Facing the COVID-19 pandemic inside maternities in Brazil: A mixed-method study within the REBRACO initiative

Abstract

Introduction COVID-19 pandemic posed major challenges in obstetric health care services. Preparedness, development, and implementation of new protocols were part of the needed response. This study aims to describe the strategies implemented and the perspectives of health managers on the challenges to face the pandemic in 16 different maternity hospitals that comprise a multicenter study in Brazil, called REBRACO (Brazilian network of COVID-19 during pregnancy). Methods Mixed-method study, with quantitative and qualitative approaches. Quantitative data on the infrastructure of the units, maternal and perinatal health indicators, modifications on staff and human resources, from January to July/2020. Also, information on total number of cases, and availability for COVID-19 testing. A qualitative study by purposeful and saturation sampling was undertaken with healthcare managers, to understand perspectives on local challenges in facing the pandemic. Results Most maternities early implemented their contingency plan. REBRACO centers reported 338 confirmed COVID-19 cases among pregnant and post-partum women up to July 2020. There were 29 maternal deaths and 15 (51.8%) attributed to COVID-19. All maternities performed relocation of beds designated to labor ward, most (75%) acquired mechanical ventilators, only the minority (25%) installed new negative air pressure rooms. Considering human resources, around 40% hired extra health professionals and increased weekly workload and the majority (68.7%) also suspended annual leaves. Only one center implemented universal screening for childbirth and 6 (37.5%) implemented COVID-19 testing for all suspected cases, while around 60% of the centers only tested moderate/severe cases with hospital admission. Qualitative results showed that main challenges experienced were related to the fear of the virus, concerns about reliability of evidence and lack of resources, with a clear need for mental health support among health professionals. Conclusion Study findings suggest that maternities of the REBRACO initiative underwent major changes in facing the pandemic, with limitations on testing, difficulties in infrastructure and human resources. Leadership, continuous training, implementation of evidence-based protocols and collaborative initiatives are key to transpose the fear of the virus and ascertain adequate healthcare inside maternities, especially in low and middle-income settings. Policy makers need to address the specificities in considering reproductive health and childbirth during the COVID-19 pandemic and prioritize research and timely testing availability.

Excess maternal mortality in Brazil: Regional inequalities and trajectories during the COVID-19 epidemic

“…It can be observed that the increase in deaths by these causes coincided with the peaks of COVID-19 in the country ( S2 Table ). In general, the overloaded medical-hospital network (especially in the North and Northeast regions) [ 35 ], in addition to patients’ reluctance to go to health services during the pandemic due to fear of contamination by SARS-CoV-2, the increasing number of confirmed COVID-19 new cases among healthcare professionals, a lack of personal protective equipment, limited precautions against infection, or even premature deaths among healthcare professionals [ 15 , 36 ] may have diminished the already limited provision and utilization of maternal healthcare services.…”

“…Between 1990 and 1999, the number of maternal deaths in the country fell significantly, followed by a relatively stable pattern between 2000 and 2013, then a slight drop between 2017 and 2019 [10]. However, recent studies suggest a reversal in the decreasing pattern of maternal deaths [11][12][13] because of serious failings in the COVID-19 epidemic's management in Brazil [14,15].…”

Role of biomarkers (sFlt-1/PlGF) in cases of COVID-19 for distinguishing preeclampsia and guiding clinical management

“…The present research is part of a large prospective cohort study included in REBRACO – Brazilian Network of COVID-19 in Obstetrics – a multicenter study of 15 Brazilian referral centers from different regions across the country aiming to understand the burden of disease on maternal and perinatal outcomes related to COVID‐19 infection, with the University of Campinas (Unicamp) as coordinating center [ [14] , [15] ]. At Unicamp, SARS-CoV-2 quantitative reverse transcriptase polymerase-chain-reaction (RT-qPCR) assay testing for suspected cases started in April 2020 and routine universal screening was implemented in June 2020.…”

The effect of the staff development program on nursing evidence-based performance regarding Covid -19 pandemic in the obstetrics - gynaecology and paediatrics departments

“…Just as critically, there are significant concerns regarding the indirect effects of the pandemic on the access and availability of healthcare services, especially for women's health. Unlike other clinical conditions or elective procedures, obstetric care cannot be postponed, childbirth cannot be rescheduled, and low-resourced settings face a significant challenge in ascertaining proper care (Costa et al, 2021).…”

“…Continuous training programs, application of evidence-based protocols and cooperative initiatives and leadership are crucial to removing the fear of the virus and attaining adequate healthcare inside maternity and child wards, especially in low and middle-income settings. (Costa et al, 2021).…”