COVID-19 does not stop obstetrics: what we need to change to go on safely birthing. The experience of a University Obstetrics and Gynecology Department in Milan

Alfieri, Nikita; Manodoro, Stefano; Marconi, Anna Maria

doi:10.1515/jpm-2020-0218

Cited by 17 publications

(33 citation statements)

References 7 publications

(5 reference statements)

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“…North Italian regions were the first in Europe to face the coronavirus disease 2019 pandemic and the associated pressure on the healthcare system and HCPs (Alfieri et al, 2020;Armocida et al, 2020;Oliva et al, 2020). High levels of burnout, psychological distress, and psychosomatic symptoms were observed in physicians, nurses, and other professionals at the peak of the pandemic (Barello et al, 2020a,b;Giusti et al, 2020;Marton et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

The Psychological Impact of COVID-19 on Healthcare Providers in Obstetrics: A Cross-Sectional Survey Study

et al. 2021

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Objective: To assess the psychological distress of healthcare providers (HCPs) working in the field of obstetrics during the coronavirus disease 2019 (COVID-19) pandemic and to identify factors associated with psychological distress at the individual, interpersonal, and organizational level.Design: Cross-sectional survey study.Setting: Four University hospitals in Italy.Participants: HCPs working in obstetrics, including gynecologists, residents in gynecology and obstetrics, and midwives.Methods: The 104-item survey Impatto PSIcologico COVID-19 in Ostetricia (IPSICO) was created by a multidisciplinary expert panel and administered to HCPs in obstetrics in May 2020 via a web-based platform.Main Outcome Measures: Psychological distress assessed by the General Health Questionnaire-12 (GHQ-12) included in the IPSICO survey.Results: The response rate to the IPSICO survey was 88.2% (503/570), and that for GHQ-12 was 84.4% (481/570). Just over half (51.1%; 246/481) of the GHQ-12 respondents reported a clinically significant level of psychological distress (GHQ-12 ≥3). Psychological distress was associated with either individual (i.e., female gender, stressful experience related to COVID-19, exhaustion, and the use of dysfunctional coping strategies), interpersonal (i.e., lower family support, limitations in interactions with colleagues), and organizational (i.e., reduced perception of protection by personal protective equipment, perceived delays on updates and gaps in information on the pandemic) factors in dealing with the pandemic.Conclusions: Results confirm the need for monitoring and assessing the psychological distress for HCPs in obstetrics. Interventions at the individual, interpersonal, and organizational level may relieve the psychological distress during the COVID-19 pandemic and foster resilience skills in facing emotional distress.

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Section: Introductionmentioning

confidence: 99%

The Psychological Impact of COVID-19 on Healthcare Providers in Obstetrics: A Cross-Sectional Survey Study

et al. 2021

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“…But women who give birth or have to go to the clinic because of complications may be exposed to infected women, so clinics had to do some restructuring. In the hospitals, separate areas, some with low pressure rooms [24,27], were set up for infected women [4,5,21,25].…”

Section: Dealing With Women With Positive Sars-cov-2 Test Resultsmentioning

confidence: 99%

“…Testing is another important protection measure that, at rst, was done only for symptomatic female patients or those in contact with infected persons [26]. Later, many hospitals began testing every woman who visited the hospital [4,5,21,24,29,30]. There were 1,344 delivery rooms in the USA: 90.2% had adequate testing capacities; 84.3% tested all pregnant women [30].…”

Section: B Personal Protective Equipment and Testsmentioning

confidence: 99%

“…Staff in health care made large adjustments to the health care delivery system to prevent infection [2,3]. Thus, the pandemic posed enormous challenges and required massive change to care also to maternity staff; prenatal examinations and births could not be postponed, unlike routine medical procedures [4,5]. At least 116 million babies will be born during the pandemic and its aftermath; millions of women will need care during pregnancy, delivery, and childbed [6].…”

Section: Introductionmentioning

confidence: 99%

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Effects of the Covid-19 pandemic on maternity staff in 2020 – a scoping review

