Experiences and attitudes of midwives during the birth of a pregnant woman with COVID-19 infection: A qualitative study.

BACKGROUND: The COVID-19 pandemic has become one of the most important threats to global health. Midwives are at the core of the response to the pandemic. Women still need midwifery support and care. The work of midwives is acknowledged as emotionally demanding, and their welfare may be compromised by a range of workplace and personal stress factors. AIM: To investigate the experiences and attitudes of midwives who have provided pregnancy and childbirth care to women with a confirmed or suspected COVID-19 infection. METHODS: A qualitative phenomenological study was carried out in two Spanish tertiary hospitals. Fourteen midwives were recruited by purposive sampling technique. Data were collected through individual in-depth interviews and analysed using Giorgi's descriptive method. FINDINGS: Three themes emerged: "challenges and differences when working in a pandemic", "emotional and mental health and wellbeing" and "women's emotional impact perceived by midwives". Midwives pointed to several factors tied to a safe, supportive and empowering work place: support from staff and managers, access to adequate personal protective equipment, and reliable guidelines. They also dealt with professional and personal challenges during the pandemic, showing feelings of fear, anxiety, uncertainty, discomfort, lack of support, and knowledge. Finally, midwives expressed their concerns about the feelings of pregnant women with COVID-19, such as fear, anxiety, and loneliness. CONCLUSION: The results of this study show some of the challenges for midwives during the course of the COVID-19 pandemic, emphasizing the value of a good communication, emotional support, and stress management, to provide woman-centred care.

Translation, adaptation and psychometric validation of the preterm birth experience and satisfaction scale (P-BESS) into Spanish.

BACKGROUND: Preterm labour and birth are two of the most important issues in perinatal care. The birth of a preterm baby is often a stressful and traumatic time for parents. Assessment of satisfaction with maternity services is crucial and questionnaires are the most common method as long as they are well-constructed. Only one, The Preterm Birth Experience and Satisfaction Scale (P-BESS), developed in United Kingdom, has been designed for this specific birth type. OBJECTIVES: To translate, transculturally adapt and assess the psychometric properties of the P-BESS into Spanish. DESIGN: Cross-sectional study. SETTING: Maternity unit of a tertiary level hospital in Spain. PARTICIPANTS: A total of 182 woman who gave birth before 37 weeks of gestation. METHODS: The instrument was translated and back translated. The P-BESS was tested for face validity and construct validity by carrying out an exploratory/confirmatory factor analysis. Reliability was estimated from the internal consistency, with the Cronbach's alpha (α), and the test-retest, with the  intraclass correlation coefficient (ICC). FINDINGS: The principal component analysis revealed the presence of three factors with eigenvalues greater than 1, explaining a total variance of 66.6%. A subsequent varimax rotation revealed the presence of strong loadings on each of the three components. Confirmatory factor analysis was performed, offering the model a very good fit to the data: chi-square was χ2(df=149)=362.727 (p = 0.000); the root mean square error of approximation (RMSEA)=0.089; the normed fix index (NFI )= 0.852 and the comparative fit index (CFI)=0.905. The total scale and subscales had good reliability with all Cronbach´s alpha above the acceptable level of 0.7. The total ICC was 0.994 (CI 95%, 0.988-0.997). CONCLUSIONS: The Spanish version of P-BESS appears to be a robust, valid and reliable instrument for assessing satisfaction with care during preterm birth. IMPLICATIONS FOR PRACTICE: the instrument provides a more comprehensive understanding of this complex experience. It allows the detection of areas of intervention in order to empower strategies to cope with preterm births and to maximise feelings of self-confidence and control.