ABSTRACT
In this article, we describe the results of a rapid qualitative study conducted between May 19 and June 25, 2020 on the work experience of midwives during the first wave of the COVID-19 pandemic in Brussels and Wallonia (Belgium). Using semi-structured interviews conducted with fifteen midwives working in hospitals or practicing privately, we investigated the impact of the first COVID-19 wave on their work experience, the woman-midwife relationship, and midwife-perceived changes in quality of care. Findings include high levels of stress and insecurity related to the lack of resources and personal protective equipment, feelings of distrust from midwives towards the Belgian State and public health authorities, as well as structural and organizational challenges within maternity wards which negatively affected quality of care. Moreover, based on the midwives experiences, we demonstrate the need to recognise the views of all stakeholders involved in maternal and newborn care provision, and share five essential lessons learned from this study: 1) it is crucial to acknowledge the central role of midwives for maintaining maternal and newborn care amidst the pandemic and beyond; 2) creating unified national guidelines could support ensuring best practice; 3) efforts must be put in place to diminish the climate of mistrust towards health authorities and to repair the relationship between midwives and decision-makers which was damaged during the pandemic; 4) caring for front-line healthcare workers mental health is critical, and 5) quality of maternal care can be improved, even in the midst of a pandemic, through team effort and creative solutions tailored to the needs and demands of each setting.
ABSTRACT
BackgroundSignificant adjustments to the provision of maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care. AimTo explore how the COVID-19 pandemic affected frontline health workers ability to provide respectful maternity care globally. MethodsWe conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected quantitative and qualitative data between July and December 2020 and conducted a qualitative content analysis to explore open-ended responses. FindingsHealth workers (n=1,127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers fear of getting infected and measures taken to minimise COVID-19 transmission. DiscussionMultidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term. ConclusionsThe measures taken during the COVID-19 pandemic disrupted the quality of care provided to women during labour and childbirth generally, and respectful maternity care specifically.
ABSTRACT
IntroductionThe COVID-19 pandemic has led to a rapid and wide implementation of telemedicine for provision of maternal and newborn health care worldwide. Studies conducted before the pandemic, mainly deriving from high-income countries, showed telemedicine was a safe and cost-effective tool for delivering healthcare under certain conditions. The objective of this study was to document the experiences of healthcare professionals globally with the provision of telemedicine for maternal and newborn healthcare during the COVID-19 pandemic. MethodsWe analysed responses received to the second round of a global, online survey of maternal and newborn health professionals, disseminated through professional networks and social media in 11 languages. Data were collected between July 5, 2020 and September 10, 2020. The questionnaire included questions regarding background, preparedness for and response to COVID-19 and experiences with providing telemedicine during the pandemic. Descriptive statistics and qualitative thematic analysis were used concurrently to analyse responses, disaggregated by country income level. ResultsResponses from 1,060 maternal and newborn health professional were analysed. Among the sample, 58% reported using telemedicine, with the lowest proportion reported by professionals working in low-income countries (24%). Two fifths of telemedicine users reported not receiving guidelines on the provision of care through technology. Key practices along the continuum of maternal and newborn healthcare provided through telemedicine included online group birth preparedness classes, antenatal and postnatal care by video/phone, setting up a COVID-19 helpline at maternity wards, and online psychosocial counselling. Challenges reported technological barriers, lack of technological literacy, financial and language barriers, lack of nonverbal feedback, and distrust from patients. Maternal and newborn health providers considered telemedicine to be an important alternative to in-person consultations to maintain care provision during the COVID-19 pandemic. However, they also emphasized the lower quality of care and risk of increasing the already existing inequalities in access to healthcare. ConclusionsTelemedicine has been applied globally to address the disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. Pitfalls of health care provision by telemedicine include exacerbated inequalities in access to care, patient-provider communication problems, and a financial burden for certain healthcare workers and women. More research regarding the effectiveness, efficacy, and quality of telemedicine for maternal health care in different contexts is highly needed before considering long-term adaptations in provision of care away from face to face interactions. Clear guidelines for care provision and approaches to minimising socio-economic and technological inequalities in access to care are urgently needed. Summary boxO_ST_ABSWhat is already known?C_ST_ABSO_LITelemedicine