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COVID-19 restrictive measures severely impacted maternity services worldwide, but little is known about the differences in women’s concerns, perception of the modifications of maternity services and childbirth programs at different times during the pandemic. Here we report data from the first COVID-19 wave in Italy, during the 2020 national lockdown (March-April) and soon after lockdown release (May).1307 pregnant women answered the survey during national lockdown (phase 1) or after restrictive measures were released (phase 2). Women reported a significantly higher COVID-19 concern during phase 1 than during phase 2 (2.34 SD 0.5 vs 2.12 SD 0.5 on a Likert scale 0-3; p<0.001). Several domains of perinatal care were affected during COVID-19 lockdown: while antenatal visits, the use of technology to keep in touch with healthcare professionals, and closeness of caregivers were generally more appreciated (especially during phase 2), women reported the greatest difficulties in receiving clear information on hospitalization, birth plan and partner’s presence at birth.Italian pregnant women’s worries about the effects of the pandemic on health and their perception of quality in the organization of maternity services improved during lockdown, but they continued to represent a challenge in May, especially regarding organizational aspects of hospitalization and childbirth.

BackgroundNewborns’ deaths and life-threatening conditions represent extremely stressful events for parents and professionals working in NICUs, facilitating the onset of secondary traumatic stress symptoms. The STRONG study aims to better understand the psychological impact on Italian NICUs staff of bereavement care.MethodsThe STRONG (STress afteR lOss in NeonatoloGy) study is a cross-sectional study based on a web survey consisted of four sections: sociodemographic, CommuniCARE-Newborn questionnaire, the Maslach Burnout Inventory and the Impact of Event Scale-Revised.Results227 NICU workers (42.7% nurses, 23.3% midwives, 22.2% physicians, 11.8% other HCPs) answered the survey. The hardest tasks were “communicating baby’s death” and “informing on autopsy results”; 44.7% of HCPs did not receive formal training in communicating bad news, 44.2% ‘learned from the field’ by watching other colleagues; 41.2% declared that they do not have any communication strategy. More than 90% of professionals thought that training on bereavement care is necessary. The majority of HCPs showed some degree of post-traumatic stress symptoms: 34% medium and 35.3% severe. Professionals with training in bereavement care and/or in communication had less probability to develop stress symptoms. A multivariate analysis showed that higher levels of burnout were associated with 4 or more monthly losses and medium or severe stress symptoms. Having a well-defined communication strategy for breaking bad news was independently associated with a better personal accomplishment.ConclusionDealing with newborns’ deaths is a highly stressful task; professionals should receive proper support such as debriefing, psychological support and training in order to prevent post-traumatic stress symptoms and reduce professional burnout.

Background: Stillbirth is a global public health issue affecting millions of parents and healthcare professionals. Quality and consistency of bereavement care after stillbirth are crucial for parents' well-being, but they depend on the implementation and impact of international guidelines. Aim: This study aimed to validate practices for stillbirth care by means of the CiaoLapo Stillbirth Support (CLASS) checklist, a tool that summarises the common elements of the main international guidelines on bereavement care after stillbirth, and to explore their association with women's satisfaction, respectful care, and psychological outcomes. Methods: A cross-sectional online survey was conducted among 261 women who experienced a stillbirth in the last 10 years in Italy, a country without official national guidelines. The survey included the CLASS checklist, the Perinatal Grief Scale, the National Stressful Events Survey PTSD Short Scale, and questions on satisfaction and respectful care. Findings: The mean score of adherence to guidelines was low, 2.0 (SD 1.1, on a 4-point scale), with regional differences. The lowest scores were in respect for the baby, communication about funeral and autopsy, creating memories, and aftercare. Adherence to at least 40 out of 60 CLASS checklist items was independently associated with greater satisfaction and respectful care, and lower grief and posttraumatic stress symptoms. Conclusion: The study shows that women who receive care that adheres to stillbirth guidelines have a better psychological outcome, with lower levels of grief and posttraumatic stress symptoms. The study also highlights the need for official national guidelines and adequate training and support for healthcare professionals in countries where they are lacking.

BackgroundAt the onset of the COVID-19 pandemic, support for breastfeeding was disrupted in many countries. Italy was severely impacted by the pandemic and is known to have the lowest exclusive breastfeeding rate of all European countries. Considering the inverse association between anxiety and breastfeeding, maternal concerns about the COVID-19 emergency could reduce breastfeeding rates. The aim of the study is to explore the association between infant feeding practices and maternal COVID-19 concerns.MethodsThis paper is a secondary analysis of the cross-sectional study COVID-ASSESS conducted in Italy in 2020. The original survey was administered in two phases: during the first lockdown and during the reopening. The survey included five sections: socio-demographic, medical history, concerns about the COVID-19 pandemic, infant feeding practices and psychometric evaluation. Participants were considered eligible for the post-hoc analyses if they were exclusively breastfeeding or they were feeding with infant formula (either alone or with breastfeeding) at the time of the interview.ResultsBetween phase 1 and phase 2 there was a decrease in anxiety and concerns about the danger of COVID-19 to general health, except for concerns about their baby's health. Women using formula were more concerned about all the health topics investigated. Moreover, they showed higher levels of stress, state anxiety, somatization and PTSD symptoms.ConclusionBreastfeeding during the first pandemic lockdown in Italy seems to have been an independent factor associated with lower anxiety about COVID-19, fewer psychopathological symptoms, and a positive experience of infant feeding.