Precarity and preparedness during the SARS‐CoV‐2 pandemic: A qualitative service evaluation of maternity healthcare professionals

Abstract

Introduction The SARS‐CoV‐2 pandemic has devastated populations, posing unprecedented challenges for healthcare services, staff and service‐users. In the UK, rapid reconfiguration of maternity healthcare service provision changed the landscape of antenatal, intrapartum and postnatal care. This study aimed to explore the experiences of maternity services staff who provided maternity care during the SARS‐CoV‐2 pandemic to inform future improvements in care. Material and methods A qualitative interview service evaluation was undertaken at a single maternity service in an NHS Trust, South London. Respondents ( n = 29) were recruited using a critical case purposeful sample of maternity services staff. Interviews were conducted using video‐conferencing software, and were transcribed and analyzed using Grounded Theory Analysis appropriate for cross‐disciplinary health research. The focus of analysis was on staff experiences of delivering maternity services and care during the SARS‐CoV‐2 pandemic. Results A theory of “Precarity and Preparedness” was developed, comprising three main emergent themes: “Endemic precarity: A health system under pressure”; “A top‐down approach to managing the health system shock”; and “From un(der)‐prepared to future flourishing”. Conclusions Maternity services in the UK were under significant strain and were inherently precarious. This was exacerbated by the SARS‐CoV‐2 pandemic, which saw further disruption to service provision, fragmentation of care and pre‐existing staff shortages. Positive changes are required to improve staff retention and team cohesion, and ensure patient‐centered care remains at the heart of maternity care.

Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis

“…The overall study was designed as a service evaluation, the results of which have been published elsewhere [ 13 ]. As is often the case with qualitative data and with the nature of the pandemic circumstances, respondents provided much richer data than expected, allowing us to conduct subsequent analyses of the interview data.…”

“…Following grounded theory methodology [ 37 ], the theory was subjected to within-team defence, twice, when it was further refined, ratified, and approved unanimously; this ensured that no other explanations were evident. Presented here are analyses addressing the individual experiences of providing maternity care during the pandemic; analyses addressing the system-level response to reconfiguring services during the pandemic has been published elsewhere [ 13 ].…”

“…Maternity services, in particular, were reconfigured to minimise the risk of SARS-CoV-2 to both pregnant women and their babies [ 3 – 9 ]. Challenges for maternity care-providers were numerous, including shortages of resource; these were physical (e.g., lack of beds as maternity wards were converted into ‘COVID-19 wards’) [ 10 – 12 ] and human (due to staff illness, self-isolation, shielding practices, or redeployment to provide other types of care) [ 3 , 13 , 14 ]. Further, there was rapid implementation of virtual care, in an environment which was not digitally-advanced [ 3 , 13 , 15 – 18 ].…”

“…In the UK, reconfiguration of maternity care services was documented in a nationwide audit which suggested a reduction in scheduled antenatal and postnatal care appointments, an increase in provision of virtual care, and at least temporary suspension of support for homebirths, continuity of care, and midwifery-led birthing units [ 14 ]. These changes were perceived as resulting in less personal, more fragmented care for women and their babies – antenatally, intrapartum, and postnatally [ 13 , 19 – 26 ].…”

The antenatal psychological experiences of women during two phases of the COVID-19 pandemic: A recurrent, cross-sectional, thematic analysis

“…Uncertain risks of illness transmission to one’s infant or family increased stress and anxiety [ 27 ]. Antenatal and services for children aged 0–5 were deprioritised in support of the pandemic response [ 28 ] and outpatient clinics were temporarily closed to prioritize the treatment of COVID-19 patients, which left many women without access to time-sensitive maternal health care [ 29 , 30 ]. Restrictions placed on number of visitors, length of visiting hours, and opening times for pre-existing services were also implemented to minimize unnecessary exposure to COVID-19 [ 31 , 32 ].…”