Schmitt

Mattern

Cignacco

et al. 2021

Preprint

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In the spring of 2020, the SARS-CoV-2 virus caused the Covid-19 pandemic, bringing with it drastic changes and challenges for health systems and medical staff. Among the affected were obstetricians and midwives, whose close physical contact with pregnant women, women who recently gave birth, and their children was indispensable. In the obstetric setting, births cannot be postponed, and maternity staff had to adapt to assure obstetric safety while balancing evidence-based standards with the new challenges posed by the pandemic. This scoping review gives a comprehensive overview of the effecs the Covid-19 pandemic had on maternity staff. We followed the evidence-based approach described by Arksey & O’Malley: we searched several databases for English and German articles published between January 2020 and January 2021 that discussed or touched upon the effects the pandemic had on maternity staff in OECD countries and China. We found that structural challenges caused by the crisis and its subjective effects on maternity staff fell into two main topic areas. Structural challenges (the first main topic) were divided into five subtopics: staff shortages and restructuring; personal protective equipment and tests; switching to virtual communication; handling women with a positive SARS-CoV-2 infection; and excluding accompanying persons. The pandemic also strongly affected the staff’s mental health (the second main topic.) Attempting to meet challenges posed by the pandemic while afraid of contamination, suffering overwork and exhaustion, and struggling to resolve ethical-moral dilemmas had severe negative subjective effects. Several studies indicated increased depression, anxiety, stress levels, and risk of post-traumatic stress symptoms, although the crisis also generated strong occupational solidarity. Care for pregnant, birthing, and breast-feeding women cannot be interrupted, even during a pandemic crisis that requires social distancing. Maternity staff sometimes had to abandon normal standards of obstetric care and were confronted with enormous challenges and structural adjustments that did not leave them unscathed: their mental health suffered considerably. Researchers should study maternity staff’s experiences during the pandemic to prepare recommendations that will protect staff during future epidemics.

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“…Our result suggested that while implementing the IHSD system, some healthcare facilities reduced the provision of elective procedures. 43 45 However, a similar strategy cannot be implemented for some routine service delivery systems such as obstetrics care, 65 immunisation of children 66 and cardiovascular emergencies. 67 Thus, the integrated care delivery application during pandemic also needs to ensure the undisrupted provision of these critical routine care services.…”

Section: Policy Recommendationsmentioning

confidence: 99%

Integrated health service delivery during COVID-19: a scoping review of published evidence from low-income and lower-middle-income countries

et al. 2021

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BackgroundIntegrated health service delivery (IHSD) is a promising approach to improve health system resilience. However, there is a lack of evidence specific to the low/lower-middle-income country (L-LMIC) health systems on how IHSD is used during disease outbreaks. This scoping review aimed to synthesise the emerging evidence on IHSD approaches adopted in L-LMIC during the COVID-19 pandemic and systematically collate their operational features.MethodsA systematic scoping review of peer-reviewed literature, published in English between 1 December 2019 and 12 June 2020, from seven electronic databases was conducted to explore the evidence of IHSD implemented in L-LMICs during the COVID-19 pandemic. Data were systematically charted, and key features of IHSD systems were presented according to the postulated research questions of the review.ResultsThe literature search retrieved 1487 published articles from which 18 articles met the inclusion criteria and included in this review. Service delivery, health workforce, medicine and technologies were the three most frequently integrated health system building blocks during the COVID-19 pandemic. While responding to COVID-19, the L-LMICs principally implemented the IHSD system via systematic horizontal integration, led by specific policy measures. The government’s stewardship, along with the decentralised decision-making capacity of local institutions and multisectoral collaboration, was the critical facilitator for IHSD. Simultaneously, fragmented service delivery structures, fragile supply chain, inadequate diagnostic capacity and insufficient workforce were key barriers towards integration.ConclusionA wide array of context-specific IHSD approaches were operationalised in L-LMICs during the early phase of the COVID-19 pandemic. Emerging recommendations emphasise the importance of coordination and integration across building blocks and levels of the health system, supported by a responsive governance structure and stakeholder engagement strategies. Future reviews can revisit this emerging evidence base at subsequent phases of COVID-19 response and recovery in L-LMICs to understand how the approaches highlighted here evolve.

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COVID-19 does not stop obstetrics: what we need to change to go on safely birthing. The experience of a University Obstetrics and Gynecology Department in Milan

Cited by 17 publications

References 7 publications

The Psychological Impact of COVID-19 on Healthcare Providers in Obstetrics: A Cross-Sectional Survey Study

The Psychological Impact of COVID-19 on Healthcare Providers in Obstetrics: A Cross-Sectional Survey Study

Effects of the Covid-19 pandemic on maternity staff in 2020 – a scoping review

Integrated health service delivery during COVID-19: a scoping review of published evidence from low-income and lower-middle-income countries

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