Midwives’ and maternity support workers’ perceptions of the impact of the first year of the COVID-19 pandemic on respectful maternity care in a diverse region of the UK: a qualitative study

Abstract

ObjectivesTo explore midwives’ and maternity support workers’ perceptions of the impact of the COVID-19 pandemic on maternity services and understand factors influencing respectful maternity care.DesignA qualitative study. Eleven semistructured interviews were conducted (on Zoom) and thematically analysed. Inductive themes were developed and compared with components of respectful maternity care.SettingMaternity services in a diverse region of the United Kingdom.ParticipantsMidwives and maternity support workers who worked during the first year of the COVID-19 pandemic.ResultsThe findings offer insights into the experiences and challenges faced by midwives and maternity support workers during the first year of the COVID-19 pandemic in the UK (March 2020–2021). Three core themes were interpreted that impacted respectful maternity care: (1) communication of care, (2) clinical care and (3) support for families. 1. Midwives and maternity support workers felt changing guidance impaired communication of accurate information. However, women attending appointments alone encouraged safeguarding disclosures. 2. Maternity staffing pressures worsened and delayed care provision. The health service’s COVID-19 response was thought to have discouraged women’s engagement with maternity care. 3. Social support for women was reduced and overstretched staff struggled to fill this role. The continuity of carer model of midwifery facilitated supportive care. COVID-19 restrictions separated families and were considered detrimental to parents’ mental health and newborn bonding. Overall, comparison of interview quotes to components of respectful maternity care showed challenges during the early COVID-19 pandemic in upholding each of the 10 rights afforded to women and newborns.ConclusionsRespectful maternity care was impacted through changes in communication, delivery of clinical care and restrictions on social support for women and their infants in the first year of the COVID-19 pandemic. Future guidance for pandemic scenarios must make careful consideration of women’s and newborns’ rights to respectful maternity care.

Linking Patient Safety Climate With Missed Nursing Care in Labor and Delivery Units: Findings From the LaborRNs Survey

“…Missed care may have been even more relevant in the COVID-19 pandemic because of the maternity staffing crisis. [54][55][56][57] Based on in-depth interviews with midwives and maternity support workers, maternity staffing shortages and pressures worsened and delayed nursing care provision during the pandemic. 57 In practice, seamless communication can facilitate the process of handing over cases, exchanging clinical information, and establishing a relationship with birthing people.…”

“…[54][55][56][57] Based on in-depth interviews with midwives and maternity support workers, maternity staffing shortages and pressures worsened and delayed nursing care provision during the pandemic. 57 In practice, seamless communication can facilitate the process of handing over cases, exchanging clinical information, and establishing a relationship with birthing people. However, the physical barrier of personal protective equipment provided an additional barrier to communication with birthing women and within the care team.…”

“…However, the physical barrier of personal protective equipment provided an additional barrier to communication with birthing women and within the care team. 57 Therefore, the challenge of missed perinatal care in the pandemic needs to more attention.…”

“…Data for this study were collected before the COVID-19 pandemic. Missed care may have been even more relevant in the COVID-19 pandemic because of the maternity staffing crisis 54–57 . Based on in-depth interviews with midwives and maternity support workers, maternity staffing shortages and pressures worsened and delayed nursing care provision during the pandemic 57 .…”

Self-Reported Experiences of Midwives Working in the UK across Three Phases during COVID-19: A Cross-Sectional Study

“…Outcomes in maternity care were found to have worsened due to the pandemic, with increased maternal deaths, stillbirths, and maternal depression [ 51 , 52 ]. Furthermore, studies of respectful maternity care during the pandemic found that changes in services and restrictions to social support had led to compromises in quality of care [ 53 , 54 ]. It is argued that increased staffing in maternity care can reduce incidence of post-partum haemorrhage, maternal readmission, neonate resuscitation, and epidural use [ 55 ], potentially increasing safety.…”