The impacts of the COVID-19 pandemic on birth satisfaction in a prospective cohort of 2,341 U.S. women

Abstract

Problem Birth satisfaction is an important health outcome that is related to postpartum mood, infant caretaking, and future pregnancy intention. Background The COVID-19 pandemic profoundly affected antenatal care and intrapartum practices that may reduce birth satisfaction. Aim To investigate the extent to which pandemic-related factors predicted lower birth satisfaction. Methods 2,341 women who were recruited prenatally in April-May 2020 and reported a live birth between April-October 2020 were included in the current analysis. Hierarchical linear regression to predict birth satisfaction from well-established predictors of birth satisfaction (step 1) and from pandemic-related factors (step 2) was conducted. Additionally, the indirect associations of pandemic-related stress with birth satisfaction were investigated. Findings The first step of the regression explained 35% of variance in birth satisfaction. In the second step, pandemic-related factors explained an additional 3% of variance in birth satisfaction. Maternal stress about feeling unprepared for birth due to the pandemic and restrictions on companions during birth independently predicted lower birth satisfaction beyond the non-pandemic variables. Pandemic-related unpreparedness stress was associated with more medicalized birth and greater incongruence with birth preference, thus also indirectly influencing birth satisfaction through a mediation process. Discussion Well-established contributors to birth satisfaction remained potent during the pandemic. In addition, maternal stress and restriction on accompaniment to birth were associated with a small but significant reduction in birth satisfaction. Conclusion Study findings suggest that helping women set flexible and reasonable expectations for birth and allowing at least one intrapartum support person can improve birth satisfaction.

Parental experiences with changes in maternity care during the Covid-19 pandemic: A mixed-studies systematic review

“…Additionally, mothers (14.5% to 97%) were made to wear masks or even PPE during labour, birth, breastfeeding and throughout their hospital stay regardless of their COVID-19 status [35] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , 13% of mothers were annoyed by having to wear PPE during labour [35] , [48] . Another mother shared how the mask-wearing impaired mother-child bonding, as her newborn was unable to see her face [50] .…”

“…Restricted access to maternity healthcare services was associated with a higher risk of psychological distress and mental health impairment [62] . In-person appointments were often suspended, rescheduled, or converted to virtual or telemedicine [31] , [37] , [49] . The suspension of in-person pregnancy-related services led to some mothers giving up on pregnancy care [31] , [37] , and caused others to feel anxious, neglected, sad, frustrated [37] , lonely [30] , and fearful of not receiving desired treatment [63] .…”

“…The suspension of in-person pregnancy-related services led to some mothers giving up on pregnancy care [31] , [37] , and caused others to feel anxious, neglected, sad, frustrated [37] , lonely [30] , and fearful of not receiving desired treatment [63] . Altered appointments also reduced birth satisfaction [49] and maternal perception of quality of care [37] . Moreover, approximately 70% of mothers who changed their birth plan due to COVID-19-related reasons reported experiencing some level of distress [64] .…”

Childbirth Satisfaction during the COVID-19 Pandemic in a Hospital in Southwestern Spain

“…This meant maintaining and reinforcing restrictions within the hospital, not only for COVID-19-infected women, but preventively for all others, since vaccination had not yet been started in pregnant women [ 26 ]. These restrictions and changes in care are associated with low satisfaction with care received [ 20 , 27 ].…”

“…We cannot affirm the cause of this result, although it could be because the actual companion was not who was chosen prior to childbirth; we found somewhat lower satisfaction scores among women whose companion was not who they had initially chosen. A prospective longitudinal study carried out at the beginning of the pandemic found that restrictions on companions negatively affected satisfaction, along with other factors, such as the stress perceived by the woman or the use of a mask [ 27 ]. No other factors related to satisfaction were found in this study; however, other previous studies found that a lower level of education is associated with greater satisfaction [ 14 ], that the type of childbirth influences satisfaction [ 30 , 32 ] and that spontaneous onset of labor is associated with higher satisfaction [ 14 , 30 ].…”