By Jeanine Mikek, MSN, RN, CEN, RNC-NIC
Maternal Child Health Educator, IU Arnett Hospital, Lafayette, IN
SYNOPSIS: In this cross-sectional descriptive study, women using the Ovia pregnancy app expressed receiving adequately safe maternal care during the COVID-19 pandemic, but voiced concerns related to obtaining infant supplies and prenatal education.
SOURCE: Burgess A, Breman RB, Bradley D, et al. Pregnant women’s reports of the impact of COVID-19 on pregnancy, prenatal care, and infant feeding plans. MCN Am J Matern Child Nurs 2021;46:21-29.
When severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first hit the United States in early 2020, many healthcare facilities adapted their current practices to adhere to recommended infection prevention measures. Some offices and clinics opted to complete virtual visits with patients, and many hospitals restricted the number of visitors allowed. Coronavirus disease 2019 (COVID-19) has led to financial, economic, and health insecurities for many among the general population, including pregnant women and those with small infants at home. Burgess et al aimed to decipher how COVID-19 has changed prenatal maternity practices, infant feeding plans, and other aspects of care for pregnant or postpartum women. Through the use of an app-based survey that was open for one week in May 2020, women were able to score their perceptions of care and write anecdotal comments related to their concerns and experiences.
The majority of participants identified themselves as white (82.9%), married (80.9%), primiparous (62%), actively seeing an OB/GYN for care (81.3%), and more than 24 weeks of gestation (53.9%). Nearly three-fourths of participants stated their chosen birth facility was only allowing one support person during labor and delivery, which 17% found too restrictive. Fifty percent of the women reported interest in childbirth education classes, but 75% of those participants stated classes were canceled while only 54% reported being given an option to attend virtually. An overwhelming majority of the women who originally planned to attend classes (93.2%) reported they would have preferred face-to-face classes.
COVID-19 also hindered the perception and emotional aspect of the provider visit. Although more than 60% of the women reported being satisfied with their virtual prenatal visits, many commented that the care seemed inadequate, impersonal, or unsafe. Difficulties in obtaining appointments or missing out on important checks, such as fetal heartbeat or maternal blood pressure, were voiced. Interestingly, six of the women said their infant feeding plan changed because of COVID-19, with five of those participants switching from formula to breast milk. Four of those women reported they thought that breast milk would better protect their baby from infection. From a financial aspect, a large number of canceled baby showers and a seemingly low supply of essential items (such as diapers and wipes) also concerned the women.
A major limitation to this qualitative study is the small number of women who responded. Although more than 90,000 application users received the link to the survey, only 442 (4%) opened the link and 258 completed the survey (58% of those who opened the survey and 0.2% of eligible participants). Despite the pertinent comments made by the participants, generalization of the results is questionable because of the small sample size. In addition, there are numerous applications and sites that pregnant women use. The survey used for the Ovia app is a good start to review perceptions and experiences, but the results may have varied across other platforms and with a larger participant response. This also would expand the characteristics of study participants, which may factor in socioeconomic difficulties in obtaining care.
Despite the limitation of the study, it is clear that COVID-19 has not only affected healthcare from the provider viewpoint, but from the patient perspective as well. Virtual visits often are applied to reduce the amount of people and foot traffic in an enclosed building, but the impersonal feel may hinder a pregnant woman from feeling comfortable, asking questions, or being reassured that she and the fetus are healthy. In-office visits may be postponed or canceled if the woman is having any COVID-19-associated symptoms, and telehealth may not be an option for those with limited technology access.1 Prenatal and antenatal education classes can be a remarkable benefit to women and their partners as they prepare for their newborn, and that education should not cease. Although the virtual platform is not ideal in this setting, the education still should be available and shared regardless of the obstacles that COVID-19 has created. Interactions and visits should be used to assess the physical, as well as the emotional, well-being of the mother during this time of uncertainty.
- Fryer K, Delgado A, Foti T, et al. Implementation of obstetric telehealth during COVID-19 and beyond. Matern Child Health J 2020;24:1104-1110.