Abstract:The coronavirus 2019 (COVID-19) pandemic and related policies have led to an unequal distribution of morbidity and mortality in the U.S. For Black women and birthing people, endemic vulnerabilities and disparities may exacerbate deleterious COVID-19 impacts. Historical and ongoing macro-level policies and forces over time have induced disproportionately higher rates of maternal morbidity and mortality among Black women and birthing people, and contemporary macroeconomic and healthcare policies and factors cont… Show more
“…Our finding that Black and Latina women were more likely to report perceived health care discrimination during childbirth fuels concerns that the co-pandemics of COVID-19 and racism may exacerbate existing racial-ethnic disparities in adverse maternal outcomes (Howell et al, 2020;Lemke & Brown, 2020). Women of color are more likely to be infected with SARS-CoV-2 during pregnancy (Emeruwa et al, 2020), suffer from higher risk of COVID-19 disease and adverse outcomes (Woodworth et al, 2020), and experience higher rates of COVID-19 pandemic stress and anxiety (Gur et al, 2020;Preis et al, 2020).…”
Objective
To examine the impact of the COVID-19 pandemic on birth satisfaction and perceived health care discrimination during childbirth, and in turn, the influence of these birth experiences on postpartum health.
Study Design
We conducted a cross-sectional, bilingual web survey of 237 women who gave birth at two hospitals in New York City and assessed patient-reported experience and outcomes following the first wave of SARS-CoV-2 infections in the New York region. We ascertained SARS-CoV-2 status at delivery from the electronic medical record using participant-reported name and date of birth. We compared birth experience during the COVID-19 pandemic (March 15, 2020–May 11, 2020) to a pre-pandemic response period (January 1, 2020–March 14, 2020). We estimated risk ratios for associations between birth experience and anxiety, depressive symptoms, stress, birth-related PTSD, emergency department visits, timely postpartum visit, and exclusive breastfeeding. Multivariable models adjusted for age, race-ethnicity, insurance, education, parity, BMI, previous experience of maltreatment/abuse and cesarean delivery.
Results
Women who gave birth during the peak of the pandemic response, and those that were SARS-CoV-2 positive, Black, and Latina, had lower birth satisfaction and higher perceived health care discrimination. Women with lower birth satisfaction were more likely to report higher postpartum anxiety, stress, depressive symptoms, and lower exclusive breastfeeding. Experiencing one or more incident of health care discrimination was associated with higher levels of postpartum stress and birth-related PTSD.
Conclusion
Hospitals and policy-makers should institute measures to safeguard against a negative birth experience during the ongoing COVID-19 pandemic, particularly among birthing people of color.
“…Our finding that Black and Latina women were more likely to report perceived health care discrimination during childbirth fuels concerns that the co-pandemics of COVID-19 and racism may exacerbate existing racial-ethnic disparities in adverse maternal outcomes (Howell et al, 2020;Lemke & Brown, 2020). Women of color are more likely to be infected with SARS-CoV-2 during pregnancy (Emeruwa et al, 2020), suffer from higher risk of COVID-19 disease and adverse outcomes (Woodworth et al, 2020), and experience higher rates of COVID-19 pandemic stress and anxiety (Gur et al, 2020;Preis et al, 2020).…”
Objective
To examine the impact of the COVID-19 pandemic on birth satisfaction and perceived health care discrimination during childbirth, and in turn, the influence of these birth experiences on postpartum health.
Study Design
We conducted a cross-sectional, bilingual web survey of 237 women who gave birth at two hospitals in New York City and assessed patient-reported experience and outcomes following the first wave of SARS-CoV-2 infections in the New York region. We ascertained SARS-CoV-2 status at delivery from the electronic medical record using participant-reported name and date of birth. We compared birth experience during the COVID-19 pandemic (March 15, 2020–May 11, 2020) to a pre-pandemic response period (January 1, 2020–March 14, 2020). We estimated risk ratios for associations between birth experience and anxiety, depressive symptoms, stress, birth-related PTSD, emergency department visits, timely postpartum visit, and exclusive breastfeeding. Multivariable models adjusted for age, race-ethnicity, insurance, education, parity, BMI, previous experience of maltreatment/abuse and cesarean delivery.
