Background
Methods
Inclusion criteria
Search strategy
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S: mother OR woman OR women OR midwives OR midwife* OR nurs* OR clinician OR physician OR doctor OR obstetric* OR professional AND
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PI: (maternity ADJ care) OR healthcare OR ‘health-care’ OR matern* OR birth* OR childbirth OR prenan* OR labour OR labor OR antenatal OR antepartum OR postnatal OR postpartum OR post-partum OR puerperium AND coronavirus* OR corona virus* OR COVID-19 OR COVID OR covid OR Covid2019 OR SARS-CoV* OR SARSCov* OR new CoV* OR novel CoV* AND
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E and R: experiences OR experience OR view* OR perceptions OR perception OR voices OR narratives OR qualitative OR (mixed ADJ method) OR ‘grounded theory’ OR phenomenology OR ‘action research’.
Study selection
Quality assessment
Data extraction and synthesis
Assessment of confidence in the review findings
GRADE-CERQual
Results
Search and selection
Ref No | Aim | Country | Description of participants | Number |
---|---|---|---|---|
Studies contributing data on women’s views and experiences | ||||
33 | Personal narrative of experiences during COVID-19 | UK | Primiparous woman with gestational diabetes accessing public maternity care | N = 1 |
34 | To study the perspectives of pregnant women in relation to the impact of the COVID-19 pandemic on their pregnancy experience | Australia | Pregnant women any gestation booked and receiving antenatal care at the hospital | N = 15 |
35 | To investigate the pregnancy experiences of women during the COVID-19 pandemic | Turkey | Pregnant women admitted to the study site, > 20 years old, communicating in Turkish and not COVID-19 positive (n = 14) | N = 14 |
36 | To assess stressors, coping behaviors, and resources needed in relation to the COVID-19 pandemic in a sample of perinatal women in the United States | USA | Pregnant or postpartum women, ≥ 18 years of age, English-speaking, and gave birth between Jan and May 2020 | N = 42* |
37 | To describe the impact of the COVID-19 pandemic on birth experiences centering the perspective of the birthing person | USA | Women ≥ 18 years of age who gave birth after 01 Mar 2020 in the US using the Ovia Parenting app | N = 202& |
38 | Personal narrative of experiences during COVID-19 | UK | Postpartum woman of twins | N = 1 |
39 | To better understand the care that women are receiving and/or seeking in response to COVID-19 in order to inform Government and other key stakeholders | Australia | All women who were pregnant in Australia | N = 2750+ |
40 | To gain an understanding of women’s experiences of visiting restrictions imposed due to COVID-19 and to provide information to inform policy development in relation to visiting | Ireland | Women during the antenatal period in a large urban maternity unit | N = 303& |
41 | To explore the experience of expectant parents who accessed hypnobirthing online classes during the COVID-19 pandemic | UK | Pregnant or postpartum women | N = 25 |
42 | To better understand mental health and well-being, as well as sources of resilience, for women in the perinatal period during the COVID-19 pandemic | USA | Women > 18 years, English-speaking, currently living in Colorado, and being pregnant or within the first 6-months postpartum | N = 31 |
43 | To examine the impact of COVID on patients' access and utilization of prenatal genetic screens and diagnostic tests at the onset of the COVID‐19 pandemic | USA | Pregnant women in first and second trimesters | N = 40 |
44 | To explore childbearing experiences of COVID-19 positive mothers who gave birth in a Northern Italy maternity hospital | Italy | All women who tested positive for COVID-19 at the research site during the months of Mar and Apr 2020 | N = 22 |
45 | To identify challenges with healthcare interactions experienced by postpartum patients during the pandemic | USA | Postpartum women: the median time between birth and the interviews was 10 weeks | N = 40 |
46 | To explore if and how women perceived their prenatal care to have changed due to COVID-19 and the emotional impact of those changes on pregnant women | USA | Pregnant women able to complete an online survey in English, regardless of gestational age of the pregnancy, location of residence or utilization of services | N = 2519 |
47 | To explore pregnant women’s perceptions of COVID-19 and their healthcare experiences | UK | Women currently pregnant or postpartum since the COVID-19 pandemic commenced | N = 1451 |
48 | To capture peripartum women's lived experiences during the COVID-19 pandemic | India | Pregnant women > 30th week of gestation to 1-month postpartum who could speak English or Hindi language | N = 25 |
