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1.
Int J Environ Res Public Health ; 19(4)2022 02 10.
Article in English | MEDLINE | ID: covidwho-1690253

ABSTRACT

(1) Background: Approximately one in five women will experience mental health difficulties in the perinatal period. Women from ethnic minority backgrounds face a variety of barriers that can prevent or delay access to appropriate perinatal mental health care. COVID-19 pandemic restrictions created additional obstacles for this group of women. This study aims to explore minority ethnic women's experiences of perinatal mental health services during COVID-19 in London. (2) Methods: Eighteen women from ethnic minority backgrounds were interviewed, and data were subject to a thematic analysis. (3) Results: Three main themes were identified, each with two subthemes: 'Difficulties and Disruptions to Access' (Access to Appointments; Pandemic Restrictions and Disruption), 'Experiences of Remote Delivery' (Preference for Face-to-Face Contact; Advantages of Remote Support); and 'Psychosocial Experiences' linked to COVID-19 (Heightened Anxiety; Social Isolation). (4) Conclusions: Women from ethnic minority backgrounds experienced disrupted perinatal mental health care and COVID-19 restrictions compounding their mental health difficulties. Services should take women's circumstances into account and provide flexibility regarding remote delivery of care.


Subject(s)
COVID-19 , COVID-19/epidemiology , Child , Female , Humans , Infant, Newborn , London/epidemiology , Mental Health , Minority Groups , Pandemics , Perinatal Care , Pregnancy , Qualitative Research , SARS-CoV-2
2.
Int J Environ Res Public Health ; 19(3)2022 Feb 04.
Article in English | MEDLINE | ID: covidwho-1674621

ABSTRACT

Mental health is especially important as women transition into parenthood. The COVID-19 pandemic has necessitated the rapid reconfiguration of maternity services, including perinatal mental healthcare, as offered by Specialist Perinatal Mental Health Midwives, in NHS Trusts in the United Kingdom. This article represents work undertaken in rapid response to the COVID-19 pandemic and aims to document the findings from March 2020 up until May 2021 in literature published on perinatal mental health through the pandemic, as well as to engage in a knowledge mapping exercise across five NHS Trusts in London. In this research, we utilised a critical review methodology which purposefully selects and synthesises materials after extensive literature searching to provide a broad and informed narrative around an issue. For our knowledge mapping exercise, we utilised an inclusive stance to gather, pool, and synthesise data from five NHS Trusts regarding the provisions and reconfigurations of their perinatal mental health services, creating a comparable and translatable snapshot in time. Our rapid, critical review highlighted two themes: 'Increased Perinatal Distress' and 'Inaccessible Services and Support'. Our knowledge mapping exercise produced four themes: 'Retention of Existing Service Provision'; 'Additional Services Provided'; 'Reconfiguration of Service Provision'; 'Additional Provision to Support Staff Wellbeing'. We conclude by offering best practice guidance in order to provide shared learning to aid the transition through para-pandemic circumstances to service delivery in a post-pandemic 'new normal'.


Subject(s)
COVID-19 , Female , Humans , Mental Health , Pandemics , Parturition , Pregnancy , SARS-CoV-2
3.
BMC Pregnancy Childbirth ; 21(1): 840, 2021 Dec 22.
Article in English | MEDLINE | ID: covidwho-1637767

ABSTRACT

BACKGROUND: The COVID-19 pandemic poses an unprecedented risk to the global population. Maternity care in the UK was subject to many iterations of guidance on how best to reconfigure services to keep women, their families and babies, and healthcare professionals safe. Parents who experience a pregnancy loss or perinatal death require particular care and support. PUDDLES is an international collaboration investigating the experiences of recently bereaved parents who suffered a late miscarriage, stillbirth, or neonatal death during the global COVID-19 pandemic, in seven countries. In this study, we aim to present early findings from qualitative work undertaken with recently bereaved parents in the United Kingdom about how access to healthcare and support services was negotiated during the pandemic. METHODS: In-depth semi-structured interviews were undertaken with parents (N = 24) who had suffered a late miscarriage (n = 5; all mothers), stillbirth (n = 16; 13 mothers, 1 father, 1 joint interview involving both parents), or neonatal death (n = 3; all mothers). Data were analysed using a template analysis with the aim of investigating bereaved parents' access to services, care, and networks of support, during the pandemic after their bereavement. RESULTS: All parents had experience of utilising reconfigured maternity and/or neonatal, and bereavement care services during the pandemic. The themes utilised in the template analysis were: 1) The Shock & Confusion Associated with Necessary Restrictions to Daily Life; 2) Fragmented Care and Far Away Families; 3) Keeping Safe by Staying Away; and 4) Impersonal Care and Support Through a Screen. Results suggest access to maternity, neonatal, and bereavement care services were all significantly reduced, and parents' experiences were notably affected by service reconfigurations. CONCLUSIONS: Our findings, whilst preliminary, are important to document now, to help inform care and service provision as the pandemic continues and to provide learning for ongoing and future health system shocks. We draw conclusions on how to enable development of safe and appropriate services during this pandemic and any future health crises, to best support parents who experience a pregnancy loss or whose babies die.


