Nurse-midwives reconfiguring care in the scope of labor and births in COVID-19 times

Abstract

Objectives: to analyze how the nurse-midwives of maternity wards that were fields of practice for an improvement course in obstetrics have reorganized care in the context of labor and birth amidst the COVID-19 pandemic. Methods: this is a descriptive, exploratory and qualitative study carried out with nine nurse-midwives who are preceptors and collaborators in maternity wards that were fields of practice for an improvement course, between February and April 2020, through a semi-structured interview through WhatsApp®. Content analysis was used to treat the information. Results: the pandemic brought the need to reorganize work, with a focus on service training and maintenance of good practices in labor and birth, whose movement was intensely experienced, interfering in nurse-midwives’ mental health. Conclusion: nurse-midwives have faced the pandemic with concerns about maintaining safe care, focused on practices based on updated scientific evidence.

Maternity care during COVID-19: a qualitative evidence synthesis of women’s and maternity care providers’ views and experiences

“…Many maternity care providers, however, acknowledged that such uncertainty lessened over time as clear national guidelines became established and implemented, and the communication around care protocols improved [ 17 , 62 , 65 , 66 , 73 ].…”

“…Some practice changes, however, were viewed as having a positive impact on care due to fewer women attending services which increased the time available to spend with each woman and which facilitated a more efficient service [ 73 ]. Despite the pandemic and the associated changes to care structures and provision, maternity care providers were emphatic in describing that the need for maternity care did not stop as “women’s health care needs …could not be put on pause” [15, p.3]; something which was considered unique to maternity care provision [ 15 , 60 , 62 , 63 , 69 ].…”

“…Professional impact was predominantly negative for maternity care providers. Staff shortages [ 65 , 73 ], additional tasks due to new care practices [ 62 , 66 , 68 , 69 ], and longer and more frequent appointments as pregnant and postpartum women required more interaction due to anxiety and uncertainty, all contributed to an increased workload [ 17 , 59 , 64 , 68 , 73 ]. For maternity care providers working outside the traditional hospital system, such as independent community midwives, their workload substantially increased as the demand for a non-hospital birth experience increased [ 17 ].…”

“…A further ‘silver lining’ described by maternity care providers from the experience of working on the frontline during the pandemic was ‘the bond’ it created amongst providers as they worked together [ 15 , 61 , 70 ]. The uncertainty and chaos introduced by the pandemic helped to build relationships as maternity care providers supported one another in providing care during these unprecedented times [ 61 , 62 , 66 , 74 ]. In some ways, life in a maternity care setting acted as a bubble to the outside world where it was perceived that people were cut off from each other to a greater extent, and the hospital was associated with a greater sense of calm and camaraderie [ 59 , 60 ].…”

“…This self-imposed isolation led to concerns about the wellbeing of dependent family members where maternity care providers questioned their parenting capacity; this further added to their experience of emotional burden, a burden which was further compounded by the feeling of abandonment by management [ 69 , 74 ]. Maternity care providers described making substantial sacrifices to ensure the continuation of care but felt that little recognition was being given for this [ 62 , 74 ]. Some maternity care providers also spoke about the financial burden that they were experiencing because of the pandemic, which added to existing emotional burden [ 64 , 68 , 73 ].…”