Early Perinatal Workforce Adaptations to the COVID-19 Pandemic

Abstract

The objective of this study was to describe the system's initial pandemic response from the perspectives of perinatal health workers and to identify opportunities for improved future preparedness. An exploratory survey was designed to identify perinatal practice changes and workforce challenges during the initial weeks of the COVID-19 pandemic. The survey included baseline data collection and weekly surveys. A total of 181 nurses, midwives, and physicians completed the baseline survey; 84% completed at least 1 weekly survey. Multiple practice changes were reported. About half of respondents (50.8%) felt the changes protected patients, but fewer (33.7%) felt the changes protected themselves. Most respondents providing out-ofhospital birth services (91.4%) reported increased requests for transfer to out-of-hospital birth. Reports of shortages of personnel and supplies occurred as early as the week ending March 23 and were reported by at least 10% of respondents through April 27. Shortages were reported by as many as 38.7% (personal protective equipment), 36.8% (supplies), and 18.5% (personnel) of respondents. This

Policies and Practices on Out-of-Hospital Birth: a Review of Qualitative Studies in the Time of Coronavirus

“…Findings also show the positive role of community midwives in supporting birthing women during the pandemic and their ability to find innovative ways to offer care in the pandemic situation. Flexibility and their ability to work when supplies or institutional support is limited were particularly useful during this period [ 13 , 16 , 19 , 26 , 27 , 29 , 31 , 33 – 35 ]. Changes reported in their practices included more wearing of personal protective equipment (masks and gloves); sanitizing their workspace; fewer in-persons visits or childbirth classes; more video calls, phone calls, and virtual prenatal and post-partum visits; and sharing online documents to inform women [ 26 , 27 , 31 , 35 ].…”

Midwifery Autonomy and Employment Changes During the Early COVID‐19 Pandemic

“…Importantly, midwives and other birth workers are included as part of an all‐hands‐on‐deck approach that considers the role community settings may have in rationing hospital resources 47 . Implementing this guidance during the current pandemic and future disasters could allow perinatal health care systems to flex more efficiently to balance patient needs with risks of transmission and/or resource rationing 48 …”

“…A survey of people giving birth during the pandemic indicated that high‐quality perinatal care, defined by patient ratings of perceived autonomy and respectful care, was more likely for those giving birth in community settings or with midwives and less likely for people identifying as Black, as Indigenous, and as people of color and for those giving birth in hospitals or with physician care 35 . However, a national survey of perinatal care providers indicated that most midwives providing community care declined some patient transfers from hospital‐based care during the COVID‐19 pandemic because of patient inability to pay 48 . Thus, the pandemic effects of policies restricting licensure, reimbursement, and autonomy of qualified midwives compounded the harm to communities already suffering the consequences of a system plagued by structural racism.…”

“…47 Implementing this guidance during the current pandemic and future disasters could allow perinatal health care systems to flex more efficiently to balance patient needs with risks of transmission and/or resource rationing. 48 An equitable infrastructure with levels of care that meet patient needs-including the needs of healthy pregnant people-should not be a luxury, but policies in the United States that restrict midwifery care and access to community birth contribute to a system of inequity. During the early months of the COVID-19 pandemic when nothing was yet known about the disease's effects on pregnancy, hospitals and organizations scrambled to determine guidelines to balance patient needs for in-person care with the risks of transmission.…”

“…35 However, a national survey of perinatal care providers indicated that most midwives providing community care declined some patient transfers from hospital-based care during the COVID-19 pandemic because of patient inability to pay. 48 Thus, the pandemic effects of policies restricting licensure, reimbursement, and autonomy of qualified midwives compounded the harm to communities already suffering the consequences of a system plagued by structural racism. As the Institute for Medicaid Innovation report noted, policy changes to facilitate midwifery-led care, particularly by supporting birth center birth and autonomous midwifery practice, were needed even more because of the pandemic than before.…”