Background Infectious outbreaks are known to cause fear and panic. Exploration of pregnant individuals’ psychosocial condition using a qualitative lens during an infectious outbreak is limited. In this study we explore pregnant individuals’ lived experiences as well as their psychological and behavioural responses during COVID-19 with the goal of providing useful strategies from the patient’s perspective to enable health care providers to help pregnant patients navigate this and future pandemics. Methods Pregnant individuals between 20-weeks gestation and 3 months postpartum who received maternity care from an urban academic interprofessional teaching unit in Toronto, Canada were invited to participate. Semi-structured 60 min interviews were audio-recorded, transcribed and analyzed using descriptive thematic analysis. Interview questions probed psychological responses to the pandemic, behavioural and lifestyle changes, strategies to mitigate distress while pregnant during COVID-19 and advice for other patients and the healthcare team. Results There were 12 participants, mean age 35 years (range 30–43 years), all 1 to 6 months postpartum. Six main themes emerged: 1) Childbearing-related challenges to everyday life; 2) Increased worry, uncertainty and fear; 3) Pervasive sense of loss; 4) Challenges accessing care; 5) Strategies for coping with pandemic stress; 6) Reflections and advice to other pregnant people and health care professionals. Pregnant individuals described lack of social support due to COVID-19 pandemic restrictions and a profound sense of loss of what they thought their pregnancy and postpartum period should have been. Advice to healthcare providers included providing mental health support, clear and up to date communication as well as more postpartum and breastfeeding support. Conclusions These participants described experiencing psychosocial distress during their pregnancies and postpartum. In a stressful situation such as a global pandemic, health care providers need to play a pivotal role to ensure pregnant individuals feel supported and receive consistent care throughout the pregnancy and postpartum period. The health care provider should ensure that mental health concerns are addressed and provide postpartum and breastfeeding support. Without addressing this need for support, parental mental health, relationships, parent-infant bonding, and infant development may be negatively impacted.

ObjectivesProcurement's important role in healthcare decision making has encouraged criticism and calls for greater collaboration with health technology assessment (HTA), and necessitates detailed analysis of how procurement approaches the decision task.MethodsWe reviewed tender documents that solicit medical technologies for patient care in Canada, focusing on request for proposal (RFP) tenders that assess quality and cost, supplemented by a census of all tender types. We extracted data to assess (i) use of group purchasing organizations (GPOs) as buyers, (ii) evaluation criteria and rubrics, and (iii) contract terms, as indicators of supplier type and market conditions.ResultsGPOs were dominant buyers for RFPs (54/97) and all tender types (120/226), and RFPs were the most common tender (92/226), with few price-only tenders (11/226). Evaluation criteria for quality were technical, including clinical or material specifications, as well as vendor experience and qualifications; “total cost” was frequently referenced (83/97), but inconsistently used. The most common (47/97) evaluative rubric was summed scores, or summed scores after excluding those below a mandatory minimum (22/97), with majority weight (64.1 percent, 62.9 percent) assigned to quality criteria. Where specified, expected contract lengths with successful suppliers were high (mean, 3.93 years; average renewal, 2.14 years), and most buyers (37/42) expected to award to a single supplier.ConclusionsProcurement's evaluative approach is distinctive. While aiming to go beyond price in the acquisition of most medical technologies, it adopts a narrow approach to assessing quality and costs, but also attends to factors little considered by HTA, suggesting opportunities for mutual lesson learning.

Objectives To explore the psychosocial and behavioural responses of pregnant and postpartum individuals during the COVID-19 pandemic in order to develop strategies for healthcare providers to support patients through a pandemic. Methods Mixed-methods study of patients in an urban Toronto multidisciplinary Family Health Team who were between 20 weeks pregnant and 5 months postpartum from June to August 2020. Using a questionnaire and qualitative interviews, we explored psychosocial and behavioral impacts of the COVID-19 pandemic, including access to prenatal care, lifestyle changes, and strategies for mitigating distress. Results Forty-seven pregnant (and 62 postpartum individuals responded (response rate 52%)); 12 semi structured interviews were completed. Respondents indicated a loss of freedom (93%), lonely/lack of support (66%), and nearly/totally housebound (63%). About half (46-54%) were worried/very worried for themselves ortheir baby contracting COVID-19 and 13% scored > 13 on EPDS indicating depression. Helpful strategies included keeping busy (86%), exercise (84%), and talking to their healthcare provider (79%). Qualitatively, participants expressed profound feelings of loss and persistent fear, anxiety, loneliness/isolation, and uncertainty. Adaptive behaviours included seeking mental health services, participating in online support groups, connecting with family/friends, avoiding information fatigue, and exercising. Maladaptive behaviours included overeating, becoming sedentary, and social isolation. Conclusions Notwithstanding the “normal” stresses of pregnancy andparenthood, the added burden of pandemic-related stressors may impact parental mental health and relationships, parent-infant bonding, and infant development. Understanding psychosocial and behavioural responses to pregnancy during COVID-19 will enable healthcare providers to mitigate these impacts by providing appropriate supports.