‘COVID-19 has a wide range of impacts on medicinal and health industries, especially maternity care by affecting provider well being and patient care.’
“Maternity care providers in Michigan experienced a range of complex challenges due to the pandemic, with many experiencing conflicts and questioning their role as a provider amid concerns of the effects of COVID-19 on themselves and their families,” according to the report by Dr. Lisa Kane Low, PhD, CNM, and her fellow colleagues of University of Michigan, Ann Arbor.
Key Themes Related to Pandemic’s Impact on Maternity Units
In early February 2020, Dr. Kane Low and her colleagues set up maternity care teams across the state of Michigan, which were in the process of administering a survey, participating in the Obstetrics and Gynecology Initiative (OBI) for data-driven quality improvement. The purpose of this survey was to assess the influence of maternity ward culture on cesarean birth rates, but researchers wanted to further capture how the global health crisis could affect the maternity care landscape in Michigan as the pandemic unfolds. In mid-April 2020, they proposed an open-ended question as “How has COVID-19 impacted your work?”
Nurses, physicians, midwives, and other maternity care professionals from 21 hospitals, representing a range of type of hospital (academic medical centers and community hospitals) and settings (rural and urban), were asked to fill in a questionnaire form and 647 responses were received.
In a complete analysis of the survey responses, the research team identified the following themes:
- Patient care impact. Patients, who thought that they have been in a labor pain, waited longer to go to the hospital due to the cancelation of elective procedures and shifting from in-person to telehealth visits. However, respondents received positive effects at some hospitals that included more women coming to the hospital in active labor and fewer undergoing induced labor. “It seems as though this has decreased the intervention rate and maybe the cesarean section rate,” a nurse-midwife wrote.
- Burdens of personal protective equipment (PPE). All providers reported that challenges are related to the new reality of being masked when providing patient care. Nurses provided “more intense” responses and they described that barriers to provide hands-on care as well as fatigue and discomfort from wearing PPE all day.
- Visitor restrictions. Restrictions on visitors to reduce COVID-19 spread had somewhat mixed mixed effects, negative in decreased support for laboring women and positive in some health care providers, who felt that fewer visits led to increased rest for patients and decreased stress for staff.
- Ethical challenges and moral distress. Respondents had some concerns regarding the complex balance between their own health and well-being and the ability to carry out their professional roles. In a hospital with high COVID-19 case rates, the concerns of “moral distress” were most prevalent.
This study provides an important evidence and direct quotes from a wide range of maternity care providers across Michigan in “real time” as the COVID-19 pandemic is unfolded. “This ongoing disruption to usual care has taken a physical and emotional toll on all maternity care professionals,” Dr. Low and coauthors conclude.
“Resources are necessary to support providers who experience distress to promote wellbeing and retention of this essential workforce.”