49 | To assess pregnant women’s satisfaction with antenatal care and social support and to examine stress-reduction strategies women used during the pandemic | International | Pregnant women aged 18 years or older irrespective of gestational age, nationality, or geographical location | N = 558& |
50 | To explore the lived experiences of pregnant women during the COVID-19 pandemic to better understand their experience of pregnancy so that better support could be provided | Iran | Pregnant women who were registered in public health centers affiliated with Sabzevar University of Medical Sciences | N = 19 |
2 | To gain insight and understanding of women’s experiences of maternity care during the first national lock-down phase of COVID-19 in one hospital setting | Ireland | Women ≥ 18 years of age, able to read and speak English, and had experienced pregnancy, childbirth (between 37 and 42 weeks of pregnancy) and postnatal care at the study site during the first national lock-down period | N = 19 |
51 | To investigate how COVID-19 and associated restrictions influence mood and parenting confidence of expectant parents and those in early parenthood | UK | Women currently pregnant or postpartum | N = 564$ |
53 | To gain insights into the attitudes and experiences of expectant and recent parents during COVID-19 | UK | Women who were Baby Buddy App users, irrespective of their gestational stage and baby age < 24 weeks | N = 32& |
53 | To understand the experiences of pregnant women during the COVID-19 pandemic | Turkey | Pregnant women > 18 years who speak Turkish, not diagnosed with COVID-19 and are residents of Turkey | N = 15 |
54 | To explore perceptions of social support among breastfeeding mothers during the COVID-19 pandemic | Not stated | Postpartum women currently breastfeeding | N = 29 |
55 | To better understand the ways in which new families experience pregnancy and lactation during the COVID-19 pandemic | USA | Healthy first-time mothers with a prenatal intention to breastfeed | N = 3 |
56 | To describe childbearing women’s experiences of becoming a mother during the first wave of the COVID-19 pandemic | Australia | Women of different ethnicities living in varied geographical locations across Australia, and seeking care from a wide variety of models of care | N = 27& |
57 | To describe lived experience in COVID -19 lockdown period from the perspective of pregnant women | India | Pregnant women in any trimester | N = 4 |
58 | Personal narrative of experiences during COVID-19 | UK | One multiparous woman | N = 1 |
Studies contributing data on maternity care professionals’ views and experiences | ||||
59 | To explore and describe midwives’ experiences of providing maternity care during the COVID-19 pandemic | Australia | Registered midwives who had provided maternity care since March 2020 | N = 16& |
60 | Personal narrative of lived experience during COVID-19 | Not stated | Resident on a labour and delivery ward | N = 1 |
61 | Real time experiences of providing care, services and programming to directly address the needs of pregnant and parenting New Yorkers during COVID-19 | USA | Not explicitly described (maternity care providers) | N = 9 |
15 | Narrative description of lived experiences | USA | Obstetricians-gynecologists | N = 2 |
62 | To analyze how the nurse-midwives of maternity wards have reorganized care in the context of labor and birth amidst the COVID-19 pandemic | Brazil | Nurse-midwife preceptors and collaborators of maternity wards that were fields of practice of the Enhancement Course for Nurse-Midwives | N = 9 |
63 | To assess how obstetrics and gynecology NCHDs viewed and were affected by measures taken in response to Covid-19 pandemic | Ireland | Non-consultant hospital doctors in maternity units | N = 74 |
64 | Maternal and newborn health professionals experience of providing care to pregnant and postpartum women and their newborns using telemedicine during the COVID-19 pandemic | International | Midwives, nurses, obstetricians, gynecologists, neonatologists, and other maternity health professionals working in urban and rural settings | N = 1060 |
65 | 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 | Spain | Midwives who provided pregnancy and childbirth care to women with a confirmed or suspected COVID-19 infection (average experience of 8 years working as a midwife) | N = 14 |
17 | To explore the experience of private practicing midwives in relation to the response to planning for the COVID-19 pandemic | Australia | Midwives currently providing any type of private midwifery services for antenatal, labour and birth and/or postnatal services | N = 103 |
66 | To describe nurses’ experiences of caring for perinatal women and newborns during the pandemic | South Korea | Registered Nurses working in hospitals that had confirmed or suspected COVID-19 cases | N = 24 |
