Introduction
Methods
Design
Participants
Data collection
Data analysis
Ethics
Results
Demographics
Category | Interview participants |
---|---|
Gender | |
Male | 3 |
Female | 12 |
Profession | |
Allied Health Professionala | 2 |
Midwife | 2 |
Nurse | 2 |
Obstetricianb | 5 |
Perinatal Support Workersc | 4 |
Years of experience | |
< 5 | 2 |
5 to 9 | 5 |
10 to 19 | 5 |
20 + | 3 |
Ontario region of practiced | |
Eastern | 10 |
Greater Toronto Area (GTA) | 2 |
Central | 2 |
Northern | 1 |
Theme 1. Impacts of COVID-19 on perinatal providers
Subtheme: Psychosocial stress |
“….I was raising my son, and working and pregnant, and then all of a sudden, the pandemic hit right? Everything shut down March for me and I was due at the end of April. So with that I was forced to go off work about a month and a half earlier than I was going to. I was working like crazy because financially like we couldn't afford for me not to be working. So when I wasn't allowed to work my stress just like through the roof … had my baby in May and I stayed off for six months because that's what made me and my husband felt safe in doing with our family. …. I stayed off longer than I normally would have if there wasn't a pandemic.” (Interview 6, Thunder Bay Registered Massage Therapist) |
“… I think we still felt the pandemic drain … Some of our nurses were shuffled around a little bit which I know was incredibly draining for them. And then, especially because it was so many unknowns and it seemed like directors were changing….Especially early on when we were just getting a handle on things like a lot of contradictory information that would come out day to day, which is just a bit of a mental drain and I think it was quite stressful and just that added drain coming to work. And then you know the fear for patients as well that they wouldn't always be upfront with us because they would worry that it would impact their care. So if they were having any COVID symptoms they would often lie and say they weren’t because they thought they wouldn’t be seen. And then you walk into a room without full PPE [personal protective equipment] and you find a patient coughing away, and you're like, oh thank you for exposing me, if you would have told us we could have just put on our PPE but they didn’t tell us because they were worried we wouldn't see them- which would never have been the case.” (Interview 10, Toronto Ob/Gyn Resident) |
Subtheme: Healthcare system barriers |
" I can only speak to my realm as a physician and surgeon, and it has made it exceedingly challenging and exceedingly stressful for the families and also for the care teams. Things take longer, there was a lot of uncertainty in protocol, uncertainty in personal protective equipment-what was required, what wasn't. … we're trying to protect ourselves and others 'cause we don't want to be a vector of infection, but at the same time every second that we take delayed by donning and doffing PPE, scrubbing and scrubbing could result in an adverse outcome. … It makes going to work much more challenging and stressful knowing that everyone is on edge, the demands are high, the resources are low. Whether that's because there's a gap in the supply chain, whether that's because there are people off work because they're quarantining or they're unvaccinated so they’re no longer able to work. With less hands on deck the work still needs to get done." (Interview 5, Toronto Ob/Gyn Resident) |
“…. we've had to change our whole clinic structure …. so our office wasn’t IPAC compliant [Infection and Prevention Control (ICAP) Canada]- meaning that…for infection control… We had to change our whole clinic in terms of [IPAC]… we needed new flooring, new couches. All of the nice kind of stuff that made our office feel homey is all gone. Definitely the whole infection control, so just kind of the rigorous cleaning and all of that stuff …. The masking is definitely one thing and then we changed our whole clinic schedule in terms of how often we're seeing people and if some of their appointments are now virtual as opposed to in person.” (Interview 11, Ottawa Indigenous Midwife) |
Subtheme: Healthcare system opportunities |
“I actually really love how it [COVID-19] opened up everything- to make it even more flexible …. Even for things like family physicians they were never able to bill for phone visits or doing other things and now OHIP [Ontario Health Insurance Program] kind of included different codes for them to also be able to be more flexible in how they care for patients which is super awesome. Because you don’t necessarily have to be displaced to have access to good care. If you just have questions, if you just need something faxed somewhere, like if you need a note, like it just more easy to do… And then the flexibility for people to have video appointments … if it’s a time where I don’t necessarily need to see them in person. I really notice people like it. I like it myself” (Interview 1, Ottawa Midwife) |
