COVID-19 and clinical outcomes of pregnancy: a comparative study
A series of changes in maternity care provision were implemented internationally in response to the COVID-19 pandemic. This study aimed to assess the impact of COVID-19 on maternal clinical outcomes, resulting from these changes to care provision.
A before and during comparative study of maternal pregnancy, childbirth, and postpartum clinical outcomes was conducted at a maternity hospital in Ireland. Inferential statistics were used to compare datasets with significance set at P<0.05.
Overall, no difference in caesarean section rates between the two study periods was observed, although more caesarean sections were observed in multiparous women during the pandemic (30% vs 35%, P=0.01). The rate of elective compared to emergency caesarean section was also higher during the pandemic, from a proportionate difference of 3.6% pre-pandemic to 13.6% during the pandemic. Rates of induction of labour for post-dates (post-maturity induction) were also increased during the pandemic.
The changes to maternity care because of the COVID-19 pandemic appear to have affected some maternal clinical outcomes, and thus, potentially, women's overall intrapartum and postnatal health and wellbeing.
In March 2020, the first of a series of national lockdowns was implemented in Ireland as a means of reducing the community spread of COVID-19. This resulted in changes to maternity care practices that had the potential to impact the clinical and experiential outcomes of women accessing maternity care during this time (Coxon et al, 2020). Some of the implemented changes included restrictive visiting policies, such as having one designated parent for babies in the neonatal intensive care unit, no visiting on antenatal, postnatal and gynaecology wards, reconfiguration of physical space to accommodate suspected or confirmed cases of women with COVID-19, suspension of key services such as parent education, antenatal classes and birth reflection clinics, increased antenatal and postnatal telephone consultations and displacement of some outreach antenatal clinics back to the hospital. Many of these changes, while described in the Irish context, are not isolated to maternity care in Ireland, rather they reflect changes that occurred internationally (Menendez et al, 2020; Renfrew et al, 2020; Roberton et al, 2020; Jardine et al, 2021). For example, in the UK, around one-third of NHS Trusts suspended the provision of home birth services, affecting place of birth choices for many women (Sherwood, 2020). Over a year later, many of these changes remain in place in Ireland, and are increasingly receiving media attention, especially policies that restrict partner visiting and the effect this is having on women's wellbeing (Power and O'Halloran, 2021).
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