67 | To determine to what degree prenatal care was able to be transitioned to telehealth during COVID-19 and describe providers’ experience with this transition | USA | All providers who conducted telehealth visits during the implementation period | N = 11& |
68 | To document the experiences of Black birth workers supporting pregnant and birthing people and new mamas during the first six months of COVID-19 | USA | Black maternity care providers | N = 38 |
69 | To understand how COVID-19 has impacted childbirth | Puerto Rico | Puerto Rican women working in the fields of reproductive health | N = 11 |
70 | To evaluate the provision of obstetrics and gynecology services during the acute phase of COVID-19 | UK | Junior doctors in obstetrics and gynecology across all training units in the NHS | N = 148 |
71 | To determine changes to breastfeeding support services during the coronavirus-2019 pandemic according to trained lactation providers | USA | MCPs currently offering breastfeeding services to pregnant/postpartum women, had formal training to provide support, and were over the age of 18 | N = 39 |
72 | To prospectively document experiences of frontline maternal and newborn healthcare providers | International | Any health professionals directly providing maternal or newborn care, from various countries, contexts, services and facilities at the early stage of the COVID-19 pandemic | N = 714 |
73 | To explore and describe doctors’ experiences of providing maternity care during the COVID-19 pandemic | Australia | Medical practitioners who provided care across any part of the antenatal, labour and postnatal continuum since March 2020 | N = 8& |
Studies contributing data on both women’s and professionals’ views and experiences | ||||
74 | To explore how experiences of pregnancy and birth were impacted by the COVID-19 pandemic, both from the patients’ and nurses’ perspectives to understand the multifaceted and intersectional impacts from these adaptations | USA | Women: people who were pregnant or had given birth since Mar 2020, restricted to those living in Washington State MCPs: Registered nurses currently working in a perinatal setting since March 2020 from across the US | N = 15 (women) N = 14 (MCPs) |
75 | To describe the hospitalization and early postpartum psychological experience for asymptomatic obstetric patients tested for SARS-CoV-2 and to report the impact of on labor and delivery health care workers’ job satisfaction and workplace anxiety | USA | Women: All women presenting for obstetric care at the two hospitals during the recruitment period MCPs: on obstetric units in the two hospitals | N = 318 (women) N = 158 (MCPs) |
76 | To describe the short-term impacts of the COVID-19 pandemic and hints at its potential long-term effects | Italy | Women: who had given birth during or immediately after lockdown (Mar-May 2020) MCPs: midwives active in the city of Bologna | N = 49 (women) N = 18 (MCPs) |
77 | To explore COVID-19 related factors influencing ANC service uptake | Ethiopia | Pregnant women: who did not attend all recommended ANC visits, third trimester and above, able to speak the local language, age group 18 to 45 MCPs: working in facilities in selected districts | N = 44 (women) N = 9 (HCPs) |
78 | To describe how indigent mothers have responded to and coped with the dramatic changes that have occurred in birth practices as a result of this pandemic | Keyna | Women: mothers who were either expectant or gave birth during the COVID-19 pandemic MCPs: matrons (nurse-midwives who serve as department heads) in charge of maternal health services and traditional midwives | N = 20 (women) N = 5 (MCPs) |
79 | To evaluate initial adoption and patient and provider care experience with a COVID-19 prenatal care model at a single institution | USA | Pregnant women: All patients at > 20 weeks’ gestation who were receiving prenatal care MCPs: obstetricians, gynecologists, maternal–fetal medicine physicians, family medicine physicians, and certified nurse midwives | N = 150& (women) N = 53& (MCPs) |
Description of included studies
Quality assessment
Quality criteria | |
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Quality of the study reporting A = Aims and objectives clearly reported B = Adequately described the context of the research C = Adequately described the sample and sampling methods D = Adequately described the data collection methods E = Adequately described the data analysis methods | There was good or some attempt to establish the F = Reliability of the data collection tools G = Validity of the data collection tools H = Reliability of the data analysis I = Validity of the data analysis |
