Freedom for some, but not for Mum: the reproductive injustice associated with pandemic 'Freedom Day' for perinatal women in the United Kingdom.

Healthcare services for pregnant and postpartum ('perinatal') women were reconfigured significantly at the advent and for the duration of the SARS-CoV-2 pandemic, and despite the United Kingdom announcing 'Freedom Day' on 19 July 2021 (whereafter all legal lockdown-related restrictions were lifted), restrictions to maternity (antenatal, intrapartum, and postnatal) services remained. This study presents data from eight perinatal women about their experiences of psychosocial wellbeing and maternity care in the post-'Freedom Day' epoch. Semi-structured interviews were conducted virtually, with data recorded, transcribed, and analysed by hand. Grounded theory analysis was employed with the final theory assessing the reproductive injustice of the pandemic 'Freedom Day'. Analysing iteratively and inductively led to four emergent themes: 'A Failing System, Failing Women'; 'Harm Caused by a State of Difference'; 'The Privileges (Not Rights) of Reproductive Autonomy, Agency, and Advocacy'; and 'Worried Women and Marginalised Mothers'. Together, these themes form the theory of 'Freedom for some, but not for Mum'. Women experienced a lack of high-quality reliable information about the pandemic, vaccination against the virus, and the changes to, and decision-making surrounding, their perinatal care. Women recognised healthcare professionals and maternity services were stretched and that maternity services were failing but often reported hostility from staff and abandonment at times when they were unsure about how to navigate their care. The most singular injustice was the disparity between women having to accept continuing restrictions to their freedom whilst receiving maternity care and the (reckless) freedom being enacted by the general public.

Silverio SA ，Harris EJ ，Jackson L ，Fallon V ，PRaM Study Group ，Easter A ，von Dadelszen P ，Jurković D ，Magee LA ... -  《Frontiers in Public Health》

Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis.

Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom - a region of high ethnic diversity with varied levels of social complexity. We conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research. Maternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) 'Reflective decision-making'; 2) 'Pragmatic decision-making'; and 3) 'Reactive decision-making'. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decision-making, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service. Decision-making within maternity care was found to take three forms - where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and change-making in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation.

Silverio SA ，De Backer K ，Brown JM ，Easter A ，Khazaezadeh N ，Rajasingam D ，Sandall J ，Magee LA ... -  《BMC Pregnancy and Childbirth》

Women's experiences of receiving antenatal and intrapartum care during COVID-19 at public hospitals in the Sidama region, Ethiopia: A qualitative study using the combination of three delay and social-ecological framework (hybrid framework).

Kassa ZY ，Scarf V ，Turkmani S ，Fox D ... -  《-》

Women's experiences of maternity service reconfiguration during the COVID-19 pandemic: A qualitative investigation.

To explore women's experiences of maternity service reconfiguration during the first wave of the SARS-CoV-2 (COVID-19) pandemic. Qualitative interview study. South London, United Kingdom. Women (N=23) who gave birth between March and August 2020 in one of the ten South London maternity hospitals. Semi-structured interviews were conducted (N=23), via video-conferencing software. Transcribed interviews were analysed 'by hand' using Microsoft Word. Template analysis was selected to code, analyse, and interpret data, according to the findings of a recently-published national survey of maternity service reconfiguration across the UK in response to COVID-19. Three main themes emerged through analysis: (i) Disruption to In-Person Care and Increased Virtual Care Provision, (ii) Changes to Labour and Birth Preferences and Plans, (iii) Advice for Navigating Maternity Services During a Pandemic. Women reported mixed views on the reduction in scheduled in-person appointments. The increase in remote care, especially via telephone, was not well endorsed by women. Furthermore, women reported an under-reliance on healthcare professionals for support, rather turning to family. We provide insight into the experiences of women who received antenatal, intrapartum, and postnatal care during the first wave of the COVID-19 pandemic. Our findings should inform healthcare policy to build back better maternity care services after the pandemic.

Silverio SA ，De Backer K ，Easter A ，von Dadelszen P ，Magee LA ，Sandall J ... -  《-》

Women's experiences of maternity care in the United Kingdom during the COVID-19 pandemic: A follow-up systematic review and qualitative evidence synthesis.

Maternity care services in the United Kingdom have undergone drastic changes due to pandemic-related restrictions. Prior research has shown maternity care during the pandemic was negatively experienced by women and led to poor physical and mental health outcomes in pregnancy. A synthesis is required of published research on women's experiences of maternity care during the latter half of the COVID-19 pandemic. To update a previous systematic review of maternity care experiences during the pandemic to June 2021, exploring experiences of maternity care specifically within the United Kingdom and how they may have changed, in order to inform future maternity services. A systematic review of qualitative literature was conducted using comprehensive searches of five electronic databases and the Cochrane COVID Study Register, published between 1 June 2021 and 13 October 2022, and further updated to 30 September 2023. Thematic Synthesis was utilised for data synthesis. Of 21,860 records identified, 27 studies were identified for inclusion. Findings included 14 descriptive themes across the five core concepts: (1)Care-seeking and experience; (2)Virtual care; (3)Self-monitoring; (4)COVID-19 vaccination; (5)Ethical future of maternity care. Our findings in the UK are consistent with those globally, and extend those of the previous systematic review, particularly about women's perceptions of the COVID-19 vaccine during pregnancy. Our findings suggest the following are important to women for future maternity care: personalisation and inclusiveness; clear and evidence-based communication to facilitate informed decision-making; and achieving balance between social commitments and time spent settling into motherhood.

Dasgupta T ，Horgan G ，Peterson L ，Mistry HD ，Balls E ，Wilson M ，Smith V ，Boulding H ，Sheen KS ，Van Citters A ，Nelson EC ，Duncan EL ，von Dadelszen P ，RESILIENT Study Group ，Rayment-Jones H ，Silverio SA ，Magee LA ... -  《-》