How COVID-19 challenged care for women and their newborns: a qualitative case study of the experience of Belgian midwives during the first wave of the pandemic

Abstract

In this article, we describe the results of a rapid qualitative study conducted between May 19 and June 25, 2020 on the work experience of midwives during the first wave of the COVID-19 pandemic in Brussels and Wallonia (Belgium). Using semi-structured interviews conducted with fifteen midwives working in hospitals or practicing privately, we investigated the impact of the first COVID-19 wave on their work experience, the woman-midwife relationship, and midwife-perceived changes in quality of care. Findings include high levels of stress and insecurity related to the lack of resources and personal protective equipment, feelings of distrust from midwives towards the Belgian State and public health authorities, as well as structural and organizational challenges within maternity wards which negatively affected quality of care. Moreover, based on the midwives' experiences, we demonstrate the need to recognise the views of all stakeholders involved in maternal and newborn care provision, and share five essential lessons learned from this study: 1) it is crucial to acknowledge the central role of midwives for maintaining maternal and newborn care amidst the pandemic and beyond; 2) creating unified national guidelines could support ensuring best practice; 3) efforts must be put in place to diminish the climate of mistrust towards health authorities and to repair the relationship between midwives and decision-makers which was damaged during the pandemic; 4) caring for front-line healthcare workers' mental health is critical, and 5) quality of maternal care can be improved, even in the midst of a pandemic, through team effort and creative solutions tailored to the needs and demands of each setting.

‘We are not going to shut down, because we cannot postpone pregnancy’: a mixed-methods study of the provision of maternal healthcare in six referral maternity wards in four sub-Saharan African countries during the COVID-19 pandemic

“…Maternity skilled health personnel (SHP)—including doctors, nurses and midwives—were at the forefront of implementing these regularly updated guidelines and faced many challenges during the COVID-19 pandemic 3. In a global context of shortage of personal protective equipment (PPE), pre-existing shortage of SHP, and lack of clear information and guidelines,22 23 maternal and newborn SHP worried about their own health and were concerned over occupational exposure to COVID-19 in the workplace, and transmitting the infection to patients, family and friends 3 24–27. A meta-analysis shows that stress disorders, depression, anxiety, and insomnia are highly prevalent among SHP during periods of epidemics and pandemics, including COVID-19 28.…”

Midwives providing woman-centred care during the COVID-19 pandemic in Australia: A national qualitative study

“…These involve practising in different ways such as trying to maintain social distancing during face-to-face visits, replacing antenatal assessments with telehealth, and limiting postnatal care visits [11,12]. Other research has found that midwives have been confused with major discrepancies in guidelines between hospitals and the constant changing of the guidelines and the effect of COVID-19 on pregnant women [13]. Recent Australian research has shown that prior to the pandemic, midwives were facing both physical and emotional exhaustion, with high rates of stress and burnout, often related to their inability to provide woman-centred care within medical models [14].…”

Experiences of Dutch Midwives Regarding the Quality of Care during the COVID-19 Pandemic

“…However, they noticed that sometimes the quality of care was compromised [12]. In addition, qualitative studies from Belgium and Australia indicated that the midwives experienced high levels of stress because of the constantly changing measures and lack of resources which negatively affected the quality of care [13,14]. To provide a Dutch qualitative perspective, this study examined the experiences of Dutch midwives regarding the quality of care during the first two months of the COVID-19 pandemic.…”

“…However, they noticed that sometimes the quality of care was compromised [ 12 ]. In addition, qualitative studies from Belgium and Australia indicated that the midwives experienced high levels of stress because of the constantly changing measures and lack of resources which negatively affected the quality of care [ 13 , 14 ].…”