Quality of the methods J = Used the appropriate data collection methods to allow for expression of views K = Used the appropriate methods for ensuring the analysis was grounded in the views L = Actively involved the participants in the design and conduct of the study | |
Study | Criteria met |
Atmuri 2021 [34] | A, B, C, D, E, F, G, H, I, J, K, L |
Aydin 2021 [35] | A, B, C, D, E, F, G, H, I, J, K, L |
Barbosa-Leiker 2021 [36] | A, B, C, D, E, FP, GP, H, I, JP, KP |
Bremen 2020 [37] | A, B, C, D, E, F, G, H, I, J, K, L |
Cooper 2021 [39] | A, BP, CP, DP, EP, FP, GP, HP, IP, JP, KP |
Cullen 2021 [40] | A, B, CP, D, E, FP, GP, H, I, JP, K |
Einion-Waller 2021 [41] | AP, BP, CP, DP, HP |
Farewell 2020 [42] | A, B, C, D, E, F, GP, H, I, J, K |
Farrell 2021 [43] | A, B, C, DP, E, F, G, H, I, J, K |
Fumagalli 2021 [44] | A, B, C, D, E, F, G, H, I, J, K |
Gomez-Roas 2021 [45] | A, CP, DP, E, J, K |
Javaid 2021 [46] | A, B, C, D, E, F, G, HP, IP, J, KP |
Karavadra 2020 [47] | A, B, CP, D, E, FP, GP, HP, IP, KP |
Kumari 2021 [48] | A, BP, C, D, E, F, GP, H, I, J, K |
Meaney 2021 [49] | A, B, CP, D, E, FP, GP, H, I, JP, K |
Mortazavi 2021 [50] | A, B, C, D, E, F, GP, H, I, JP, K |
Panda 2021 [2] | A, B, C, D, E, F, G, H, I, J, K |
Perez 2021 [51] | A, B, CP, D, E, FP, GP, H, I, JP, K, L |
Rhodes 2020 [52] | A, B, C, D, E, F, G, H, I, J, K, LP |
Sahin 2021 [53] | A, B, C, D, E, FP, G, H, I, J, K |
Spatz 2021 [55] | A, B, CP, D, E, F, G, H, I, J, K |
Sweet 2021 [56] | A, B, C, D, E, F, GP, H, I, J, K |
Upendra 2020 [57] | A, BP, CP, D, E, F, GP, H, I, J, K |
Bradfield 2021 [59] | A, B, C, D, E, F, G, H, I, J, K |
Dulfe 2021 [62] | A, B, DP, E, FP, GP, H, I, JP, K |
Elsayed 2021 [63] | A |
Galle 2021 [64] | A, B, C, D, E, F, GP, H, I, J, K |
Gonzalez-Timoneda 2020 [65] | A, B, C, D, E, F, G, H, I, J, K |
Homer 2021 [17] | A, B, CP, D, E, H, I, JP, K |
Kang 2021 [66] | A, B, C, D, E, F, G, H, I, J, K |
Madden 2020 [67] | A, B, CP, DP, E, FP, GP, HP, I, J, K |
Oparah 2021 [68] | B, D, E, F, G, H, I, J, K, LP |
Reyes 2021 [69] | B |
Rimmer 2020 [70] | A, B, CP, E, H, IP, K |
Schindler-Ruwisch 2021 [71] | A, B, CP, DP, EP, FP, GP, H, I, JP, K |
Semaan 2020 [72] | AP, B, CP, DP, E, FP, GP, H, IP, J, K, L |
Szabo 2021 [73] | A, B, CP, DP, E, FP, GP, HP, IP, JP, K |
Altman 2021 [74] | A, B, C, D, E, F, G, H, I, J, K, L |
Bender 2020 [75] | A, B, CP, D, EP, FP, GP, HP, IP, JP, KP |
Bengalia 2021 [76] | AP, B, CP, DP |
Hailemariam 2021 [77] | A, B, CP, D, E, F, GP, H, I, J, K |
Ombere 2021 [78] | AP, B |
Peahl 2021 [79] | A, B, CP, D, EP, FP, GP, HP, IP, JP, KP, LP |
Synthesis and findings
Codes (reduced for illustrative purposes) | Descriptive themes | Analytical sub-themes | Analytical theme |
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Virtual care worked well; Virtual care problematic; Virtual care | Providing care virtually | Telehealth | Theme 1 Altered maternity care |
New model of care good; Rushed care; Changed maternity care; Faster appointments; Cancelled appointments; Varied care; Continuity of care; Increased medicalisation; Preparedness for birth hampered; Increased stress/anxiety due to changes in care | Changes to usual care structures, processes and care provision and the impact of these | Altered care structures, processes, provision, and access | |
Feeling sad for partner; partner unable to bond with baby in first few days; partner attendance; partner restrictions; Feeling guilty as partner not present; Feeling angry as partner missing out | Restrictions on partner attendance and impact of this | “It felt cruel” – restricting partners attendance | Theme 2 COVID related restrictions |
Alone or isolated (because of visiting or social distancing restrictions) | Feeling alone and isolated | Restrictions in general: pros and cons | |
Visiting restrictions (in general); Self-restricting contact with others; Separated from baby; Forming close relationships with other women; Feeling cheated; Missing out | General visiting, access, and social restrictions; advantages and disadvantages | ||
Safety prioritised over experience; Staff safety prioritised over woman’s care; Precautions taken by MCPs; COVID testing/diagnosis | HCP precautionary and safety activities to protect against infection | N/A | Theme 3 Infection prevention and risk |
Fear/worry of contracting COVID at visits; Hospital care less safe/as safe; Time of uncertainty; Benefit outweighs risk; Changing place of birth | Women’s thoughts and actions related to contracting/avoid contracting COVID | ||
Reduced support; Access to support; Loss of support; Good support; Seeking support; Sources of support; Breastfeeding support; Postpartum support; Mental health issues undetected | Support systems affected by COVID (mostly negatively) | Psychosocial and information support | Theme 4 “The lived reality” – navigating support systems |