is the delivery of healthcare services by healthcare professionals from distance through using information and communication technologies for the exchange of valid and correct information. C_LIO_LITelemedicine for maternal and newborn health can safely be used to deliver certain components of care in highly controlled settings where the technology is available and accessible to patients C_LIO_LITelemedicine has been applied rapidly and on a wide scale during the COVID-19 pandemic to replace face to face visits along the continuum of maternal and newborn health care. C_LI What are the new findings?O_LIMaternal and newborn healthcare providers globally considered telemedicine of benefit during the pandemic and applied it on a wide scale for different aspects of maternal and newborn healthcare. C_LIO_LIThe rapid adaptation to provision of care via telemedicine was not optimally supported by guidelines, training for health providers, adequate equipment, reimbursement for cost of connectivity and insurance payments for care provided remotely. C_LIO_LIHealthcare providers reported not being able to reach a substantial group of families by telemedicine and encountered different barriers in providing high quality maternity care by telemedicine due to challenges present worldwide, but more prominent in low- and middle-income countries. C_LI What do the new findings imply?O_LIPre-existing inequalities in terms of access to high quality care might have increased by the large scale and rapid implementation of telemedicine during the COVID-19 pandemic in different settings. C_LIO_LIAccess to telemedicine for women was hampered by various factors such as internet connection problems, lack of the necessary equipment, digital illiteracy and distrust. C_LIO_LIIn-depth research is needed to formalise evidence-based guidelines for the implementation of telemedicine along the continuum of maternal and newborn care as lessons learned for building back beyond the COVID-19 pandemic and also for future emergency preparedness. C_LI
ABSTRACT
ObjectiveTo prospectively document experiences of frontline maternal and newborn healthcare providers during the COVID-19 pandemic. DesignCross-sectional study via an online survey disseminated through professional networks and social media in 12 languages. We analysed responses using descriptive statistics and qualitative thematic analysis disaggregating by low- and middle-income countries (LMICs) and high-income countries (HICs). Setting81 countries, between March 24 and April 10, 2020. Participants714 maternal and newborn healthcare providers. Main outcome measuresPreparedness for and response to COVID-19, experiences of health workers providing care to women and newborns, and adaptations to 17 outpatient and inpatient care processes during the pandemic. ResultsOnly one third of respondents received training on COVID-19 from their health facility and nearly all searched for information themselves. Half of respondents in LMICs received updated guidelines for care provision compared with 82% in HICs. Overall, only 47% of participants in LMICs, and 69% in HICs felt mostly or completely knowledgeable in how to care for COVID-19 maternity patients. Facility-level responses to COVID-19 (signage, screening, testing, and isolation rooms) were more common in HICs than LMICs. Globally, 90% of respondents reported somewhat or substantially higher levels of stress. There was a widespread perception of reduced use of routine maternity care services, and of modification in care processes, some of which were not evidence-based. ConclusionsSubstantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19. Formal information sharing channels for providers must be established and mental health support provided. Surveys of maternity care providers can help track the situation, capture innovations, and support rapid development of effective responses. Key MessagesO_LSTWhat is already knownC_LSTO_LIIn addition to lack of healthcare worker protection, staffing shortages, heightened risk of nosocomial transmission and decreased healthcare use described in previous infectious disease outbreaks, maternal and newborn care during the COVID-19 pandemic has also been affected by large-scale lockdowns/curfews. C_LIO_LIThe two studies assessing the indirect effects of COVID-19 on maternal and child health have used models to estimate mortality impacts. C_LIO_LIExperiences of frontline health professionals providing maternal and newborn care during the COVID-19 pandemic have not been empirically documented to date. C_LI O_LSTWhat this study addsC_LSTO_LIRespondents in high-income countries more commonly reported available/updated guidelines, access to COVID-19 testing, and dedicated isolation rooms for confirmed/suspected COVID-19 maternity patients. C_LIO_LILevels of stress increased among health professionals globally, including due to changed working hours, difficulties in reaching health facilities, and staff shortages. C_LIO_LIHealthcare providers were worried about the impact of rapidly changing care practices on health outcomes: reduced access to antenatal care, fewer outpatient visits, shorter length-of-stay in facilities after birth, banning birth companions, separating newborns from COVID-19 positive mothers, and postponing routine immunisations. C_LIO_LICOVID-19 illustrates the susceptibility of maternity care services to emergencies, including by reversing hard-won gains in healthcare utilisation and use of evidence-based practices. These rapid findings can inform countries of the main issues emerging and help develop effective responses. C_LI
