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2.
Semin Perinatol ; 45(5): 151431, 2021 08.
Article in English | MEDLINE | ID: covidwho-1454526

ABSTRACT

We discuss the use of tele-mental health in settings serving expectant parents in fetal care centers and parents with children receiving treatment in neonatal intensive care units within a pediatric institution. Our emphasis is on the dramatic rise of tele-mental health service delivery for this population in the wake of the onset of the COVID-19 pandemic in the U.S., including relevant practice regulations, challenges and advantages associated with the transition to tele-mental health in these perinatal settings.


Subject(s)
Delivery of Health Care , Intensive Care Units, Neonatal/trends , Mental Health/trends , Perinatal Care , Psychosocial Intervention , Telemedicine , COVID-19/epidemiology , COVID-19/prevention & control , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Female , Humans , Infection Control , Male , Parents/education , Parents/psychology , Perinatal Care/methods , Perinatal Care/organization & administration , Pregnancy , Prenatal Education/trends , Psychosocial Intervention/methods , Psychosocial Intervention/trends , SARS-CoV-2 , Telemedicine/methods , Telemedicine/organization & administration , United States/epidemiology
3.
BMC Pregnancy Childbirth ; 21(1): 670, 2021 Oct 03.
Article in English | MEDLINE | ID: covidwho-1448217

ABSTRACT

BACKGROUND: Coronavirus currently cause a lot of pressure on the health system. Accordingly, many changes occurred in the way of providing health care, including pregnancy and childbirth care. To our knowledge, no studies on experiences of maternity care Providers during the COVID-19 Pandemic have been published in Iran. We aimed to discover their experiences on pregnancy and childbirth care during the current COVID-19 pandemic. METHODS: This study was a qualitative research performed with a descriptive phenomenological approach. The used sampling method was purposive sampling by taking the maximum variation possible into account, which continued until data saturation. Accordingly, in-depth and semi-structured interviews were conducted by including 12 participants, as 4 gynecologists, 6 midwives working in the hospitals and private offices, and 2 midwives working in the health centers. Data were analyzed using Colaizzi's seven stage method with MAXQDA10 software. RESULTS: Data analysis led to the extraction of 3 themes, 9 categories, and 25 subcategories. The themes were as follows: "Fear of Disease", "Burnout", and "Lessons Learned from the COVID-19 Pandemic", respectively. CONCLUSIONS: Maternal health care providers experience emotional and psychological stress and work challenges during the current COVID-19 pandemic. Therefore, comprehensive support should be provided for the protection of their physical and mental health statuses. By working as a team, utilizing the capacity of telemedicine to care and follow up mothers, and providing maternity care at home, some emerged challenges to maternal care services can be overcome.


Subject(s)
COVID-19/psychology , Health Personnel/psychology , Maternal Health Services/statistics & numerical data , Perinatal Care/statistics & numerical data , Adult , Burnout, Psychological/psychology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Emotions/physiology , Female , Gynecology/statistics & numerical data , Health Personnel/statistics & numerical data , Humans , Infant, Newborn , Interviews as Topic , Iran/epidemiology , Maternal Health Services/trends , Middle Aged , Midwifery/statistics & numerical data , Perinatal Care/organization & administration , Phobic Disorders/psychology , Pregnancy , Qualitative Research , SARS-CoV-2/genetics , Stress, Psychological/psychology , Telemedicine/methods
5.
Clin Obstet Gynecol ; 64(2): 333-344, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1197047

ABSTRACT

Telehealth has expanded its reach significantly since its inception due to the advances in technology over the last few decades. Social determinants of health (SDOH) negatively impact the health of pregnant and postpartum women and need to be considered when deploying telehealth strategies. In this article, we describe telehealth modalities and their application to improve the SDOH that impact pregnancy and postpartum outcomes. Physicians and patients alike report satisfaction with telehealth as it improves access to education, disease monitoring, specialty care, prenatal and postpartum care. Ten years ago, we developed a program, Moms2B, to eliminate disparities in pregnancy outcomes for underserved women. Using a case study, we describe how Moms2B, devoted to improve the SDOH for pregnant women, transitioned from an in-person to a virtual format. Telehealth benefited women before the recent coronavirus disease 2019 pandemic and increasingly after emergency authorizations has allowed telehealth to flourish.


