Where do women birth during a pandemic? Changing perspectives on Safe Motherhood during the COVID-19 pandemic

Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, health systems all over the world are either stressed to their maximum capacity or anticipating becoming overwhelmed. The population is advised not to attend hospital unless strictly necessary, yet this advice seems to apply to all but healthy women during childbirth.Specialized hospital care during childbirth can be lifesaving in case of obstetric complications or for COVID-19 symptomatic women, while strong evidence suggests the appropriateness of midwifery units that are integrated into the healthcare system for eligible women. We must ask ourselves whether obstetric units are the appropriate birthing facilities for healthy women during the pandemic.We have learned from previous crises that the needs of women and children are often badly served during disasters. The COVID-19 pandemic raises concerns over escalation of mistreatment and abuse media are already reporting on restrictions to the rights of birthing women in Europe and the US. In addition, concerns have emerged over increased risk of infection to COVID-19 among birthing women and familied by concentrating all women in obstetric units and lack of optimal care due to pressure on staff and resources. Women's rights in childbirth are being threatened by lack of care during labor, restrictions on accompaniment, unnecessary interventions including inductions, separation of mother and baby and prohibition on breastfeeding.An effective response to the crisis depends on strong and coordinated health care systems where mothers can birth safely, and the needs of the newborn babies are met.The interpretation of what constitute safe care is a stimulus for a strong debate between those who argue for strengthening community and primary care services and those who recommend for centralization of all births in hospitals. This debate is particularly salient during this pandemic and in preparation of future pandemics.We propose a strategic response in the face of the pandemic by expanding the use of midwifery units both alongside the obstetric unit and freestanding (in the community). Where midwifery units are absent pop-up units can be created quickly following the example of the Netherlands.

The impact of planning for COVID-19 on private practising midwives in Australia

“…Some midwives even made their own hand sanitizer. These experiences are similar to many health care providers across the world who have been calling for better access to PPE [ 20 ] including in community-based maternity settings [ 6 ].…”

“…Effective PPE must be available for midwives based in the community for antenatal appointments and for assisting births [ 6 ]. Studies of infection control and personal protective equipment (PPE) in home healthcare have focused on hospital-in-the-home, where healthcare workers are caring for unwell people and often doing regular invasive procedures [ 21 , 22 ] rather than in the context of pregnancy care.…”

“…In Australia, the Commonwealth Government’s coronavirus emergency response plan was triggered in late February and a suite of approaches, including travel restrictions, quarantine measures and physical distancing were announced to both suppress the spread of the virus and allow health systems to prepare [ 5 ]. Maternity services in all countries have been impacted by the COVID-19 response including the implementation of telehealth, social distancing, use of personal protective equipment for clinical care and reduced visitors and support people [ 6 ]. In the middle of the focus on COVID-19, women and families are still having babies and having to navigate a complex health system [ 7 ].…”

The impact of the Covid-19 lockdown on the experiences and feeding practices of new mothers in the UK: Preliminary data from the COVID-19 New Mum Study

“…Our analysis showed that 39% of women who delivered since lockdown reported that their birth plans had changed due to COVID-19. One of the most frequent examples was having to give birth in a hospital rather than in a midwife-led unit, which could increase their risk of infection ( Rocca-Ihenacho and Alonso, 2020 ). Practices in the United Kingdom during the pandemic have varied, with some services maintaining and expanding their midwife-led unit services while others have moved towards centralization ; ( Rocca-Ihenacho and Alonso, 2020 ).…”

Good Practices in Perinatal Mental Health during the COVID-19 Pandemic: A Report from Task-Force RISEUP-PPD COVID-19

“…Seeking mental health treatment in the perinatal period is important to reduce distress, yet many women do not seek help (Bina, 2020). The COVID-19 pandemic may have increased barriers to seeking help due to home isolation (Holmes et al, 2020), or lower screening rates due to minimization of contacts with and shortage of healthcare providers (Rocca-Ihenacho & Alonso, 2020;Thapa et al, 2020). Nonetheless, these restrictions may bring around new opportunities in the form of digital mental health screening and treatment (Zhou et al, 2020).…”