Subject(s)
Abortion, Spontaneous/psychology , Bereavement , COVID-19/psychology , Grief , Parents/psychology , Perinatal Death , Stillbirth/psychology , Continuity of Patient Care/standards , Female , Health Services Accessibility/standards , Humans , Infant, Newborn , Male , Pregnancy , Preliminary Data , Psychosocial Support Systems , Qualitative Research , Quarantine/psychology , SARS-CoV-2 , United Kingdom/epidemiology
4.
Women Birth ; 2021 Oct 11.
Article in English | MEDLINE | ID: covidwho-1458649

ABSTRACT

PROBLEM: Disrupted access to social and healthcare professional support during the COVID-19 pandemic have had an adverse effect on maternal mental health. BACKGROUND: Motherhood is a key life transition which increases vulnerability to experience negative affect. AIM: Explore UK women's postnatal experiences of social and healthcare professional support during the COVID-19 pandemic. METHODS: Semi-structured interviews were conducted with 12 women, approximately 30 days after initial social distancing guidelines were imposed (T1), and a separate 12 women were interviewed approximately 30 days after the initial easing of social distancing restrictions (T2). Recurrent cross-sectional thematic analysis was conducted in NVivo 12. FINDINGS: T1 themes were, 'Motherhood has been an isolating experience' (exacerbated loneliness due to diminished support accessibility) and 'Everything is under lock and key' (confusion, alienation, and anxiety regarding disrupted face-to-face healthcare checks). T2 themes were, 'Disrupted healthcare professional support' (feeling burdensome, abandoned, and frustrated by virtual healthcare) and 'Easing restrictions are bittersweet' (conflict between enhanced emotional wellbeing, and sadness regarding lost postnatal time). DISCUSSION: Respondents at both timepoints were adversely affected by restricted access to informal (family and friends) and formal (healthcare professional) support, which were not sufficiently bridged virtually. Additionally, the prospect of attending face-to-face appointments was anxiety-provoking and perceived as being contradictory to social distancing guidance. Prohibition of family from maternity wards was also salient and distressing for T2, but not T1 respondents. CONCLUSION: Healthcare professionals should encourage maternal help-seeking and provide timely access to mental health services. Improving access to informal and formal face-to-face support are essential in protecting maternal and infant wellbeing.

5.
BMC Pregnancy Childbirth ; 21(1): 625, 2021 Sep 17.
Article in English | MEDLINE | ID: covidwho-1412672

ABSTRACT

BACKGROUND: COVID-19 has placed additional stressors on mothers during an already vulnerable lifecourse transition. Initial social distancing restrictions (Timepoint 1; T1) and initial changes to those social distancing restrictions (Timepoint 2; T2) have disrupted postpartum access to practical and emotional support. This qualitative study explores the postpartum psychological experiences of UK women during different phases of the COVID-19 pandemic and associated 'lockdowns'. METHODS: Semi-structured interviews were conducted with 12 women, approximately 30 days after initial social distancing guidelines were imposed in the UK (22 April 2020). A separate 12 women were interviewed approximately 30 days after the initial easing of social distancing restrictions (10 June 2020). Data were transcribed verbatim, uploaded into NVivo for management and analysis, which followed a recurrent cross-sectional approach to thematic analysis. RESULTS: Two main themes were identified for T1: 'Motherhood is Much Like Lockdown' and 'A Self-Contained Family Unit'. Each main T1 theme contained two sub-themes. Two main themes were also identified for T2: 'Incongruously Held Views of COVID-19' and 'Mothering Amidst the Pandemic'. Each main T2 theme contained three sub-themes. Comparisons between data gathered at each timepoint identified increased emotional distress over time. Current findings call for the improvement of postpartum care by improving accessibility to social support, and prioritising the re-opening of schools, and face-to-face healthcare appointments and visitation. CONCLUSION: Social distancing restrictions associated with COVID-19 have had a cumulative, negative effect on postpartum mental health. Recommendations such as: Allowing mothers to 'bubble' with a primary support provider even at their healthcare appointments; allowing one support partner to attend all necessary healthcare appointments; and providing tailored informational resources, may help to support postpartum emotional wellbeing during this, and similar health crises in the future.


