- BPAS releases new research today from its WRISK project on pregnancy with Cardiff University, exploring the impact of the pandemic on maternity care in the UK
- Its results found that restrictions placed on partner involvement in maternity care caused widespread distress and anxiety, particularly during scans, emergency attendances, and labour assessments.
- Women with complex pregnancies were concerned that changes in the health and wellbeing of their baby could go unnoticed due to reduced antenatal and postnatal checks.
- COVID-19 restrictions compounded existing failures in hospital-based postnatal care to meet the needs of new parents.
- Nearly a quarter of women surveyed (23.3%) felt their needs were not at all met by virtual healthcare appointments.
- On postnatal wards 71.9% reported feeling lonely, 43.7% being very unhappy and 57.5% feeling they needed visitors to provide practical help not provided by staff.
- Women report feeling “abandoned,” “deeply anxious and traumatised” and that “the system has completely failed [me].”
BPAS releases new research today from its WRISK project on pregnancy with Cardiff University, exploring the impact of COVID-19 restrictions in maternity care on pregnant women.
The COVID-19 pandemic saw radical changes to NHS maternity services to protect pregnant women and people from transmission which included less face-to-face antenatal and postnatal contact; using virtual care appointments; closing midwifery units and stopping home births; and restrictions on partner and family visits.
The report explores women’s experiences and the emotional consequences of COVID-19 risk messaging and ‘socially-distanced’ maternity care. Whilst a small number of women were unphased by COVID-19 maternity restrictions, for most, the strict changes resulted in feelings of distress, anxiety, and isolation during an already-difficult time for pregnancy.
The role of maternity services to meet the emotional and physical needs of pregnant women and people was found to have been sacrificed to some extent during the pandemic.
While recent recommendations to relax partner and visitor restrictions are welcomed, allowing local interpretation of rules risks the continued use of stringent measures by organisations and individuals. BPAS are concerned that this may lead to a continued ‘patchwork’ of restrictions in maternity services across the UK.
Many women who had an ultrasound scan during the pandemic found attending alone to be distressing, particularly when a problem was identified, if they had experienced a previous pregnancy loss, or if the care was unscheduled:
“Having my 20-week scan alone, being told there was a problem with the baby was awful. Communication was poor with the sonographer and the consultant, and I was extremely distressed after 2 miscarriages in the past. Then having to relay the information to my partner whilst sobbing on the phone. Every appointment since had been awfully distressing.”
Women found attending emergency antenatal care alone particularly distressing. They described having to attend when bleeding in pregnancy, for reduced fetal movements, and in other situations when they could be informed that their baby had died – all without a partner for support:
“Awful. I was told at a routine 12-week scan that I'd had a missed miscarriage. I was on my own and my partner was in the car. I had to go through a very difficult scan alone and then also had to relay that information to my husband. It made an already difficult situation much more challenging.”
Nearly a quarter of women surveyed (23.3%) felt their needs were not at all met by virtual healthcare appointments:
“It has felt very hands off. I've had two very brief phone calls. Whilst I have been pregnant before, it ended in miscarriage very early, so this feels like the first time I've been properly pregnant. As I haven't been through the NHS antenatal care pathway before it feels a bit daunting with so much uncertainty and so little contact.”
Generally, women did not feel they went home before they were ready, but many reported being unhappy whilst in hospital:
“It was awful to be alone after giving birth. I had my twins 12 weeks early via emergency C-section and then my partner had to go home and I was left in a side room, with no husband and no babies. I was only allowed into NICU for 2 hours and my husband and I were not allowed to visit together. It was terrible.”
Overall, participants reported negative feelings towards policies of restrictive visiting on postnatal wards, with 71.9% feeling lonely, 43.7% being very unhappy and 57.5% feeling they needed visitors to provide practical help not provided by staff.
“My post-natal support hasn't been great after the first week. I feel like I've pretty much been abandoned and left to it. My health visitor spoke to me once for 5 minutes and I've never heard from her again.”
“Postnatal care has been awful. Health visitor called me and talked through what was clearly a checklist. I said I had been deeply anxious and traumatised by the ward and she completed a meaningless questionnaire with me. I have not felt supported at all by any of the postnatal care - all of my support has come from family and friends, which has been wonderful, but the system has completely failed me. I do not feel listened to and do not feel that there is any real support in place.”
The survey did not specifically ask about use of private care but several women commented on accessing private care so their partner could attend without restrictions.
“We have been lucky enough to be able to afford 2 private scans, which means he has been able to be there for some. This has cost us around £750 in total. We are lucky, many people cannot afford this.”
“I was extremely disappointed that home birth services were stopped. It presented a completely problematic situation if you had children already as your partner would either have to be with you OR them, or you broke social distancing and had someone at home / they went elsewhere. We used an independent midwife for a home birth in the end so that we could avoid this problem.”
Rebecca Blaylock, Research and Engagement Lead at BPAS and one of the study authors, said:
“We have seen time and again how the COVID-19 pandemic has reinforced existing inequalities in our society, and sadly we have found the same to be the case within maternity care. On the whole, partners were not permitted to attend NHS scan appointments, but those who could afford to pay for private scans were able to access a service where their partners were welcomed. Similarly, those who were able to pay for the enormous expense of an independent midwife were able to continue with their plans for homebirth. This is not right or fair - having your partner with you during your pregnancy should not be a luxury afforded to the rich.”
Julia Sanders, Professor of Clinical Nursing and Midwifery at Cardiff University and one of the study authors, said:
“NHS maternity visitor restrictions during the pandemic were introduced with the best of intentions - to keep women, babies and staff as safe as possible as the unknown impact of the virus unfolded. Birth is such an important social and family event it's no surprise our survey found that keeping women apart from their partners, friends and family during maternity care caused real distress and upset. The survey also showed that many women paid for private scans where their partner was welcomed.
“The continuation of visitor restrictions in maternity clinics and wards, beyond those in place outside of hospitals, is unkind, illogical and now unjustified. Many maternity units have found creative solutions and again welcome visitors. Where restrictions still apply, solutions need to be identified so all partners can accompany women to maternity appointments and throughout birth.”
Maria Booker, Programmes Director at Birthrights said: "These findings, of women left isolated, sad and anxious by changes to maternity care, and in particular being separated from their partners, echo what Birthrights has been hearing from individuals throughout the pandemic. Yet there are still maternity services in the UK where partners are only allowed on the postnatal ward for an hour or two a day. These maternity services have it on their consciences that they are actively causing harm to those using their services. We completely endorse the report's conclusion that an evidence-based approach need to be prioritised as a matter of urgency."
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BPAS is a charity which sees over 100,000 women a year for reproductive healthcare services including pregnancy counselling, abortion care, miscarriage management and contraception at clinics across Great Britain. It supports and advocates for reproductive choice. BPAS also runs the Centre for Reproductive Research and Communication, which seeks to develop and deliver a research agenda that furthers women’s access to evidence-based reproductive healthcare, driven by an understanding of women’s perspectives and needs. You can find out more here: https://www.bpas.org/get-involved/centre-for-reproductive-research-communication/
BPAS will be launching a not-for-profit fertility service in 2021 to provide ethical, evidence-based, person-centred care that supports patients. We intend to only charge what it costs to provide a safe, high-quality, and accessible service to patients who may be unable to access NHS-funded care.
About the WRISK project
The WRISK project is a collaboration between the British Pregnancy Advisory Service (BPAS) and Cardiff University. Working with stakeholders from a wide range of disciplines, the project draws on women’s experiences to understand and improve the development and communication of risk messages in pregnancy. The project is funded by the Wellcome Trust.