Media reports and influence; Information seeking; Information needs; Conflicting information; Help-seeking negatively affected; First time mother’s unique needs | Information sources and needs | ||
Finding solutions; Changing plans; Exploring alternatives; Being resilient and strong; Being in control; Preparing for birth; Comparing themselves to other women; Self-advocacy; Adapting to changes; Women’s recommendations to MCPs | How women addressed their support and information deficits | Women’s solutioning | |
Advice from MCPs; Guidance expected from MCPs/needing reassurance; Good communication important; Challenges in accessing MCPs or services; Birth options reduced; Care from/communicating with MCPs; MCP more concerned about COVID than pregnancy issues | Good and poor interactions with HCPs and services | N/A | Theme 5 Interactions with maternity services |
Feeling forgotten about; Feeling abandoned; Being cared for stopped; Unmet expectations; Awful experience; Poor care; Compassionate care; Disrespectful care | Care quality |
Codes (reduced for illustrative purposes) | Descriptive themes | Analytical sub-themes | Analytical theme |
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Inadequate staff resources; Adequate staff resources; Access to safety resources; Staff training; Reduced capacity to provide care; Limited staff; Fear of illness impacting provision of care; Lack of personal contact as barrier to care provision; Language barriers; Lack of digital literacy as barrier to care; Clear communication as enabler; Telehealth enabling continued care | Staff resources, barriers, and enablers of care | Capacity to provide care | Theme 1 Altered maternity care |
Reducing in-person care; Need for flexibility; Increased demand for homebirth; Restrictions impacting on women’s autonomy; Move to telehealth; Telehealth not optimal; Increased medicalization of birth; Rapid change; Changing protocols; Uncertainty in protocol; Certainty of protocol; Lack of informed decisions; COVID exacerbating inequalities; Racial inequalities; Inequalities in care; Minimal change to care | Changing provision of care, uncertainty, inequalities and continued need for care | Altered care structures and provision | |
Positive change to workload; Increased staff workload; Increased staff need; Sense of collegiality; Impact on colleague relationships; Lack of support (colleagues/management); Feeling supported; Conflicting professional beliefs; Inequalities in staff | Impact on workload and relationships with colleagues | Professional Impact | Theme 2 Professional and Personal Impact |
Increased personal burden; Increased financial burden; Emotional burden; Fear and anxiety; Two different worlds – in and outside hospital; Managing two lives – work and home; Sense of exclusion. Combative environment; A feeling of inevitability; Self as threat to others; COVID as threat to self | Burden, different worlds, and COVID as a personal threat | Personal Impact | |
Future worries; Longer term impact on care provision; Longer term health outcomes | Future worries | N/A | Theme 3 Broader structural impact |
COVID viewed as an opportunity; Improved provision of care; Improved health outcomes; Gaining a new perspective | COVID as an opportunity |
Women’s views and experiences of maternity care during COVID-19
Theme 1: Altered maternity care (women)
Sub-theme 1.1: Altered care structures, processes, provision, and access
“Everything felt very rushed…. Nobody spent more than 10 minutes with me…. The entire time (in the hospital) I just felt rushed and alone.” [37, p.8]
Sub-theme 1.2 Telehealth
“And this telehealth situation, this monitoring from home, that’s a joke. It’s not going to work. How can you tell me that my C-section isn’t hurting when I’m telling you that it is hurting but you can’t see it” [74, p.4]
“And over the phone just doesn’t do it like. You don’t get the same, to look into somebody’s eyes and to trust them and for them to say, you’re okay” [2, p.14]
Theme 2: COVID related restrictions
“I’m so angry that neither I, nor [name], will ever get that day back. I will never be able to correct it or make it a better experience … it felt cruel [38, p.1]“… denying my husband, the right to be there, or me the support he provides is a disgusting standard of care which will have lifelong effects” [39, p.6]
Sub-theme 2.2: Restrictions in general: pros and cons
“It’s made it definitely a more somber experience and it has been difficult to be excited because you can’t share it with people.” [42, p.5]
“It is a lot quieter, more time to adjust and try to get a hang of breastfeeding without an audience” [40, p.220]
Theme 3: Infection prevention and risk
