Women's perceptions of COVID-19 and their healthcare experiences: a qualitative thematic analysis of a national survey of pregnant women in the United Kingdom.

BACKGROUND: The aim of this national survey was to explore pregnant women's perceptions of COVID-19 and their healthcare experiences. METHODS: Through patient and public involvement, a questionnaire was developed and advertised via the BBC website, Twitter and other online media during May 2020. The findings were analysed by qualitative thematic analysis. Women who are currently pregnant, or who have delivered during the COVID-19 pandemic were invited to partake in a national online survey. RESULTS: One thousand four hundred fifty-one participants replied to the online questionnaire. Participants provided significant insight into the perceived barriers to seeking healthcare during this pandemic. These include 'not wanting to bother anyone', 'lack of wider support from allied healthcare workers' and the influence of the media. Other concerns included the use of virtual clinics antenatally and their acceptability to patients, the presence of birthing partners, and the way in which information is communicated about rapidly changing and evolving services. The influence of the media has also had a significant impact on the way women perceive hospital care in light of COVID-19 and for some, this has shaped whether they would seek help. CONCLUSIONS: This is the first ever reported study in the United Kingdom to explore pregnant women's perceptions of COVID-19 and their subsequent healthcare experiences. It has also provided insight into perceived barriers into seeking care as well as maternal concerns antenatally, intrapartum and postpartum.

A Safety Evaluation of the Impact of Maternity-Orientated Human Factors Training on Safety Culture in a Tertiary Maternity Unit.

BACKGROUND: Human factors have risen to attention in maternity as key contributors to patient harm. Despite national recommendation for multidisciplinary human factors training, there is a lack of guidance and healthcare-orientated training. OBJECTIVES: The aim of the study was to evaluate the impact of maternity-orientated human factors training program on safety culture in a tertiary maternity unit. METHODS: This prospective observational cohort study was conducted for 6 months in a tertiary maternity unit. Participants involved in high-risk intrapartum care completed the Hospital Survey of Patient Safety Culture before and after intervention. Statistical analysis was performed using the χ test with statistical significance at 5% (P = 0.05). INTERVENTION: The human factors curriculum included situational awareness, communication, decision-making, conflict resolution, teamwork, and leadership. A train-the-trainer approach generated a faculty to disseminate multidisciplinary training. Traditional classroom teaching, social media content, and cognitive activities provided theoretical foundations. Forum theater and behavioral simulation taught complex communication issues. Regular labor ward simulations helped embed training into clinical practice. RESULTS: The results demonstrated statistically significant improvement in safety culture domains of communication openness, handover, nonpunitive response to error, and overall safety perception. Participants felt more able to challenge decisions or actions of those in authority, 33% responded "most of the time or always" in August increasing to 42% in January with a reduction of 50% in those responding "never" (P = 0.02). No change was found relating to team working, staffing or manager expectations promoting patient safety. CONCLUSIONS: This study is proof-of-concept that maternity-orientated human factors training can improve safety culture.

Haemolytic disease of the fetus and newborn diagnosed after delivery of a baby to a mother with low anti-E antibody titres.

The authors report a term male neonate who was born in unexpectedly poor condition with low Apgar scores and low venous cord gas pH. He required admission to the neonatal unit and was found to have developed haemolytic anaemia with associated hydrops, following a presumed severe antenatal insult. Antenatally, low levels of anti-E antibodies (titre 8) had been detected at 28 weeks' gestation. Following the British Society for Haematology and local neonatal team guidance, advice was given for cord direct antiglobulin test, full blood count and bilirubin at delivery. This case highlights the rare case of haemolytic disease of the fetus and newborn on a background of maternal low titre anti-E antibodies.

Each baby counts: National quality improvement programme to reduce intrapartum-related deaths and brain injuries in term babies.

Although the most recent MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) perinatal mortality report has shown a downward trend in perinatal mortality, the UK still lags behind the best-performing countries in Europe. The burden of perinatal morbidity and mortality is wide-reaching and devastating for the families and care-providers involved. The aim of the Each Baby Counts (EBC) project is to reduce intrapartum term stillbirths, early neonatal deaths, and severe brain injuries by 50% by 2020. Every maternity care provider has been asked to report their intrapartum term stillbirths, early neonatal deaths and severe brain injuries to the EBC project and provide a copy of the local review. The local reviews are assessed by two trained EBC reviewers in order to establish whether the reviews are of adequate quality. The EBC reviewers are asked independently to assess whether there is sufficient clinical information to make a clinical judgement about care, and whether different care could have had a positive impact on the outcome. The reviewers are asked to indicate in what areas care might be improved. The analysis of the local reports will be twofold. Initially quantitative analysis will provide us with information about the scale of the problem, the quality of the local review process into adverse events, and who is involved in such reviews. Qualitative analysis of the themes highlighted in the reviews will enable us to develop care bundles or other tools to drive local quality improvement.