Subject(s)
Health Services Accessibility/organization & administration , Health Status Disparities , Healthcare Disparities , Perinatal Care/methods , Prenatal Care/methods , Social Determinants of Health , Telemedicine/methods , Female , Humans , Mobile Applications , Ohio , Outcome Assessment, Health Care , Perinatal Care/organization & administration , Poverty , Pregnancy , Pregnancy Outcome , Prenatal Care/organization & administration , Telemedicine/organization & administration
6.
Semin Perinatol ; 45(5): 151429, 2021 08.
Article in English | MEDLINE | ID: covidwho-1164467

ABSTRACT

The COVID-19 pandemic has caused an explosive adoption of telehealth in pediatrics . However, there remains substantial variation in evaluation methods and measures of these programs despite introduction of measurement frameworks in the last five years. In addition, for neonatal health care, assessing a telehealth program must measure its benefits and costs for four stakeholder groups - patients, providers, healthcare system, and payers. Because of differences in their role within the health system, each group's calculation of telehealth's value may align or not with one another, depending on how it is being used. Therefore, a common mental model for determining value is critical in order to use telehealth in ways that produce win-win situations for most if not all four stakeholder groups. In this chapter, we present important principles and concepts from previously published frameworks to propose an approach to telehealth evaluation that can be used for perinatal health. Such a framework will then drive future development and implementation of telehealth programs to provide value for all relevant stakeholders in a perinatal health care system.


Subject(s)
COVID-19 , Child Health Services , Neonatology/trends , Perinatal Care , Remote Consultation , Telemedicine , COVID-19/epidemiology , COVID-19/prevention & control , Child Health Services/organization & administration , Child Health Services/trends , Female , Health Services Accessibility , Humans , Infant Health/trends , Infant, Newborn , Infection Control/methods , Perinatal Care/organization & administration , Perinatal Care/trends , Pregnancy , Program Evaluation , Remote Consultation/organization & administration , Remote Consultation/statistics & numerical data , SARS-CoV-2 , Telemedicine/methods , Telemedicine/organization & administration , United States/epidemiology
10.
BMC Pregnancy Childbirth ; 21(1): 171, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1112430

ABSTRACT

BACKGROUND: Psychological stress and coping experienced during pregnancy can have important effects on maternal and infant health, which can also vary by race, ethnicity, and socioeconomic status. Therefore, we assessed stressors, coping behaviors, and resources needed in relation to the COVID-19 pandemic in a sample of 162 perinatal (125 pregnant and 37 postpartum) women in the United States. METHODS: A mixed-methods study captured quantitative responses regarding stressors and coping, along with qualitative responses to open-ended questions regarding stress and resources needed during the COVID-19 pandemic. Logistic and linear regression models were used to analyze differences between pregnant and postpartum participants, as well as differences across key demographic variables. Qualitative content analysis was used to analyze open-ended questions. RESULTS: During the COVID-pandemic, food scarcity and shelter-in-place restrictions made it difficult for pregnant women to find healthy foods. Participants also reported missing prenatal appointments, though many reported using telemedicine to obtain these services. Financial issues were prevalent in our sample and participants had difficulty obtaining childcare. After controlling for demographic variables, pregnant women were less likely to engage in healthy stress-coping behaviors than postpartum women. Lastly, we were able to detect signals of increased stressors induced by the COVID-19 pandemic, and less social support, in perinatal women of racial and ethnic minority, and lower-income status. Qualitative results support our survey findings as participants expressed concerns about their baby contracting COVID-19 while in the hospital, significant others missing the delivery or key obstetric appointments, and wanting support from friends, family, and birthing classes. Financial resources, COVID-19 information and research as it relates to maternal-infant health outcomes, access to safe healthcare, and access to baby supplies (formula, diapers, etc.) emerged as the primary resources needed by participants. CONCLUSIONS: To better support perinatal women's mental health during the COVID-19 pandemic, healthcare providers should engage in conversations regarding access to resources needed to care for newborns, refer patients to counseling services (which can be delivered online/via telephone) and virtual support groups, and consistently screen pregnant women for stressors.