“We’re more concerned about whether we came into contact with anything in the hospital” [75, p. 1275]
“At present, all that matters is keeping the baby safe and keeping the mother well enough to give birth, disregarding the humanized dimensions of pregnancy, birth care, and the lived experience of the birthing mother” [41, p.17]
Theme 4: “The lived reality” – navigating support systems
Sub-theme 4.1: Information and psychosocial support
“One doctor would say one thing and then the next would say another.” [37, p.6]
“…and I think probably one thing that maybe could be improved is just that extra information of what you are doing with the COVID stuff in terms of precautions, what it's going to look like when I come in to have bubs, just what to expect.” [34, p.6]
“I was struggling breastfeeding. I would have gone to breastfeeding group, but that’s been cancelled…. I was in pain and I felt let down” [52, p. 20]
Sub-theme 4.2: Women’s solutioning
“And you know if you were kind of just worried, but you were able to talk to each other. And just comfort each other.” [2, p.18]
“I am forced to continually fight to be seen and have to reiterate my situation and reasoning over and over …. and now I have no choice but to advocate for myself but it has been very difficult.” [46, p.5]
Theme 5: Interactions with maternity services
“…The education given by the OB has dramatically shifted from normal pregnancy concerns to 95% about coronavirus. I feel like my questions about non-COVID issues are getting overlooked.” [46, p.4]
On several occasions they told me ‘Stay away, stay away, keep the 1-meter distance, go to that corner in the lift…. When they came in the room to wake me up at 6am they used to open the door shouting ‘masks!’ [44, p.8]
Maternity care providers’ views and experiences of maternity care during COVID-19
Theme 6: Altered Maternity Care (providers)
“Departmental protocols…were changing rapidly, leading to confusion and unclear interpretation by staff members… variation in practice and misinterpretation of guidance were expressed…especially where limited evidence is available” [70, p.1125].
“Restrictions and regulations in the time of COVID-19 have allowed for a resurgence of the racist and sexist policies…Black women’s bodies have continued to be seen as risky…leading to a lack of care and touch that continues to put Black birthing people in danger” [68, p7).
“COVID has also given practitioners justifications for many unnecessary and excessive practices; when negligence is not the issue, increased intervention is” [69, p3].
Sub-theme 6.2: Capacity to provide care
“To decrease the risk of transmission, we usually compromise the routine antenatal care service. For instance, we may not perform physical examination or draw blood, even if necessary” [77, p.4]
“Virtually the screen is small, I’m at the mercy of the person holding the phone…I have to verbally direct the mom over the phone, and many interrupt[ion]s on both sides of the conversations” [71, p.265].
“Over the telephone, it is harder to read all the non-verbal cues as you would in an in-person counselling session” [71, p.265]
“One of the biggest challenges reported was poor internet connection and/or regular interruptions in connectivity. This was a global problem reported by providers from both LMICs and HICs” [64, p.8]
Theme 7: Professional and Personal Impact
Sub-theme 7.1: Professional Impact
“It was ‘on the frontlines’ that I felt the most the distant from the pandemic itself. I felt guilty responding to messages from family and old friends, those not in medicine but trapped in their homes by an invisible enemy ravaging their cities and towns” [60, p.2]
“The pandemic has impacted the medical culture in Puerto Rico, emboldening doctors to ‘protect’ their ‘domain’… medical professionals have taken to social media…gone on the news to argue that the absolute safest place to give birth is the hospital” [69, p.5]
“Nurse participants described ...wanting more compassion and respect from hospital administration…a need to be seen as an individual who is being placed at risk” [74, p.6]
Sub-theme 7.2: Personal Burden
“Respondents themselves faced financial burdens from the use of telemedicine on two levels: not being able to afford the equipment and lack of reimbursement…for costs they incurred while providing telemedicine (including the telehealth consultation itself and its associated internet/phone/data costs)” [64, p.9]
Theme 8: Broader structural impact
“[the] lack of time and staff will lead to mothers and babies going home with very little feeding support or knowledge which will have a short- and long-term impact on their health and ability to deal with infections” [72, p.7]
