COVID-19 and Maternal health

While the COVID-19 has had a devastating effect of our clients and our communities, it has also severely impacted our front-line health workers, increasing their workloads, changing their work environments and posing threats to their own health and well-being. As policy and programme managers in public health we must also ‘care for the carers’ if we are going to successfully defeat the COVID-19 pandemic.

A paper by Semaan A, Audet C, Huysmans E, et al. titled Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic published in BMJ Global Health 2020;5:e002967. was one of the first publications to report on the experience of maternal and newborn health professionals experiences during the pandemic. This extract summarises the study and implications for the health of mothers and babies.

The COVID-19 pandemic has substantially impacted maternity care provision worldwide. Studies based on modelling estimated large indirect effects of the pandemic on services and health outcomes. The objective of this study was to prospectively document experiences of frontline maternal and newborn healthcare providers.

We conducted a global, cross-sectional study of maternal and newborn health professionals via an online survey disseminated through professional networks and social media in 12 languages. Information was collected between 24 March and 10 April 2020 on respondents’ background, preparedness for and response to COVID-19 and their experience during the pandemic. An optional module sought information on adaptations to 17 care processes. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregating by low-income and middle-income countries (LMICs) and high-income countries (HICs).

We analysed responses from 714 maternal and newborn health professionals. Only one-third received training on COVID-19 from their health facility and nearly all searched for information themselves. Half of respondents in LMICs received updated guidelines for care provision compared with 82% in HICs. Overall, 47% of participants in LMICs and 69% in HICs felt mostly or completely knowledgeable in how to care for COVID-19 maternity patients. Facility-level responses to COVID-19 (signage, screening, testing and isolation rooms) were more common in HICs than LMICs. Globally, 90% of respondents reported somewhat or substantially higher levels of stress. There was a widespread perception of reduced use of routine maternity care services, and of modification in care processes, some of which were not evidence-based practices.

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What do the new findings imply?

• COVID-19 illustrates the susceptibility of maternity care services to emergencies, including by reversing hard-won gains in healthcare utilisation and use of evidence-based practices.

• Maternity care differs from other services, inasmuch as healthy women are being brought into health facilities that are operating suboptimally, and potentially increasing risk of infection, from COVID-19 and other healthcare-associated infections.

• These rapid findings can inform countries of the main issues emerging and help develop effective responses, but similar efforts are needed to understand women’s experiences.

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Substantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19. Formal information-sharing channels for providers must be established and mental health support provided. Surveys of maternity care providers can help track the situation, capture innovations and support rapid development of effective responses.