The Impacts of COVID-19 on US Maternity Care Practices: A Followup Study

Abstract

This article extends the findings of a rapid response article researched in April 2020 to illustrate how providers’ practices and attitudes toward COVID-19 had shifted in response to better evidence, increased experience, and improved guidance on how SARS-CoV-2 and COVID-19 impacted maternity care in the United States. This article is based on a review of current labor and delivery guidelines in relation to SARS-CoV-2 and COVID-19, and on an email survey of 28 community-based and hospital-based maternity care providers in the United State, who discuss their experiences and clients’ needs in response to a rapidly shifting landscape of maternity care during the COVID-19 pandemic. One-third of our respondents are obstetricians, while the other two-thirds include midwives, doulas, and labor and delivery nurses. We present these providers’ frustrations and coping mechanisms in shifting their practices in relation to COVID-19. The primary lessons learned relate to improved testing and accessing PPE for providers and clients; the need for better integration between community- and hospital-based providers; and changes in restrictive protocols concerning labor support persons, rooming-in with newborns, immediate skin-to-skin contact, and breastfeeding. We conclude by suggesting that the COVID-19 pandemic offers a transformational moment to shift maternity care in the United States toward a more integrated and sustainable model that might improve provider and maternal experiences as well as maternal and newborn outcomes.

Experiences of health care providers on pregnancy and childbirth care during the COVID-19 pandemic in Iran: a phenomenological study

“…Accordingly, the desire of mothers also increased to give birth in private hospitals, because there is no home birth in Iran. This finding falls in line with the results from Gutschow et al [ 21 ] in the United States, healthy pregnant women increasingly seek to give birth out-of-hospital. Also, the results of a study conducted in 81 countries were in line with our results [ 5 , 21 ].…”

“…It is now clear that a decentralized approach to maternity care, which includes the use of a variety of facilities such as maternity care centers and midwifery home care for low-risk women with access to higher-level facilities where needed, results in better outcomes and is more cost-effective and woman-centered. Accordingly, flexible models of midwifery care can be used to ensure quality maternity care in the context of COVID − 19 pandemic as well as other similar critical situations in the future [ 21 , 26 ]. We hope that providers and policymakers will use the lessons learned from the COVID-19 pandemic to make fundamental changes in midwifery services in Iran and support and establish a decentralized maternity care model that integrates midwives with obstetricians and community birth providers with hospitals.…”

“…Gutschow et al (2021) believe that dialogue between all kinds of maternity care providers (midwives and obstetricians) promotes evidence-based care and it is better for obstetricians to consider midwives as colleagues rather than subordinates personnel [ 21 , 26 ]. In the context of the COVID-19 pandemic, promoting inter-professional collaboration should be known as a priority to ensure providing efficient and quality care [ 33 ].…”

The role of doulas in providing breastfeeding support during the COVID-19 pandemic

“…Doulas were able to provide families with birth information and virtually support their clients during labor. The exclusion of doulas also critically impacted hospital staff, who expressed dismay that they could not provide women in labor and postpartum with tailored support during this period; in this situation, the presence of doulas in the hospital would have been beneficial [ 26 , 38 ].…”

Postnatal Unit Experiences Associated With Exclusive Breastfeeding During the Inpatient Stay: A Cross-Sectional Online Survey

“…Inpatient breastfeeding facilitators from patient perspectives are especially critical in the context of COVID-19, as this is “a transformative moment to shift maternal care” (Gutschow & David-Floyd, 2021). Researchers found that birthing parents experienced less early postpartum contact during inpatient care through the pandemic (Brown & Shenker, 2021; Perrine et al, 2020), which helped some establish and maintain breastfeeding while for others the reduced contact created and exacerbated infant feeding issues (Brown & Shenker, 2021).…”