“I feel management will see the changes made i.e. shorter inpatient stay, increased VMS (Visiting Midwifery Service) personnel as economically beneficial and it will be difficult to revert back” [59, p.8]
“Going through this dual pandemic of COVID-19 and systemic racism is exhausting, to say the least. I reminisce of the “before” times but it’s been long overdue for the veil to be lifted - and for that reason I am grateful for the chaos” [61, p.2]
“With telehealth and remote appointments there is a lot of emphasis on self-care and being aware of your health - it is empowering for women” [69, p.5]
Confidence in the review’s findings: GRADE-CERQual
Finding | Contributing records | Methodological limitations | Coherence | Adequacy | Relevance | Overall confidence |
---|---|---|---|---|---|---|
Analytical theme 1: Altered Maternity Care (women) | ||||||
Alterations to maternity care, overall, were unsettling for women, causing increased stress, anxiety, worry, uncertainty, or dissatisfaction | 38, 40, 41, 46, 49, 50, 52, 54–56, 57 | Minor concerns | No or very minor concerns | Minor concerns | Minor concerns | High |
Uncertainty and inconsistencies surrounding maternity care were a considerable source of stress, anxiety, frustration, and dissatisfaction for women | 2, 34, 37, 39, 42, 44, 49, 56, 79 | Minor concerns | Minor concerns | Minor concerns | Minor concerns | High |
Cancelled or postponed maternity care appointments were commonly experienced leaving women feeling confused, worried, fearful, and abandoned | 2, 34, 35, 39, 43, 45–47, 49–52 | Minor concerns | No or very minor concerns | Moderate concerns | Minor concerns | Moderate |
Telehealth was noted to confer some benefits; overall, however, telehealth was problematic for women and was favoured less than in-person care | 2, 33, 34, 39, 42, 45–48, 52, 54, 55, 74, 75, 79 | Minor concerns | No or very minor concerns | Minor concerns | Minor concerns | High |
Analytical theme 2: COVID related restrictions | ||||||
Restrictions on partner attendance throughout the maternity care continuum evoked a wide array of emotions for women including intense feelings of being alone, isolated, and lonely | 2, 38–39, 42–44, 46, 47, 49, 52, 55, 56, 58, 76 | Minor concerns | No or very minor concerns | Moderate concerns | Minor concerns | Moderate |
Isolation and separation from friends and the wider family affected women in various ways (disappointment, loneliness, fear, anxiety, overwhelmed), although the wider visiting restrictions in hospital beyond partner visiting, was a positive experience for some women | 2, 34, 36–38, 40–44, 47, 49, 50, 51, 55, 56 | Minor concerns | Minor concerns | Moderate concerns | Minor concerns | Moderate |
Analytical theme 3: Infection prevention and risk | ||||||
Fear of contracting COVID-19 was prominent for women, with many fearful, worried, and wary of visiting the maternity care facility for fear of contracting the virus | 34–36, 39, 41, 43, 44, 47, 48, 50, 52, 55, 57, 75, 77 | Minor concerns | No or very minor concerns | Moderate concerns | Minor concerns | Moderate |
The interplay between balancing fear of contracting COVID-19 and the risk of not attending for care was a source of emotional conflict | 39, 46, 77 | No or very minor concerns | No or very minor concerns | Moderate concerns | Minor concerns | High |
Women were complementary and appreciative of efforts in maternity care settings to minimise virus transmission and felt reassured by these | 2, 34, 40, 44–46, 52, 58, 75 | Minor concerns | No or very minor concerns | Moderate concerns | Minor concerns | Moderate |
Analytical theme 4: “The lived reality” – navigating support systems | ||||||
Information support was affected by a lack of consistent messaging, conflicting information or a lack of clear guidance surrounding the virus and how this affected women’s care, which left women feeling lost, confused, or helpless | 37, 39, 42, 46, 49, 51, 53, 55, 56 | Minor concerns | No or very minor concerns | Moderate concerns | Minor concerns | Moderate |
Women viewed dedicated formal support from maternity care professionals as essential for their psychosocial wellbeing; however, these supports were largely diminished or lacking | 2, 34, 36, 37, 41, 42, 44, 45, 49, 51, 55, 56, 74 | Minor concerns | No or very minor concerns | No or very minor concerns | Minor concerns | High |
In navigating information support, many women resorted to alternative sources, mainly social media, television, and online sources, as well as friends, although women recognised that these alternative sources could be unreliable which caused stress and fear | 34, 38–40, 44, 47, 50, 52, 53, 55, 56 | Minor concerns | No or very minor concerns | Minor concerns | No or very minor concerns | High |