Subject(s)
Burnout, Psychological , COVID-19/psychology , Mothers/psychology , Psychological Distress , Social Support , Adult , Communicable Disease Control/methods , Cross-Sectional Studies , Female , Humans , Interviews as Topic , Mental Health Services , Postnatal Care/methods , Postpartum Period/psychology , Qualitative Research
6.
Midwifery ; 102: 103116, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1340769

ABSTRACT

OBJECTIVE: To explore women's experiences of maternity service reconfiguration during the first wave of the SARS-CoV-2 (COVID-19) pandemic. DESIGN: Qualitative interview study. SETTING: South London, United Kingdom. PARTICIPANTS: Women (N=23) who gave birth between March and August 2020 in one of the ten South London maternity hospitals. METHODS: 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. FINDINGS: 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. KEY CONCLUSIONS: 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. IMPLICATIONS FOR PRACTICE: 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.


Subject(s)
COVID-19 , Maternal Health Services/organization & administration , Pregnant Women/psychology , Telemedicine , Adult , COVID-19/epidemiology , Female , Humans , Interviews as Topic , Maternal Health Services/trends , Pandemics/prevention & control , Pregnancy , Qualitative Research , SARS-CoV-2 , United Kingdom
7.
J Psychiatr Res ; 136: 157-166, 2021 04.
Article in English | MEDLINE | ID: covidwho-1062492

ABSTRACT

BACKGROUND: When the vulnerabilities of the postnatal period are combined with the impact of the COVID-19 pandemic, psychosocial outcomes are likely to be affected. Specifically, we aim to: a) explore the psychosocial experiences of women in the early postnatal period; b) describe prevalence rates of clinically relevant maternal anxiety and depression; and c) explore whether psychosocial change occurring as a result of COVID-19 is predictive of clinically relevant maternal anxiety and depression. METHODS: A sample of UK mothers (N = 614) with infants aged between birth and twelve weeks were recruited via convenience sampling. A cross-sectional survey design was utilised which comprised demographics, COVID-19 specific questions, and a battery of validated psychosocial measures, including the EPDS and STAI-S which were used to collect prevalence rates of clinically relevant depression and anxiety respectively. Data collection coincided with the UK government's initial mandated "lockdown" restrictions and the introduction of social distancing measures in 2020. FINDINGS: Descriptive findings from the overall sample indicate that a high percentage of mothers self-reported psychological and social changes as a result of the introduction of social distancing measures. For women who reported the presence of psychosocial change, these changes were perceived negatively. Whilst seventy women (11.4%) reported a current clinical diagnosis of depression, two hundred and sixty-four women (43%) reported a score of ≥13 on the EPDS, indicating clinically relevant depression. Whilst one hundred and thirteen women (18.4%) reported a current clinical diagnosis of anxiety, three hundred and seventy-three women (61%) reported a score of ≥40 on STAI-S, indicating clinically relevant anxiety. After accounting for current clinical diagnoses of depression or anxiety, and demographic factors known to influence mental health, only perceived psychological change occurring as a result of the introduction of social distancing measures predicted unique variance in the risk of clinically relevant maternal depression (30%) and anxiety (33%). INTERPRETATION: To our knowledge, this is the first national study to examine the psychosocial experiences of postnatal women during the COVID-19 pandemic in the UK. Prevalence rates of clinically relevant maternal depression and anxiety were extremely high when compared to both self-reported current diagnoses of depression and anxiety, and pre-pandemic prevalence studies. Perceived psychological changes occurring as a result of the introduction of social distancing measures predicted unique variance in the risk for clinically relevant maternal depression and anxiety. This study provides vital information for clinicians, funders, policy makers, and researchers to inform the immediate next steps in perinatal care, policy, and research during COVID-19 and future health crises.


Subject(s)
Anxiety/epidemiology , COVID-19/epidemiology , Depression, Postpartum/epidemiology , Pandemics , Adult , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Pregnancy , Prevalence , Risk Factors , United Kingdom/epidemiology
8.
BMC Public Health ; 21(1): 176, 2021 01 21.
Article in English | MEDLINE | ID: covidwho-1041943

ABSTRACT

The response to the coronavirus outbreak and how the disease and its societal consequences pose risks to already vulnerable groups such those who are socioeconomically disadvantaged and ethnic minority groups. Researchers and community groups analysed how the COVID-19 crisis has exacerbated persisting vulnerabilities, socio-economic and structural disadvantage and discrimination faced by many communities of social disadvantage and ethnic diversity, and discussed future strategies on how best to engage and involve local groups in research to improve outcomes for childbearing women experiencing mental illness and those living in areas of social disadvantage and ethnic diversity. Discussions centred around: access, engagement and quality of care; racism, discrimination and trust; the need for engagement with community stakeholders; and the impact of wider social and economic inequalities. Addressing biomedical factors alone is not sufficient, and integrative and holistic long-term public health strategies that address societal and structural racism and overall disadvantage in society are urgently needed to improve health disparities and can only be implemented in partnership with local communities.


Subject(s)
Health Status Disparities , Maternal Health , Residence Characteristics/statistics & numerical data , COVID-19/epidemiology , COVID-19/ethnology , Cultural Diversity , Female , Humans , Maternal Health/ethnology , Poverty Areas , Pregnancy , United Kingdom/epidemiology
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