Subject(s)
Adaptation, Psychological , COVID-19 , Health Resources/organization & administration , Health Services Accessibility , Parenting/psychology , Perinatal Care , Prenatal Education/methods , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Female , Health Care Rationing/statistics & numerical data , Health Services Accessibility/standards , Health Services Accessibility/trends , Humans , Infant, Newborn , Mental Health/standards , Needs Assessment , Perinatal Care/methods , Perinatal Care/organization & administration , Perinatal Care/trends , Pregnancy , SARS-CoV-2 , Stress, Psychological/etiology , Stress, Psychological/prevention & control , Telemedicine/methods , Telemedicine/organization & administration , United States
11.
Pediatrics ; 146(Suppl 2): S218-S222, 2020 10.
Article in English | MEDLINE | ID: covidwho-1073156

ABSTRACT

Data from the past decade have revealed that neonatal mortality represents a growing burden of the under-5 mortality rate. To further reduce these deaths, the focus must expand to include building capacity of the workforce to provide high-quality obstetric and intrapartum care. Obstetric complications, such as hypertensive disorders and obstructed labor, are significant contributors to neonatal morbidity and mortality. A well-prepared workforce with the necessary knowledge, skills, attitudes, and motivation is required to rapidly detect and manage these complications to save both maternal and newborn lives. Traditional off-site, didactic, and lengthy training approaches have not always yielded the desired results. Helping Mothers Survive training was modeled after Helping Babies Breathe and incorporates further evidence-based methodology to deliver training on-site to the entire team of providers, who continue to practice after training with their peers. Research has revealed that significant gains in health outcomes can be reached by using this approach. In the coronavirus disease 2019 era, we must look to translate the best practices of these training programs into a flexible and sustainable model that can be delivered remotely to maintain quality services to women and their newborns.


Subject(s)
Health Personnel/education , Inservice Training/organization & administration , Perinatal Care/organization & administration , Capacity Building , Female , Humans , Infant , Infant Mortality , Infant, Newborn , Maternal-Child Health Services/organization & administration , Perinatal Care/standards , Pregnancy , Pregnancy Complications/prevention & control , Pregnancy Complications/therapy
12.
Epidemiol Prev ; 44(5-6 Suppl 2): 369-373, 2020.
Article in English | MEDLINE | ID: covidwho-1068159

ABSTRACT

During a pandemic, pregnancy and the postnatal period are complicated by multiple factors. On the one hand, worries about one's own health and the health of loved ones, in particular of the newborn child, can increase the risk of some mental disorders, such as depression and anxiety in the pregnant woman. On the other hand, as happened for the COVID-19 epidemic in Italy, given the need for physical distancing, the maintenance of the social and family network, so important for new parents in the perinatal period, is lacking. In addition, health services are forced to reorganize their offerings to ensure maximum safety for their operators and patients. This work proposes a model of screening and treatment aimed at identifying women at risk and providing them with effective and safe treatment.


Subject(s)
Anxiety/diagnosis , COVID-19/epidemiology , Depression/diagnosis , Mass Screening/organization & administration , Pandemics , Perinatal Care/organization & administration , Pregnancy Complications/diagnosis , Pregnant Women/psychology , Puerperal Disorders/diagnosis , SARS-CoV-2 , Adult , Anxiety/epidemiology , COVID-19/psychology , Depression/etiology , Depression/therapy , Depression, Postpartum/diagnosis , Depression, Postpartum/epidemiology , Depression, Postpartum/psychology , Depression, Postpartum/therapy , Diagnostic Self Evaluation , Empowerment , Evidence-Based Medicine , Female , Follow-Up Studies , Humans , Italy/epidemiology , Perinatal Care/methods , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/psychology , Pregnancy Complications/therapy , Program Evaluation , Puerperal Disorders/epidemiology , Puerperal Disorders/psychology , Puerperal Disorders/therapy , Risk Factors , Stress, Psychological/epidemiology , Stress, Psychological/etiology , Stress, Psychological/psychology , Telemedicine
14.
Int J Health Plann Manage ; 35(6): 1306-1310, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-738877