Women self-implemented solutions as a means of coping, including adjusting their plans, exploring other options for care or self-advocating to achieve the maternity care they desired or needed | 2, 37, 39, 47, 56 | Minor concerns | Minor concerns | Moderate concerns | No or very minor concerns | Moderate |
Analytical theme 5: Interactions with maternity services | ||||||
Women recounted being unable to contact or experienced fewer interactions with their care providers which led women, in general, to view their care as inadequate, sub-par, disrespectful or of poorer quality | 2, 36, 37, 39, 41, 43–47, 49, 52, 53, 74, 75 | Minor concerns | No or very minor concerns | Moderate concerns | Minor concerns | Moderate |
Some women who were positive for COVID-19 experienced what they perceived as nonprofessional and inappropriate interactions | 39, 44, 46, 47, 52, 55, 56, 77 | Minor concerns | No or very minor concerns | Minor concerns | Minor concerns | High |
Women experienced unmet expectations arising from interactions with their maternity care providers source which affected their ability to prepare properly for the arrival of their new baby | 39, 40–42, 44, 56 | Minor concerns | No or very minor concerns | Moderate concerns | Minor concerns | Moderate |
Analytical theme 6: Altered Maternity Care (maternity care providers) | ||||||
A feeling of uncertainty was dominant across providers, largely influenced by the uncertainty surrounding care protocols and the speed at which these changed, although this uncertainty lessened over time as national guidelines became available and communication of care protocols improved | 17, 60–63, 65, 66, 68, 70, 72–74 | Minor concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High |
The pandemic was considered to have exacerbated existing inequalities in maternity care | 61, 64,67–69, 71, 72, 74 | Minor concerns | No or very minor concerns | No or very minor concerns | Minor concerns | High |
The lack of access to adequate resources and training on safe practices resulted in providers limiting their interactions with women as they feared being infected and/or acting as a vector of infection | 17, 63, 65, 66, 70, 74, 77 | Minor concerns | No or very minor concerns | Minor concerns | No or very minor concerns | High |
A move to telehealth was viewed positively by some as it enabled continuation of care in a safe environment, although it was not without its limitations | 64, 67–69, 71 | Minor concerns | Minor concerns | Moderate concerns | Minor concerns | Moderate |
Analytical theme 7: Professional and Personal Impact | ||||||
The pandemic had resulted in an increased workload for maternity care providers, due to staff shortages, additional tasks, and more frequent and longer appointments | 17, 59, 62, 64–66, 68, 69, 73 | Minor concerns | Moderate concerns | Minor concerns | Minor concerns | Moderate |
Relationships with colleagues improved as maternity care providers supported each other through the uncertainty, although the pandemic also deepened divisions due to perceived staff hierarchies and disconnect between management and providers involved in direct care | 15, 59–63, 65, 66, 69, 70, 72, 74, 76, 77 | Moderate concerns | Minor concerns | Minor concerns | No or very minor concerns | Moderate |
Maternity care providers isolated themselves or restricted their interactions with family due to a fear of transmitting the virus to others, which carried a significant emotional burden | 17, 59, 61, 65, 66, 68, 69, 73, 77, 78 | Minor concerns | No or very minor concerns | Minor concerns | Minor concerns | High |
The pandemic had a negative financial impact for some providers due to reduced service demand and inadequate reimbursement for alternative services, such as telehealth | 64, 68, 73 | No or very minor concerns | No or very minor concerns | Moderate concerns | Moderate concerns | Moderate |
Analytical theme 8: Broader structural impact | ||||||
Restrictions were considered by some to have a negative impact on future health outcomes for parents and babies, while others worried that certain restrictions would be retained, and these would negatively influence future maternity care | 59, 69, 72, 76 | Moderate concerns | No or very minor concerns | Minor concerns | No or very minor concerns | High |
The pandemic was viewed as an opportunity to improve maternity care, including addressing inequalities, and implementing changes that supported parents and their babies | 15, 59, 61, 69, 73, 76, 78 | Moderate concerns | No or very minor concerns | No or very minor concerns | Minor concerns | High |
The pandemic prompted some maternity care providers to take a different perspective of their role and considered it an opportunity for professional growth | 59, 61, 66, 68, 69, 76 | Minor concerns | No or very minor concerns | Minor concerns | Minor concerns | High |