Abstract
Abstract
Background
Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom – a region of high ethnic diversity with varied levels of social complexity.
Methods
We conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research.
Analysis & findings
Maternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) ‘Reflective decision-making’; 2) ‘Pragmatic decision-making’; and 3) ‘Reactive decision-making’. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decision-making, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service.
Conclusions
Decision-making within maternity care was found to take three forms – where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and change-making in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation.
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynecology
Reference65 articles.
1. Lillie PJ, Samson A, Li A, Adams K, Capstick R, Barlow GD, Easom N, Hamilton E, Moss PJ, Evans A, Ivan M. Novel coronavirus disease (Covid-19): the first two patients in the UK with person to person transmission. J Infect. 2020;80(5):578–606. https://doi.org/10.1016/j.jinf.2020.02.020.
2. UK Government [Internet]. London: Public Health England; c2020–2021. Stay at home: guidance for households with possible or confirmed coronavirus (COVID-19) infection. Available from: https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-households-with-possible-coronavirus-covid-19-infection
3. Coxon K, Fernandez Turienzo C, Kweekel L, Goodarzi B, Brigante L, Simon A, Lanau MM. The impact of the coronavirus (COVID-19) pandemic on maternity care in Europe. Midwifery. 2020;88(102779):1–5. https://doi.org/10.1016/j.midw.2020.102779.
4. Grünebaum A, Dudenhausen J, McCullough LB, Chervenak FA. Women and children first: the need for ringfencing during the COVID-19 pandemic. J Perinat Med. 2020;48(4):305–6. https://doi.org/10.1515/jpm-2020-0149.
5. Lowe B, De Araujo V, Haughton H, Schweitzer J, Brazil V. Preparing maternity for COVID-19: A translational simulation approach. Aust N Z J Obstet Gynaecol. 2020;60(4):628–32. https://doi.org/10.1111/ajo.13185.