Applying Lessons Learned from the COVID-19 Pandemic to Future Threats to the Perinatal Care System.

INTRODUCTION: Health care systems will continue to face unpredictable challenges related to climate change. The COVID-19 pandemic tested the ability of perinatal care systems to respond to extreme disruption. Many childbearing people in the United States opted out of the mainstream choice of hospital birth during the pandemic, leading to a 19.5% increase in community birth between 2019 and 2020. The aim of the study was to understand the experiences and priorities of childbearing people as they sought to preserve a safe and satisfying birth during the time of extreme health care disruption caused by the pandemic. METHODS: This exploratory qualitative study recruited participants from a sample of respondents to a national-scope web-based survey that explored experiences of pregnancy and birth during the COVID-19 pandemic. Maximal variation sampling was used to invite survey respondents who had considered a variety of birth setting, perinatal care provider, and care model options to participate in individual interviews. A conventional content analysis approach was used with coding categories derived directly from the transcribed interviews. RESULTS: Interviews were conducted with 18 individuals. Results were reported around 4 domains: (1) respect and autonomy in decision-making, (2) high-quality care, (3) safety, and (4) risk assessment and informed choice. Respect and autonomy varied by birth setting and perinatal care provider type. Quality of care and safety were described in relational and physical terms. Childbearing people prioritized alignment with their personal philosophies toward birth as they weighed safety. Although levels of stress and fear were elevated, many felt empowered by the sudden opportunity to consider new options. DISCUSSION: Disaster preparedness and health system strengthening should address the importance childbearing people place on the relational aspects of care, need for options in decision-making, timely and accurate information sharing, and opportunity for a range of safe and supported birth settings. Mechanisms are needed to build system-level changes that respond to the self-expressed needs and priorities of childbearing people.

Knowledge and Attitudes Toward Prenatal Yoga Among Women with High-Risk Pregnancies.

This study sought to evaluate attitudes and knowledge about prenatal yoga and to investigate barriers and facilitators to yoga participation in high-risk pregnant women receiving prenatal care in an academic tertiary care center. We surveyed a convenience sample of women receiving prenatal care through the Maternal-Fetal Medicine practice at Brigham and Women's Hospital. We classified participants as yoga-experienced or yoga-naive depending on self-report. We compared differences between the two groups using the appropriate nonparametric tests and compared bivariate odds ratios for survey results using logistic regression. Of the 100 respondents, 53% had practiced yoga previously. Women with yoga experience were older (age 34.9 ± 5.6 vs. 31.0 ± 6.0 years, p = 0.004), more likely to be college graduates (94% vs. 68%, p = 0.002), and more likely to be White (77% vs. 47%, p = 0.002) than women without previous yoga experience. Previous yoga experience was associated with participant agreement that yoga was safe during their current pregnancy (odds ratio 5.9, 95% confidence interval 1.9-17.7). Of the women surveyed, 56% agreed that they would like to attend a prenatal yoga class. In a multivariate model including age, race, and education, previous yoga experience was the only significant predictor associated with willingness to participate in prenatal yoga classes during current pregnancy (odds ratio 3.1, 95% confidence interval 1.1-8.6). Prior yoga experience was the strongest predictor of willingness to attend a prenatal yoga class in our population. Our results suggest that women with high-risk pregnancies who may benefit from prenatal yoga interventions but lack prior yoga experience may need additional education to facilitate participation.