ABSTRACT

Throughout the world as health systems are being prepared to deal with the SARS-CoV-2 outbreak which will affect the management of HIV, diabetes, mental health and mainly maternal healthcare systems. As all efforts are focused on understanding the epidemiology, clinical features, transmission patterns, and management of the COVID-19 outbreak, there has been very little concern expressed over the effects on maternal health services. It is highly likely that the present situation may exacerbate maternal mortality in suburban and rural areas. The present situation requires governments and NGOs to make necessary arrangements to support people with prenatal and postnatal care.


Subject(s)
COVID-19/epidemiology , Maternal Health Services/organization & administration , COVID-19/prevention & control , Female , Humans , Maternal Mortality , Pakistan/epidemiology , Perinatal Care/organization & administration , Pregnancy , Prenatal Care/organization & administration
15.
Int J Gynaecol Obstet ; 151(2): 188-196, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-696170

ABSTRACT

OBJECTIVE: To provide a descriptive account of the challenges and administrative preparedness for establishing and sustaining safe obstetric services during the COVID-19 pandemic at Topiwala National Medical College & BYL Nair Charitable Hospital (NH), Mumbai, India. METHODS: The management of pregnant women with COVID-19 was implemented as per international (WHO, RCOG, ACOG) and national (Indian Council of Medical Research) recommendations and guidelines at an academic, tertiary care, COVID-19 hospital in India. RESULTS: Using a multidisciplinary approach and active engagement of a multispecialty team, obstetric services were provided to over 400 women with laboratory-confirmed COVID-19. A sustainable model is established for providing services to pregnant women with COVID-19 in Mumbai Metropolitan Region, India. CONCLUSION: With limited resources, it is possible to set up dedicated maternity services, aligned to international guidelines, for safe pregnancy outcomes in COVID-19 settings. This COVID-19 hospital addressed the challenges and implemented several known and novel methods to establish and sustain obstetric services for women with COVID-19. The model established in the present study can be replicated in other low- and middle-income countries.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Delivery, Obstetric/methods , Infection Control , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Tertiary Healthcare , Adult , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Humans , India/epidemiology , Infection Control/methods , Infection Control/standards , Organizational Innovation , Perinatal Care/organization & administration , Perinatal Care/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Pregnancy Outcome , SARS-CoV-2 , Tertiary Healthcare/methods , Tertiary Healthcare/organization & administration
16.
J Cardiovasc Med (Hagerstown) ; 21(9): 654-659, 2020 09.
Article in English | MEDLINE | ID: covidwho-681583

ABSTRACT

OBJECTIVE: By the end of February 2020, the COVID-19 pandemic infection had spread in Northern Italy, with thousands of patients infected. In Lombardy, the most affected area, the majority of public and private hospitals were dedicated to caring for COVID-19 patients and were organized following the 'Hub-and-Spoke' model for other medical specialties, like cardiac surgery and interventional procedures for congenital cardiac disease (CHD). Here, we report how the congenital cardiac care system was modified in Lombardy and the first results of this organization. METHODS: We describe a modified 'Hub-and-Spoke' model - that involves 59 birthplaces and three specialized Congenital Cardiac Centers -- and how the hub center organized his activity. We also reported the data of the consecutive cases hospitalized during this period. RESULTS: From 9 March to 15 April, we performed: a total of 21 cardiac surgeries, 4 diagnostic catheterizations, 3 CT scans, and 2 CMR. In three cases with prenatal diagnosis, the birth was scheduled. The spoke centers referred to our center six congenital cardiac cases. The postop ExtraCorporeal Membrane Oxygenation support was required in two cases; one case died. None of these patients nor their parents or accompanying person was found to be COVID-19-positive; 2 pediatric intensivists were found to be COVID-19-positive, and needed hospitalization without mechanical ventilation; 13 nurses had positive COVID swabs (4 with symptoms), and were managed and isolated at home. CONCLUSION: Our preliminary data suggest that the model adopted met the immediate needs with a good outcome without increased mortality, nor COVID-19 exposure for the patients who underwent procedures.


