Applying Lessons Learned from the COVID‐19 Pandemic to Future Threats to the Perinatal Care System

Abstract

Introduction Health care systems will continue to face unpredictable challenges related to climate change. The COVID‐19 pandemic tested the ability of perinatal care systems to respond to extreme disruption. Many childbearing people in the United States opted out of the mainstream choice of hospital birth during the pandemic, leading to a 19.5% increase in community birth between 2019 and 2020. The aim of the study was to understand the experiences and priorities of childbearing people as they sought to preserve a safe and satisfying birth during the time of extreme health care disruption caused by the pandemic. Methods This exploratory qualitative study recruited participants from a sample of respondents to a national‐scope web‐based survey that explored experiences of pregnancy and birth during the COVID‐19 pandemic. Maximal variation sampling was used to invite survey respondents who had considered a variety of birth setting, perinatal care provider, and care model options to participate in individual interviews. A conventional content analysis approach was used with coding categories derived directly from the transcribed interviews. Results Interviews were conducted with 18 individuals. Results were reported around 4 domains: (1) respect and autonomy in decision‐making, (2) high‐quality care, (3) safety, and (4) risk assessment and informed choice. Respect and autonomy varied by birth setting and perinatal care provider type. Quality of care and safety were described in relational and physical terms. Childbearing people prioritized alignment with their personal philosophies toward birth as they weighed safety. Although levels of stress and fear were elevated, many felt empowered by the sudden opportunity to consider new options. Discussion Disaster preparedness and health system strengthening should address the importance childbearing people place on the relational aspects of care, need for options in decision‐making, timely and accurate information sharing, and opportunity for a range of safe and supported birth settings. Mechanisms are needed to build system‐level changes that respond to the self‐expressed needs and priorities of childbearing people.

The Impact of the COVID-19 Pandemic on Neonatal Services: A Review Article

“…The disruption of routine immunization programs, maternal and newborn health services, medical supplies and equipment shortages, and healthcare worker shortages have increased maternal and neonatal mortality rates (22). Governments must prioritize investments in strengthening their healthcare systems to ensure that essential neonatal care services are not compromised during future pandemics or emergencies.…”

The Heat is On: Imperative for Midwifery Engagement in Climate Change

“…Two commentaries call our attention and action to the effects of climate change on perinatal mental health and to the devastating effects plastics are causing to human and environmental health 10,11 . Two other articles examine outcomes of the COVID‐19 pandemic and suggest how lessons learned in that situation may transfer to actions needed to reduce climate change and address impacts on health 12,13 . And finally, in a surprising reversal of direction, a framework of vulnerability to climate change is adapted in developing a new maternal adaptive capacity theory.…”

“…10,11 Two other articles examine outcomes of the COVID-19 pandemic and suggest how lessons learned in that situation may transfer to actions needed to reduce climate change and address impacts on health. 12,13 And finally, in a surprising reversal of direction, a framework of vulnerability to climate change is adapted in developing a new maternal adaptive capacity theory. This theory, proposed for use in future research, focuses on maternal strengths and how to remain well during pregnancy despite existing risks.…”