"If I blink twice everything is OK" - A qualitative study of Swedish midwives' strategies for supporting birthing women while working in full personal protective equipment.

PROBLEM: Midwives all over the world have had to adapt to the use of personal protective equipment (PPE) during the COVID-19 pandemic. The issue of how they managed to support birthing women, despite the use of PPE, has been insufficiently studied. BACKGROUND: Midwives support birthing women in one of their most life-changing situations. Having COVID-19 at the time of childbirth makes birthing women even more vulnerable. PPE has been shown to impact the ability of providing support to birthing women. AIM: To describe midwives' strategies for supporting birthing women while working in full PPE METHODS: A qualitative study based on focus group discussons with Swedish midwives. Data were analysed by inductive content analysis. FINDINGS: To support birthing women while in full PPE, the midwives adapted existing working methods, increased collaboration with colleagues, unveiled, adapted to the requirements for contagion prevention, addressed women's concern for the midwife and maintained focus on the birth while remaining mindful of the risk of contagion. DISCUSSION: Midwives adopted strategies in order to uphold provision of support to the birthing women, as well as to address contextual factors related to PPE that hinder provision of support. CONCLUSION: The respective effects of different PPE types and models on the birth experience should be explored. Explicit strategies for supporting birthing women while working in full PPE must be created and discussed among midwives.

Factors associated with exclusive breastfeeding at discharge during the COVID-19 pandemic in 17 WHO European Region countries.

BACKGROUND: Exclusive breastfeeding is the optimal infant nutrition, providing infants immunoprotection against many diseases including SARS-CoV-2 infection. Restrictions during the COVID-19 pandemic may have negatively affected breastfeeding practices in maternity care facilities. The aims of the study were to examine exclusive breastfeeding rates at discharge over time and to identify factors associated with exclusive breastfeeding during the pandemic. METHODS: A cross-sectional survey was conducted among mothers who gave birth in a maternity care facility in the World Health Organization (WHO) European Region countries during the COVID-19 pandemic. The socio-ecological model was employed to examine intrapersonal, interpersonal, organizational, and community/society factors associated with maternal report of exclusive breastfeeding at the time of discharge. RESULTS: There were 26,709 participating mothers from 17 European Region countries who were included in the analysis. Among the mothers, 72.4% (n = 19,350) exclusively breastfed and 27.6% (n = 7,359) did not exclusively breastfeed at discharge. There was an overall decline in exclusive breastfeeding rates over time (p = 0.015) with a significantly lower rate following the publication of the WHO breastfeeding guidelines on 23 June 2020 (AOR 0.88; 95% CI 0.82, 0.94). Factors significantly associated with exclusive breastfeeding outcomes in the logistic regression analysis included maternal age, parity, education, health insurance, mode of birth, inadequate breastfeeding support, lack of early breastfeeding initiation, lack of full rooming-in, birth attendant, perceived healthcare professionalism and attention, facility room cleanliness, timing of birth, and location of birth. CONCLUSIONS: Results from the study indicate the decline in exclusive breastfeeding rates in the WHO European Region during the COVID-19 pandemic. Using the socio-ecological model to identify factors associated with breastfeeding outcomes facilitates an integrated and holistic approach to address breastfeeding needs among women across the region. These findings demonstrate the need to augment breastfeeding support and to protect exclusive breastfeeding among mother-infant dyads, in an effort to reverse the declining exclusive breastfeeding rates. The study highlights the need to educate mothers and their families about the importance of exclusive breastfeeding, reduce maternal-infant separation, increase professional breastfeeding support, and follow evidence-based practice guidelines to promote breastfeeding in a comprehensive and multi-level manner. TRIAL REGISTRATION NUMBER: Clinical Trials NCT04847336.

The implementation process of the Confident Birth method in Swedish antenatal education: opportunities, obstacles and recommendations.

Antenatal clinics in western Sweden have recently invested in a birth method called Confident Birth. In this study, we investigate midwives' and first line managers' perceptions regarding the method, and identify opportunities and obstacles in its implementation. Semi-structured individual interviews were conducted with ten midwives and five first line managers working in 19 antenatal clinics in western Sweden. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. Intervention Characteristics-such as perceptions about the Confident Birth method-were found to have equipped the midwives with coping strategies that were useful for expecting parents during birth. Outer Setting-the method was implemented to harmonize the antenatal education, and provided a mean for a birth companionship of choice. Inner setting-included time-consuming preparations and insufficient information at all levels, which affected the implementation. Characteristics of individuals-, such as knowledge and believes in the method, where trust in the method was seen as an opportunity, while long experience of teaching other birth preparatory methods, affected how the Confident Birth method was perceived. Process-such as no strategy for ensuring that the core of the method remained intact or plans for guiding its implementation were major obstacles to successful implementation. The findings speak to the importance of adequate planning, time, information and communication throughout the process to have a successful implementation. Based on lessons learned from this study, we have developed recommendations for successful implementation of interventions, such as the Confident Birth, in antenatal care settings.