“COVID for me was a bit of a godsend… because I made more changes that I had wanted to do in 7 weeks than I did in 7 years… So … we work incredibly hard developing policies and protocols to keep patients safe and keep providers safe. So everything from PPE protocols to categorizing risks in patients … before we had COVID testing to spacing patients out, decreasing the number of visits. A lot of virtual care which I think is wonderful and that would have taken longer to adopt and adapt… And as a leader going through that I probably put in 100 h weeks, but I loved it, because it was a challenge.” (Interview 2, Ottawa Ob/Gyn) |
Theme 2. Providers’ perceived impacts of COVID-19 on pregnant people
Subtheme: Patient psychosocial stress |
“…what I did see was more things affecting people in the postpartum period…. around week four- week three or week four…I'm really lonely. I feel like I'm losing my mind like and I feel like… I think everybody is dealing with mental health issues right now Thanks COVID. … I feel like with new families that isolation really kicked in.” (Interview 8, Waterloo Doula) |
“I think COVID has instilled fear. …. And just people are anxious and then postpartum depression is through the roof. Because people can't have, you know everybody over to come and help support them. … afraid of having anybody come over, and afraid of … the baby getting COVID or somebody bringing sickness into the home… and then people who were completely isolated and not having you know, help from their grandma or their auntie or their mom or their friends, so people are sitting at home with a crying, screaming baby, and if your partner has gone back to work? Yeah, it's sad.” (Interview 11, Ottawa Indigenous Midwife) |
Minor Theme: Social and emotional support roles |
“…people were feeling alone and grieving what their pregnancy and birth experience and early post-birth experience was going to be. And so we were doing all kinds of free Zoom drop-ins every week where people could just come and share.” (Interview 9, Ottawa Social Worker) |
“… I think those early ones I had like some due you know March, April, May in those early days and I would spend just hours like crying on Zoom together. It’s loss, like everything was geared up for this type of experience. And to lose that, for those now, who..for those who got pregnant and well I can’t have a doula there.. they kind of didn’t have that expectation but I found in the early part of the pandemic that was the hardest part- it was crushing. It was really crushing for those who were expecting the support.” (Interview 14, Ottawa Doula) |
Subtheme: Amplification of existing healthcare barriers |
“A lot [of northern Indigenous patients]… come and be admitted for care and then they’d have to quarantine for two weeks before they could go home. And I think it was extremely challenging and extremely isolating. I think there was a few presentations that we saw that were probably later than necessary because patients were hesitant to seek care and resistant to wanting to travel south for care unless it was absolutely necessary. And not even just the isolation, I mean that would suck too, but I'm not, I'm not sure that all of them were… like on paid leave, you know. I’m not sure what kind of financial impact that would have on their ability to care for their families if they were, you know, taken out of work for two weeks on top of however long they needed to be down here.” (Interview 10, Toronto Ob/Gyn Resident) |
“Transportation can be a barrier for a lot of our clients, and I find one of the biggest barriers right now in the pandemic is definitely for women that have other children at our office. Right now, we are not allowing children into the office. You can now bring one support person with you, but nobody else… Typically, you wanna bring your partner with you, but they might have to stay home to look after the other child. So I definitely think the pandemic and the rules kind of implemented on healthcare facilities right now is a huge barrier to care. And midwifery is really based on… the whole family, and…I really miss having…kids involved and partners involved 'cause it's just not the same, right now.” (Interview 11, Ottawa Indigenous Midwife) |
Subtheme: Influences on reproductive decision-making |