Results
Women who gave birth during the peak of the pandemic response, and those that were SARS-CoV-2 positive, Black, and Latina, had lower birth satisfaction and higher perceived health care discrimination. Women with lower birth satisfaction were more likely to report higher postpartum anxiety, stress, depressive symptoms, and lower exclusive breastfeeding. Experiencing one or more incident of health care discrimination was associated with higher levels of postpartum stress and birth-related PTSD.
Conclusion
Hospitals and policy-makers should institute measures to safeguard against a negative birth experience during the ongoing COVID-19 pandemic, particularly among birthing people of color.
“…Given these aspects of vulnerability, the COVID-19 pandemic is likely to continue to adversely impact such families and result in furthering the gap between families who are thriving and families who experience barriers in accessing healthcare and support. Additional research should include measures for tracking these disparities over time and across race and ethnicity, as other scholars have already suggested ( Lemke and Brown, 2020 ) and as other articles in this collection attempt to do.…”
Section: Discussion and Policy Implicationsmentioning
The research aims of this project were to understand the impact of the COVID-19 pandemic on pregnancy, birthing, and postpartum experiences in the United States. Our data include responses from 34 states within the US. Findings from our analyses indicate that higher perceived social support predicted higher scores of well-being, while higher scores of perceived loneliness predicted lower scores of well-being, and higher trauma predicted lower well-being measured as satisfaction with life. Qualitative data support these findings, as well as the finding that there were various sources of stress for respondents during pregnancy, birth, and the postpartum timeframe—particularly in terms of managing work/occupation obligations and childcare. Additionally, this research fills a gap in understanding infant feeding in emergencies. Respondents perceived that early release from the hospital reduced access to lactation support, and many respondents reported receiving free samples of breastmilk substitutes through a variety of sources.
“…BIPOC communities also have higher rates of infection and death from COVID‐19 16,17 . Disparities in maternal mortality and morbidity and the disparately high impact of COVID‐19 in BIPOC communities are associated with similar preexisting inequities 18 arising from systemic and structural racism, 19–23 including inequities in the quality of perinatal care 22 . Structural racism is “the totality of ways in which societies foster racial discrimination, through mutually reinforcing inequitable systems (in housing, education, employment, earnings, benefits, credit, media, health care, criminal justice, and so on) that in turn reinforce discriminatory beliefs, values, and distribution of resources, which together affect the risk of adverse health outcomes.” 19 (p1454) To improve perinatal health and COVID‐19 related outcomes for individuals from BIPOC communities, it is essential to identify and call out the structural racism that perpetuates these inequities 20,22,24 .…”
Introduction
Quality perinatal care is recognized as an important birth process and outcome. During the coronavirus disease 2019 (COVID‐19) pandemic, quality of perinatal care was compromised as the health care system grappled with adapting to an ever‐changing, uncertain, and unprecedented public health crisis.
Methods
The aim of this study was to explore the quality of perinatal care received during the COVID‐19 pandemic in the United States. Data were collected via an online questionnaire completed by people who gave birth in the United States after March 15, 2020. The questionnaire included the Mothers on Respect Index and the Mothers Autonomy in Decision Making validated measures. Low‐quality perinatal care was defined as decreased respect and/or autonomy in the perinatal care received. Responses were geocoded by zip code to determine COVID‐19 case‐load in the county on the date of birth. Multivariate regression analyses described associations between respect and autonomy in decision‐making for perinatal care and levels of COVID‐19 outbreak across the United States.
Results
Participants (N = 707) from 46 states and the District of Columbia completed the questionnaire. As COVID‐19 cases increased, participants’ experiences of autonomy in decision‐making for perinatal care decreased significantly (P = .04). Participants who identified as Black, Indigenous, and people of color, those who had an obstetrician provider, and those who gave birth in a hospital were more likely to experience low‐quality perinatal care. Those with a midwife provider or who had a home birth were more likely to experience high‐quality perinatal care in adjusted models.
Discussion
Variability in experiences of high‐quality perinatal care by sociodemographic characteristics, birth setting, and provider type may relate to implicit bias, structural racism, and inequities in maternal health and COVID‐19 outcomes for birthing people from marginalized communities.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