Subject(s)
Cardiac Surgical Procedures , Cardiology Service, Hospital , Coronavirus Infections , Heart Defects, Congenital , Infection Control , Pandemics , Perinatal Care , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/statistics & numerical data , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Female , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/surgery , Humans , Infant, Newborn , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Models, Organizational , Organizational Innovation , Pandemics/prevention & control , Perinatal Care/methods , Perinatal Care/organization & administration , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Postoperative Care/methods , Pregnancy , SARS-CoV-2
19.
J Neonatal Perinatal Med ; 13(3): 307-311, 2020.
Article in English | MEDLINE | ID: covidwho-349047

ABSTRACT

In the context of SARS-CoV-2 pandemic, the hospital management of mother-infant pairs poses to obstetricians and neonatologists previously unmet challenges. In Lombardy, Northern Italy, 59 maternity wards networked to organise the medical assistance of mothers and neonates with suspected or confirmed SARS-CoV-2 infection. Six "COVID-19 maternity centres" were identified, the architecture and activity of obstetric and neonatal wards of each centre was reorganised, and common assistance protocols for the management of suspected and proven cases were formulated. Here, we present the key features of this reorganization effort, and our current management of the mother-infant dyad before and after birth, including our approach to rooming-in practice, breastfeeding and neonatal follow-up, based on the currently available scientific evidence. Considered the rapid diffusion of COVID-19 all over the world, we believe that preparedness is fundamental to assist mother-infant dyads, minimising the risk of propagation of the infection through maternity and neonatal wards.


Subject(s)
Coronavirus Infections , Infection Control , Infectious Disease Transmission, Vertical/prevention & control , Pandemics , Perinatal Care , Pneumonia, Viral , Practice Patterns, Physicians'/trends , Pregnancy Complications, Infectious , Betacoronavirus/isolation & purification , Breast Feeding/methods , COVID-19 , Civil Defense/organization & administration , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Delivery Rooms/standards , Delivery, Obstetric/methods , Delivery, Obstetric/trends , Female , Humans , Infant, Newborn , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Organizational Innovation , Pandemics/prevention & control , Perinatal Care/methods , Perinatal Care/organization & administration , Perinatal Care/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/prevention & control , SARS-CoV-2
20.
Am J Perinatol ; 37(8): 850-853, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-215517

ABSTRACT

Novel coronavirus disease 2019 (COVID-19) is a pandemic with most American cases in New York. As an institution residing in a high-prevalence zip code, with over 8,000 births annually, we have cared for over 80 COVID-19-infected pregnant women, and have encountered many challenges in applying new national standards for care. In this article, we review how to change outpatient and inpatient practices, develop, and disseminate new hospital protocols, and we highlight the psychosocial challenges for pregnant patients and their providers. KEY POINTS: · Novel coronavirus disease 2019 (COVID-19) information rapidly changes.. · Multidisciplinary communication is key.. · This study addresses psychosocial challenges..


Subject(s)
Coronavirus Infections , Infection Control , Pandemics , Perinatal Care , Pneumonia, Viral , Pregnancy Complications, Infectious , Standard of Care/trends , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Evidence-Based Practice/trends , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Interdisciplinary Communication , Obstetrics/organization & administration , Obstetrics/trends , Organizational Innovation , Pandemics/prevention & control , Perinatal Care/methods , Perinatal Care/organization & administration , Perinatal Care/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/prevention & control , SARS-CoV-2 , United States/epidemiology
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