“A year and a half in, looking back on it, I think the biggest change and I guess barrier is the lack of having a partner present for visits. In our site the partner is not present for prenatal visits or for ultrasounds, for example. For months they were not allowed to stay in hospital after the baby was born. You know, in the very early days, some of them weren't even present for the births of their own babies…So it's gotten so much better than it used to be and yet I still have patients that are referred to me that choose not to come and see me because they can't have their partner present at their visits….” (Interview 4, Kingston Ob/Gyn) |
“I think it [COVID-19] changed it for a lot of people. Because now what we are seeing… we're seeing a lot of people who are coming in with like crazy high anxiety and you can totally understand and appreciate that… but you know or people coming with really like strict birth plans because they've lost so much control over their lives they try to assert control in another area.” (Interview 13, Ottawa Registered Nurse) |
Theme 3. COVID-19 vaccine discourse
Subtheme: Provider empathy |
“But of all the populations the one where I have a tremendous amount empathy is pregnant individuals. As much as I believe the data would support there is no risk to the fetus …. You know it’s a time when women or pregnant individuals quit smoking, they take care of themselves, they worry about every sniffle. And having a vaccine that, let's be honest, it's very new, it’s a new generation of vaccines… And then there's all the misinformation” (Interview 2 Ottawa Ob/Gyn) |
“I mean, there's a lot of challenges still around vaccination. … It's sort of this narrative that if somebody is vaccinated that they're safe. And of course, we know that's not true…. so I do have some concerns just around that narrative of this doula is safe and this one is unsafe… Also, concerning, of course, is restrictions around support people and now some restrictions around support people being vaccinated, so I just can't even imagine someone not being able to have their partner there you know at their birth, because of that, because of their partner’s status so that’s disappointing to me.” (Interview 12, Ottawa Doula) |
Subtheme: Vaccines and patient family dynamics |
“…I’ve had so many conversations like, ‘oh my mother in law refuses to be vaccinated, but then my mother refuses to come visit me because I still see her because she’s my only source of childcare and I don’t know what to do and it’s causing a huge fight. So the dynamics of inter-family and support and the effect that it has on I think their emotional status in pregnancy ….Folks have really been suffering.” (Interview 1, Ottawa Midwife) |
“Some families have been really separated by pandemic travel restrictions. So their initial plan for support was family would come, from the States or from overseas or different provinces even. And then they can't get here. So they're alone. Currently, of course with the vaccines. It's an ongoing discussion in all of our [prenatal] classes that families are really struggling with how to set appropriate limits and make decisions around who can come visit or support them if they have a vaccine, don't have a vaccine, if they work in a higher risk environment in the community, or not, and so this additional pressure is pretty high.” (Interview 9, Ottawa Social Worker) |
Minor theme: Patient vaccine hesitancy |
“I have a patient… who has COVID. So talking to her about signs and symptoms, and of course she’s not vaccinated… And you don’t want to say I told you so, because I’m sure I talked to her multiple times about getting the vaccine. It's frustrating to see. Like hopefully she’s gonna be fine and most pregnant women who get COVID are going to be fine… but you know, it's frustrating to see this. You know the potential risk that they're putting themselves at when we know that the vaccine is safe, and the vaccine provides protection not just for her, but also it actually provides protection for the baby after delivery …But we are competing against this crazy misinformation.” (Interview 2, Kingston Ob/Gyn) |
“….I have disappointingly high prevalence of unvaccinated people. I should count to be fair, but at [clinic] I think it's about 50:50. So the people that come in and I ask them if they're vaccinated and they say no … The people who are truly vaccine hesitant, at least in pregnancy, I’m not able to shift that position.…. The other thing… our hospital currently does not allow unvaccinated partners to stay in the hospital. So they can come for the birth of the baby but then they have to leave afterwards. And that policy has been in place for a couple months now and I'm still surprised at how little shift there's been in partner vaccination because I would have thought that that would …would be a stimulus… And we have to kind of maintain that professional, compassionate background even, even though sometimes it makes you very frustrated.” (Interview 4, Kingston Ob/Gyn) |
