Positive effects of altered maternal care during COVID-19 in Australia

By Pooja Toshniwal PahariaMay 6 2022Reviewed by Aimee Molineux

In a recent study published in Midwifery, researchers reported on the positive outcomes of the coronavirus disease 2019 (COVID-19) pandemic in maternity care in Australia.

Background

In the COVID-19 scenario, several changes to maternity care were enforced across the globe, to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among pregnant women and care providers.

Studies have reported on the negative aspects of COVID-19 on maternal care. However, evidence on the positive side of COVID-19 that could be applied to maternity care going forward is scarce.

About the study

In the present study, researchers reported on COVID-19-associated changes in maternal care that were perceived as positive by pregnant and postnatal women in Australia between 2020 and 2021. 

Data were obtained from 20 Australian women who were either pregnant or gave birth during the COVID-19 pandemic (between March and December 2020) and participated in the Birth in the time of COVID-19 (BITTOC 2020) survey-based study. In addition, 16 midwives were interviewed.

The online surveys were distributed on a national scale by consumer organizations, parenting forums, and social media. Only women aged 18 years and above, Australian residents, those who gave birth during or after March 2020, those who could write and speak English, and those who had access to internet services were eligible for the study.

Data were reviewed and analyzed by two reviewers using conventional content analysis and descriptive statistics. The primary reviewer manually coded the data and the codes were subsequently reviewed by the secondary reviewer.

Results

A total of 1,343 and 1,848 pregnant and postnatal women, respectively, responded to the survey, of which 1,280 and 827 corresponding responses were discarded as they did not mention any COVID-19-associated positive changes in maternal care. As a result, 1,021 and 635 corresponding responses were analyzed. The responses were further restricted to those with applicable suggestions to improve maternity care in the future.

The positive responses were categorized into contextual factors and maternity care-associated factors. The contextual factors were further categorized as calming factors and supporting factors.

Among the care-related categories, the most frequently reported positives were increased accessibility to online and telehealth resources and fewer visitors to the hospitals. The other positives were homebirths, their partners working from home, and continuity of care by midwives.

The reported advantages of having fewer visitors were improved bonding between the parents and the baby (30 responses), increased breastfeeding opportunities (18 responses), increased time for resting and recovery (16 responses), increased midwifery time (10 responses), and reduced pressure of socializing (seven responses). However, 15 women mentioned that they missed having their parents or their other children by their side during maternity care.

The shift to telehealth services was considered a positive outcome by 85 and 76 pregnant and postnatal women, respectively, due to increased convenience and accessibility for women at remote locations. Telehealth was also preferred in case of minor appointments such as the collection of reports and referrals. However, the women stated that telehealth should be an option and not mandatory.

A transition from the two-hour-long glucose tolerance tests to fasting glucose tests for diagnosing gestational diabetes was another positive outcome mentioned by the participants as it decreased the count of women in waiting rooms of clinics.

The continuation of care and the carer was mentioned as a positive outcome by 13 and 32 pregnant and postnatal women, respectively. The responses were related to care-taking by private midwives or a midwifery group practice (MGP). Women mentioned that the relationships built between them and the provider gave them a greater sense of control and ease during pregnancy. Homebirths were preferred by 14 and 28 pregnant and postnatal women, respectively, who also stated that Medicare or health insurance services could assist with homebirths in Australia.

Care by midwives was opted by 14 and 19 pregnant and postnatal women, respectively, who stated that private care by midwives was largely unaltered during COVID-19 compared to public midwifery care, enabled in-person appointments, and improved family participation in the pregnancy.  

Among the contextual factors, working from home partners was the most frequent supportive factor reported by 29 and 76 pregnant and postnatal women, respectively, as it provided greater time for bonding and enabled increased sharing of childcare and other responsibilities. The other supportive factor mentioned by 23 and 22 pregnant and postnatal women, respectively, was having compassionate providers. In addition, 10 and 2 pregnant and postnatal women, respectively, also appreciated their providers’ prioritization of mental health during COVID-19.

The working from home option was considered a calming factor by 45 and 8 pregnant women and postnatal women, respectively, especially when they felt tired or unwell. Increased hygiene awareness of the public during COVID-19, reflected by measures such as frequent hand-washing, was the other calming factor reported by 11 and 9 pregnant and postnatal women, respectively.

Conclusion

Overall, the study findings showed that despite the negative effects of COVID-19-associated maternity care restrictions, several changes were considered positive by pregnant and postnatal women and midwives. Such changes could be incorporated to improve maternity care in the future.