Wed. Dec 1st, 2021

The UK faced the bulk of the early stage of the 2019 coronavirus disease pandemic (COVID-19), resulting in severe restrictions on personal interactions and supportive care during pregnancy, childbirth and the postpartum period. This has negatively affected women’s and their families ‘or supporters’ perceptions of their experience of pregnancy during the pandemic.

Study: Factors affecting the mental health of pregnant women using UK maternity services during the COVID-19 pandemic: A qualitative interview study. Image credit: Natalia Deriabina / Shutterstock.com

A new study published on the preprint study medRxiv * reports the results of a qualitative study of determinants of pregnant women’s mental state during the UK maternity services pandemic.

Reduced social support and inability to have a partner or support person present while using the maternity service were the main concerns reported by women in this study, as this absence removed a protective buffer in times of insecurity and distress.. “

Background

Pregnancy is among one of the most important changes that happen in a woman’s life and affects not only her physical condition but also her mental health. During pregnancy, there are many factors that create the overall experience. This includes difficulties with significant people, the responsibility of taking care of the baby, life stress, financial difficulties and unforeseen natural events.

Mental changes that occur during this time include changes in the sense of identity and meaning of life, as well as shame or guilt. Postnatal depression occurs in up to one in seven mothers, while nearly two-thirds experience negative or low mood at this time.

The presence of these changes means that women need the support of people close to them during this period, especially as their long-term health and their families depend on the way they handle this time.

In the UK, many changes were made to maternity services to protect pregnant women, who were considered at high risk for COVID-19-related complications. This included the replacement of many personal services such as outpatient appointments with virtual ones while enforcing social distance of two meters during the appointments that took place. In addition, most maternity services allowed no one but the patient to participate in such appointments, limited visits during the birth and period immediately after birth, and limited newborn babies to be largely handled by the mother alone to prevent virus transmission.

Early warnings about the negative outcomes of such changes were not lacking, including difficulties in establishing breastfeeding and less bonding between mother and child. In fact, current research suggests that these were largely correct, with mothers reporting increased depression and loneliness, especially if they had an abortion or had a high-risk pregnancy.

These effects of the COVID-19 pandemic were associated with inability to access the necessary care, resulting in missed or canceled appointments, lack of continuity of care with frequent changes in the provider, and / or poor postnatal follow-up. Not being able to have husbands, mothers, midwives or other social support people with them during these difficult times was a source of complaint and emotional stress for many women.

The reasons for this are investigated in this study. This article is among the few that examine women’s experiences of mental health throughout their pregnancy and postpartum, including those who aborted at this time.

Survey results

The researchers found six common themes during their interviews of 23 women, most of whom were married and living with their spouse. Over 60% were white Britons and 15 had one child, four had two but three were childless due to abortions during the pandemic. Eight women had been diagnosed with mental illness, including depression, anxiety and premenstrual dysphoric disorder.

Some women reported that pregnancy-related discomfort was reduced by the restrictions as people did not know about the pregnancy and therefore did not constantly ask about the mother’s health. Not having to go out to work or shop yourself reduced the need to cope with motion sickness, work routines and fatigue and / or nausea, while giving flexibility to work when they were well.

Second, some reported that their family ties were improved, thereby helping them to cope better and adapt to the changes. Access to their immediate support group was very important to allow women to get company and support while staying safe. Parent groups were the key to correct adjustments at this time, although several reported problems with the virtual meetings.

Third, some women reported grief and sadness over not being able to share their experiences of pregnancy and new parenting with others, especially in the first months after the baby is born.

The fourth area of ​​concern was the anxiety and stress experienced over the fact that support partners could not attend appointments, be in the maternity ward, especially during the birth, and especially at the time when important information is required to make decisions about the birth, f. example. The women reported a sense of loss of support and advocacy without their support staff nearby.

The women who participated in this study also believed that the process excluded the partner from any significant involvement in pregnancy and childbirth. Rapidly changing COVID-19 standards meant that patients were unable to discern how much staff were aware of applicable rules.

Hospitals often appeared to be in chaos, perhaps because staff were ill or the workload was high. The effect on the patient was a reduced perception of support, increased concern that their care was inadequate, and at the same time an induction of guilt over asking for help when things were obviously tight.

Another source of dissatisfaction was the inability to experience continuity in the care of one physician or midwife, for example, especially in high-risk pregnancies. Patients were concerned about having to repeatedly discuss their pregnancy issues and experiences that were of concern to each new provider.

Finally, the policy without touching often led to a sense of detachment or communication failure, especially with the mask on to dark facial expressions. The difficulties of building and maintaining a relationship were mentioned, as well as missing health problems due to agreements that were only implemented on the phone for several months.

Implications

Many changes in maternity health care occurred due to the pandemic, with concomitant adverse effects such as feelings of increased loneliness and isolation from social and medical support systems due to restrictions on personal interaction. The current study looked at these phenomena from the point of view of the women concerned.

The results of the current study suggest that while remote consultations may have helped improve access to health care for some groups, many women prefer personal care, especially if they have health issues. This is not consistent with all studies where an article from Canada, a larger country with a more remote population, indicates a preference for virtual care to cut down on time, expense and stress associated with hospital visits while minimizing the resulting disruption of family routines.

Inability to get in touch with healthcare providers on a personal level hinders relationship building, potentially leaving loopholes for mistrust and powerlessness. The lack of continuity of care is another hallmark of pandemic-related changes, which added to pre-existing problems in the UK healthcare system. The simultaneous reduction of social and family interactions exacerbated the feeling of loneliness and isolation.

Disconnected staff along with partner and visitor restrictions left [the women] feeling alone during childbirth and postnatal care. “

The introduction of the support bubble system was important to alleviate the problems of isolation, unfavorable pregnancy outcomes, the challenges of caring for young children and depression / anxiety. This system, where two households support each other, could have been introduced earlier to prevent the build-up of such stress, the authors note. But this system has since been extended to include survivors of domestic abuse and all parents with young children.

Flexibility in the workplace was a positive aspect of pandemic restrictions, as it made it possible to deal with pregnancy-related symptoms more easily and reduced days off among pregnant women. These restrictions also allowed for more support at home from partners, with greater family ties and joint decision-making about the future.

This suggests that the availability of a birth partner or support person should be prioritized where possible to protect the mental health of women experiencing pregnancy and abortion in times of pandemics. Support bubbles during pregnancy should be explored as a priority to provide adequate support for mental health, physical symptoms and high-risk pregnancies. “

*Important message

medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be considered as crucial, guide clinical practice / health-related behavior or be treated as established information.

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