Midwives providing woman-centred care during the COVID-19 pandemic in Australia: A national qualitative study

Abstract

Background The COVID-19 pandemic has caused isolation, fear, and impacted on maternal healthcare provision. Aim To explore midwives’ experiences about how COVID-19 impacted their ability to provide woman-centred care, and what lessons they have learnt as a result of the mandated government and hospital restrictions (such as social distancing) during the care of the woman and her family. Methods A qualitative interpretive descriptive study was conducted. Twenty-six midwives working in all models of care in all states and territories of Australia were recruited through social media, and selected using a maximum variation sampling approach. Data were collected through in-depth interviews between May to August, 2020. The interviews were recorded, transcribed verbatim, and thematically analysed. Findings Two overarching themes were identified: ‘COVID-19 causing chaos’ and ‘keeping the woman at the centre of care’. The ‘COVID-19 causing chaos’ theme included three sub-themes: ‘quickly evolving situation’, ‘challenging to provide care’, and ‘affecting women and families’. The ‘Keeping the woman at the centre of care’ theme included three sub-themes: ‘trying to keep it normal’, ‘bending the rules and pushing the boundaries’, and ‘quality time for the woman, baby, and family unit’. Conclusion Findings of this study offer important evidence regarding the impact of the pandemic on the provision of woman-centred care which is key to midwifery philosophy. Recommendations are made for ways to preserve and further enhance woman-centred care during periods of uncertainty such as during a pandemic or other health crises.

Effects of the COVID-19 Pandemic and Telehealth on Antenatal Screening and Services, Including for Mental Health and Domestic Violence: An Australian Mixed-Methods Study

“…These largely align with the more general findings of this study, with midwives reporting challenges to provision of woman-centered care (20, 22), and difficulties coping with rapid changes to care (including telehealth) and "COVID-19 causing chaos" (20)(21)(22). As in this study, "silver linings" included the perceived positive impact of visiting restrictions on postnatal care (20,22). The women themselves noted the impact of navigating a changing healthcare system, the impact on preparedness in pregnancy and for parenting, and facing the uncertainty of a pandemic (23,24).…”

“…In the Australian context, a number of qualitative studies have been performed to date from the perspective of midwives regarding provision of maternity care ( 20 – 22 ) and of women regarding their maternity care experiences ( 23 , 24 ). These largely align with the more general findings of this study, with midwives reporting challenges to provision of woman-centered care ( 20 , 22 ), and difficulties coping with rapid changes to care (including telehealth) and “COVID-19 causing chaos” ( 20 – 22 ). As in this study, “silver linings” included the perceived positive impact of visiting restrictions on postnatal care ( 20 , 22 ).…”

Midwives’ experiences of providing maternity care to women and families during the COVID-19 pandemic in Northern Italy

“…The midwives found adjusting to the continuous, rapid and drastic re-organisation of maternity services, mostly based on the limited evidence available at that moment, particularly challenging. This is confirmed by Stulz et al [36] and Bradfield et al [19] , who stated that the COVID-19 pandemic was a rapidly evolving situation resulting in midwives being disoriented and confused by the constantly adaptation to new policies and management decisions, in addition to resource limitations and the need to reassure service users during uncertain times [18] .…”

Experiences of Dutch Midwives Regarding the Quality of Care during the COVID-19 Pandemic

“…However, they noticed that sometimes the quality of care was compromised [12]. In addition, qualitative studies from Belgium and Australia indicated that the midwives experienced high levels of stress because of the constantly changing measures and lack of resources which negatively affected the quality of care [13,14]. To provide a Dutch qualitative perspective, this study examined the experiences of Dutch midwives regarding the quality of care during the first two months of the COVID-19 pandemic.…”

“…However, they noticed that sometimes the quality of care was compromised [ 12 ]. In addition, qualitative studies from Belgium and Australia indicated that the midwives experienced high levels of stress because of the constantly changing measures and lack of resources which negatively affected the quality of care [ 13 , 14 ].…”