Access to and Quality of Healthcare for Pregnant and Postpartum Women During the COVID-19 Pandemic

Abstract

Introduction: During the COVID-19 pandemic, obstetric care has adopted new precautions to ensure services can be maintained for pregnant women. The aim of this study was to describe access to and quality of obstetric care for pregnant and postpartum women during the COVID-19 pandemic and to identify factors that predict quality of care at this time.Methods: Between May 3 and June 28, 2020, we recruited women who were pregnant or within the first 6 months after delivery to participate in an online survey. This included questions on access to obstetric healthcare (type and place of health care provider, changes to obstetric appointments/services, appointment preferences) and the Quality of Prenatal Care Questionnaire (QPCQ).Results: Of the 917 eligible women, 612 (67%) were pregnant and 305 (33%) were in the first 6 months after delivery. Sixty-two percent (n = 571) reported that COVID-19 had affected their healthcare; appointments were rearranged, canceled or occurred via virtual means for 29% (n = 166), 29% (n = 167), and 31% (n = 175) of women, respectively. The majority preferred to physically attend appointments (74%; n = 676) and perceived the accompaniment of birth partners as important (77%; n = 471). Sixty-two percent (n = 380) were permitted a birth partner at delivery, 18% (n = 111) were unsure of the rules while 4% (n = 26) were not permitted accompaniment. During pregnancy, QPCQ was negatively associated with disruption to obstetric services including exclusion or uncertainty regarding birth partner permissions [F(7, 433) = 11.5, p < 0.001, R2 = 0.16] while QPCQ was negatively associated with inadequate breastfeeding support postpartum [F(1, 147) = 12.05, p = 0.001, R2 = 0.08].Conclusion: Pregnant and postpartum have experienced disruption in their access to obstetric healthcare. Perceived quality of obstetric care was negatively influenced by cancellation of appointment(s), suspension of services and exclusion of birth partners at delivery. During this time, continuity of care can be fulfilled via virtual and/or phone appointments and women should receive clear guidance on changes to services including birth partner permissions to attend delivery.

Quality and satisfaction with care following changes to the structure of obstetric care during the COVID-19 pandemic in a safety-net hospital in Georgia: Results from a mixed-methods study

“… 5 , 6 However, it is higher than responses found by Brislane et al in an online, global survey, where mean subscale responses on the same instrument (Quality of Prenatal Care Questionnaire) ranged from 3.4 to 4.1. 3 It is possible that respondents in single health system studies tended to rate their quality higher compared to respondents recruited online from a general population. Population average responses remained high (∼5) for all subscales in our study; however, several participants endorsed poor quality indicators including feeling rushed, that the provider was rude, and that test results were not explained in a way they could understand.…”

“… 2 Health systems implemented a wide variety of changes to obstetric care, including the introduction of telehealth, limits on support persons at delivery or prenatal visits, and reduced-frequency prenatal visits. 2 , 3 Emerging evidence shows that reduced-frequency in-person prenatal care visits during the pandemic were not associated with worse birth or obstetric outcomes. 2 , 4 One survey conducted in a privately-insured Michigan suburban health system suggests most patients found that virtual visits were lower quality than in-person care (72.9%) but reported satisfaction with the visits (77.5%).…”

“… 6 One global online survey of quality showed that pregnant people who faced limits to support people in labor reported lower overall quality of prenatal care. 3 However, these data are all from majority-white, high socioeconomic status (e.g., privately-insured and/or majority college educated) populations and may not reflect experiences in safety-net hospitals, who serve communities most impacted by the COVID-19 pandemic.…”

Assessing Perception of Prenatal Care Quality Among Black Women in the United States

“…The study revealed that women would benefit from guidance on birth options, COVID-19 risks and safety, general pregnancy-related information, and coping with postpartum loneliness. 31 More knowledge about the quality of prenatal care could lead to targeted interventions and resources to ultimately improve maternal and child health among Black families. The investment in ensuring access to prenatal care in the United States may need to pivot to embrace assurance of quality alongside quantity.…”

Pregnant under quarantine: Women's agency and access to medical care under Wuhan's COVID-19 lockdown

“…Pregnant women have experienced fears of infection, especially at hospitals ( Davis-Floyd et al, 2020 ; Goyal et al, 2021 ), and anxiety about potential difficulties accessing medical care ( Overbeck et al, 2020 ). Many women have experienced some curtailment of in-person care appointments ( Altman et al, 2021 ; Blankstein Breman et al, 2021 ; Brislane et al, 2021 ; Goyal et al, 2021 ) and changes to the frequency of checkups ( Montagnoli et al, 2021 ; Rudrum, 2021 ). Many women have reported anxieties about changeable hospital policies that restricted the presence of support persons during delivery and enforced isolation during labor and after birth ( Blankstein Breman et al, 2021 ; Brislane et al, 2021 ; Davis-Floyd et al, 2020 ; DeYoung & Mangum, 2021 ; Gutschow & Davis-Floyd, 2021 ; Rudrum, 2021 ).…”