Mobilizing a Public Health Response: Supporting the Perinatal Needs of New Yorkers During the COVID-19 Pandemic

Abstract

Background/Context In March 2020 New York City became the epicenter of the COVID-19 pandemic. By mid-March, nearly all the 6500 employees of the New York City Department of Health and Mental Hygiene (NYC Health Department), the largest public health department in the nation, began working from home. Reports quickly emerged of the immense stress on hospital and public health systems, with critical personal protective equipment (PPE) shortages, lack of testing capacity, and strained emergency response. At the same time, NYC Health Department staff were hearing daily updates about a growing number of COVID-19 cases and deaths among New Yorkers. Agency home visiting staff learned that one of their colleagues had died from COVID-19, and two others became ill, with one requiring hospitalization. While in mourning for our colleagues and the city, it became apparent that, once again, Black and Brown people were disproportionately impacted by a health condition; in NYC the age adjusted rate of hospitalization and death among Black/African-American and Hispanic/Latinx people was twice as high as among White and Asian/Pacific Islander people.(NYC Health 2020a) Meanwhile the NYC Health Department continued to do its work serving pregnant and

Maternity care during COVID-19: a qualitative evidence synthesis of women’s and maternity care providers’ views and experiences

“…Of the 50 records, seven were not subjected to an assessment of methodological quality due to their study design (i.e., case report of lived experiences or study abstract) [ 33 , 38 , 54 , 58 , 60 , 61 ]. The quality of the remaining 43 records ranged from four studies meeting all 12 quality assessment criteria to two studies meeting one quality criterion only.…”

“…Many maternity care providers also believed that the pandemic exacerbated existing inequalities in maternity care. The closing of some services or moving maternity appointments to virtual or tele settings were viewed as having a greater impact on at-risk communities as this group were less likely to be able to access these types of alternative services [ 61 , 64 , 67 , 69 , 71 , 72 ]. Furthermore, some maternity care providers held the view that other providers were instigating racist or sexist practices based on inappropriate or misconstrued beliefs around the risk of COVID-19 in certain population groups, subsequently exacerbating the existing challenges that pregnant or postpartum women may already be facing [ 61 , 68 , 74 ].…”

“…The closing of some services or moving maternity appointments to virtual or tele settings were viewed as having a greater impact on at-risk communities as this group were less likely to be able to access these types of alternative services [ 61 , 64 , 67 , 69 , 71 , 72 ]. Furthermore, some maternity care providers held the view that other providers were instigating racist or sexist practices based on inappropriate or misconstrued beliefs around the risk of COVID-19 in certain population groups, subsequently exacerbating the existing challenges that pregnant or postpartum women may already be facing [ 61 , 68 , 74 ]. “Restrictions and regulations in the time of COVID-19 have allowed for a resurgence of the racist and sexist policies…Black women’s bodies have continued to be seen as risky…leading to a lack of care and touch that continues to put Black birthing people in danger” [68, p7).…”

“…There was one ‘lone voice’, however, that expressed a more positive experience in relation to workload whereby previous practices such as ‘overbooking of inductions’ ceased and ‘caesarean section lists reduced’ as part of pandemic efforts to strictly manage numbers in the hospital [ 70 ]. A further ‘silver lining’ described by maternity care providers from the experience of working on the frontline during the pandemic was ‘the bond’ it created amongst providers as they worked together [ 15 , 61 , 70 ]. The uncertainty and chaos introduced by the pandemic helped to build relationships as maternity care providers supported one another in providing care during these unprecedented times [ 61 , 62 , 66 , 74 ].…”

“…A further ‘silver lining’ described by maternity care providers from the experience of working on the frontline during the pandemic was ‘the bond’ it created amongst providers as they worked together [ 15 , 61 , 70 ]. The uncertainty and chaos introduced by the pandemic helped to build relationships as maternity care providers supported one another in providing care during these unprecedented times [ 61 , 62 , 66 , 74 ]. In some ways, life in a maternity care setting acted as a bubble to the outside world where it was perceived that people were cut off from each other to a greater extent, and the hospital was associated with a greater sense of calm and camaraderie [ 59 , 60 ].…”