Minor Theme: COVID-19 related misinformation |
“I think that's the thing about the Internet is that with enough looking you can find people and information to support whatever your position is. So if you’re a person who is vaccine hesitant you can find a whole community with a whole bunch of information, much of which is misinformation.” (Interview 4, Kingston Ob/Gyn) |
“People are using- which I commend them for- the Internet, to try to educate themselves. But there's such an epidemic of misinformation that it has clouded certain individuals’ beliefs of what should be done, what’s effective and what’s evidence-based. …you’re having to talk them down, to dispel myths, to use extra time and resources to counteract some of those ill effects of this misinformation. Or perhaps you’ll involve other services because now they may have anxiety or mental health issues that need to be addressed.” (Interview 5, Toronto Ob/Gyn Resident) |
Theme 4. Virtual pregnancy care
Subtheme: Disadvantages of virtual pregnancy care |
“I hate virtual. I don't think it's the same as sitting with somebody and being present with them, and being able to touch them if they're telling you something emotional. …You don’t give a client, a hug after they have their baby, which is what we used to always do. So I think virtual has helped us, you know, can keep that access with people. But it’s not the same. And it's limiting, right? Like some people don't have access to a computer or a cell phone … They can't afford that, so it's definitely there's the good and the bad with kind of how everything has had to change in COVID, I feel. But it's definitely impacted the relationship that midwifery tends to build with clients and we don't meet the partners, we don't meet their kids until, maybe we see them in the postpartum, but especially for me, having repeat clients, I want to see their previous kids 'cause I was with them when they had those babies.” (Interview 11, Ottawa Indigenous Midwife) |
“I think it's a lot easier to build a trusting therapeutic relationship when you are meeting someone face to face rather than on video. And I think it’s just, I don’t know I find video conferences sometimes a little awkward because you don't wanna, conversation just doesn't seem to be as organic like you don't wanna interrupt and I feel like some of the things that patient might have just snuck in and mentioned like off the cuff are not going to come through in video chat in the same way that they would… in a face to-face conversation.” (Interview 10, Toronto Ob/Gyn Resident) |
Subtheme: Benefits of virtual pregnancy care |
“Coming to a hospital, waiting in an office, taking half a day off work for the individual, waiting late for a five-minute appointment, it’s inconvenient for patients, it costs money for patients, it's disruptive to their families… I mean I think there's something about the human touch and being in a room with somebody…it’s [virtual care] 80% as good, but it’s 80% better than being in an office during COVID with someone coughing next to you.” (Interview 2, Ottawa Ob/Gyn) |
“…Being allowed to communicate with the care provider virtually…. keeping that aspect has been really valuable. Being able to upload videos for example… they can show me stuff … this happened at 3:00 o'clock in the morning and they can show me.” (Interview 7, Kitchener-Waterloo Lactation Consultant/Prenatal Educator) |
Subtheme: Adaptation of standard care practices |
“One of the things that we happily decide to do about a year ago is to start to do podcasts, and the first one we did was about COVID and pregnancy… I did another on the vaccine… So, you know, we're basically fighting misinformation on social media with true information. … I think that helped to allay lot of fears, … because we were so proactive in talking to our patients and providing them with the information… [the pandemic] really, made people be more creative in terms of how they get the information out there, which I think has been good.” (Interview 3, Kingston Ob/Gyn) |
“So obviously just not having the capability to be there in person was a huge change. We did do extra prenatal appointments to prepare people…. we would practice out common labor scenarios, but do it over the video call. … we had a whole list of them that were more advocacy and intervention based … …. And we gave them a lot more information than we had before because we weren't there. So one of the things that we do with all of our clients is created labor cheat sheet. So a list of all the different positions and pain management, natural pain management things that we've shown them” Interview 8 Waterloo Doula |