 pandemic, our centre made adjustments that reduced the number of patient visits, ultrasound scans, laboratory investigations, and face-to face instructions. The objective of this study was to evaluate whether these changes had any effect on the pregnancy rate for patients undergoing infertility treatment. The primary outcome was clinical pregnancy rates from intrauterine insemination and frozen embryo transfer.Clinical pregnancy rates were not statistically different between patients who underwent either procedure before and after the protocols were put in place. It is reassuring to know our pandemic protocol adjustments did not have a negative impact on infertility treatment outcomes.     

Exploring the Birth Stories of Women on the Autism Spectrum

ObjectiveTo explore birth stories of autistic women to understand how they make sense of the experience of childbirth.DesignNarrative analysis.SettingOnline interviews.ParticipantsSixteen women on the autism spectrum shared 19 birth stories.MethodsParticipants were recruited from online autism forums and were invited to share their birth stories via online asynchronous interviews. Using Burke’s approach to narrative analysis, we identified five elements within each story, including Scene (when/where), Agents (who), Act (what), Agency (how), and Purpose (why). We explored parts of the narratives where two or more elements were out of balance with each other.ResultsTension most often occurred when actions taken by the health care team (Act) were out of balance with their approach to care (Agency), which left participants feeling that their concerns were minimized, their wishes were ignored, and they were left out of critical communication and education. Participants also struggled when their own autistic traits (Agent), such as sensory sensitivities, were out of balance with the birth environment (Scene), which impaired their ability to communicate with providers and participate in the birth.ConclusionPoor communication, untreated pain, and sensory overload dominated the birth narratives of participants. Nurses should trust women’s reports of pain and anxiety because autistic women may appear calm even when in severe distress. Environmental adjustments, such as dimming the lights, can help minimize sensory overload. Nurses need to provide thorough and nonjudgmental education about the birth process to ensure that autistic women feel safe and in control and do not withdraw from care.     

Education in Trauma-Informed Care in Maternity Settings Can Promote Mental Health During the COVID-19 Pandemic

Globally, the pandemic has adversely affected many people’s mental health, including pregnant women and clinicians who provide maternity care, and threatens to develop into a mental health pandemic. Trauma-informed care is a framework that takes into account the effect that past trauma can have on current behavior and the ability to cope and can help to minimize retraumatization during health care encounters. The purpose of this article is to highlight the pressing need for perinatal clinicians, including nurses, midwives, physicians, doulas, nurse leaders, and nurse administrators, to be educated about the principles of trauma-informed care so that they can support the mental health of pregnant women, themselves, and members of the care team during the pandemic.     

Normalizing Birth in England: A Qualitative Study

Introduction : This study examined factors that foster or hinder the support of normal birth in two English National Health Service Trusts identified for public recognition of their work to normalize birth. Methods : This interpretative qualitative study was guided by institutional ethnographic and narrative methods. Purposive sampling was conducted to achieve maximal variation across social, demographic, cultural and ethnic groups. In‐depth interviews explored clinician's and women's views and experiences of normal birth. Ethnographic observations of practice, clinical and administrative meetings, educational sessions, and informal discussions were conducted over 6 months at one of the maternity settings. Antenatal and intrapartum clinical guidelines were reviewed and analyzed. Results : Three key strategies supported the normalization of birth: 1) an “ethos” of normality; 2) “working” the evidence; and 3) “trusting” women to make informed choices best for them. Inappropriate use of technology, disregarding risk status when assigning women to units, lack of physician preparation in normal birth, and poor staffing levels were cited as barriers. Discussion : These strategies should be carefully examined for translation to the United States and future research. J Midwifery Womens Health 2010;55:262–269 c̊ 2010 by the American College of Nurse‐Midwives.     

Impact of the COVID-19 Pandemic on Delivery of Gynecology and Obstetrics Services at a Maximum Care University Hospital in Germany

Introduction The COVID-19 pandemic has been the cause of drastic measures within the national health system. This led us to analyze the clinical and economic performance indicators for gynecology and obstetrics services at the University Hospital of Marburg, which is one of the regional maximum care university hospitals. Therefore, we evaluated the impact of the pandemic on monthly inpatient and outpatient case numbers and the associated ICD and DRG codes, in order to identify any shortcomings in the care provided. Methods and Materials The study is based on a retrospective analysis of data relating to inpatient and outpatient cases that received treatment from 2016 to 2020. We used QlikView, the hospital’s internal performance monitoring program, to evaluate the data from 9487 cases from the gynecology department and 19597 cases from the obstetrics department. Results In line with the nationwide dynamics of the pandemic, we observed a 6% drop in the number of inpatient gynecology cases, while the volume of obstetrics cases rose by 11% in 2020. Overall, the impact on outpatient services was less severe. We also observed a location-specific drop in the number of C50 “malignant neoplasm of breast” cases by 7.4%, and a 14% drop in the number of C56 “malignant neoplasm of ovary” cases. A return to the level of service delivered in the previous year was achieved in three months for outpatient services, and in five months for inpatient services. Conclusion The negative effects of the COVID-19 pandemic primarily affected the gynecology clinic. An increase in obstetrics cases was achieved due to public trust in the safety of the university hospital care, and the service offered of allowing prospective fathers to take part in the birthing process following a rapid test. The return to a pre-pandemic level of service continues to be sluggish, while the outpatient sector, which was less affected in the first place, is showing a more rapid recovery. The location-specific decrease in C50 and C56 diagnoses is concerning, and needs to be assessed from an epidemiological perspective. The impact of the pandemic on case numbers is also reflected in the financial performance indicators. Schlüsselwörter: COVID-19, Pandemie, Versorgungsforschung, Maximalversorger, Universitätsklinikum     

Facilitators and Barriers of Independent Decisions by Midwives During Labor and Birth

Introduction: The purpose of this study was to explore the factors that affect labor management decisions of midwives in hospitals and freestanding birth centers. Methods: A qualitative study was conducted using one‐on‐one tape recorded interviews of midwives who had experience managing labor and birth in both hospitals and freestanding birth centers. Ten interviews consisting of several open‐ended questions were conducted, coded, and analyzed in a stepwise fashion to identify codes, categories, and themes. Seven participants reviewed the final framework and confirmed credibility and trustworthiness. Results: Four overall themes were identified: trust birth, the woman, the environment, and the labor team. Discussion: When making labor management decisions, midwives are affected by their trust in birth, the woman, the health care team, and the birth environment. Midwives report more resistance when making labor management decisions in hospitals. The findings of this study provide insight into both the decision making of midwives and how factors in different environments, in this case hospitals and freestanding birth centers, influence the ability of midwives to make independent labor management decisions.