Factors affecting the mental health of pregnant women using UK maternity services during the COVID-19 pandemic: a qualitative interview study

  1. A. R. McKinlay
  2. D. Fancourt
  3. A. Burton

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Background

People using maternity services in the United Kingdom (UK) have faced significant changes brought on by the COVID-19 pandemic and social distancing regulations. We focused on the experiences of pregnant women using UK maternity services during the pandemic and the impact of social distancing rules on their mental health and wellbeing.

Methods

We conducted 23 qualitative semi-structured interviews from June 2020 to August 2021, with women from across the UK who experienced a pregnancy during the pandemic. Nineteen participants in the study carried their pregnancy to term and four had experienced a miscarriage during the pandemic. Interviews took place remotely over video or telephone call, discussing topics such as mental health during pregnancy and use of UK maternity services. We used reflexive thematic analysis to analyse interview transcripts.

Results

We generated six higher order themes: [1] Some pregnancy discomforts alleviated by social distancing measures, [2] The importance of relationships that support coping and adjustment, [3] Missed pregnancy and parenthood experiences, [4] The mental health consequences of birth partner and visitor restrictions, [5] Maternity services under pressure, and [6] Lack of connection with staff. Many participants felt a sense of loss over a pregnancy experience that differed so remarkably to what they had expected because of the pandemic. Supportive relationships were important to help cope with pregnancy and pandemic-related changes; but feelings of isolation were compounded for some participants because opportunities to build social connections through face-to-face parent groups were unavailable. Participants also described feeling alone due to restrictions on their partners being present when accessing UK maternity services.

Conclusions

Our findings highlight some of the changes that may have affected pregnant women’s mental health during the COVID-19 pandemic. Reduced social support and being unable to have a partner or support person present during maternity service use were the greatest concerns reported by participants in this study. Absence of birth partners removed a protective buffer in times of uncertainty and distress. This suggests that the availability of a birth partner or support person must be prioritised wherever possible in times of pandemics to protect the mental health of people experiencing pregnancy and miscarriage.

Article activity feed

  1. Version published to 10.1186/s12884-022-04602-5
  2. ScreenIT

    SciScore for 10.1101/2021.10.20.21265279: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: We obtained ethical approval prior to undertaking the study from the University College London Ethics Committee (Project ID: 14895/005).
    Consent: Eligibility criteria included being 18 years or older, having experienced a pregnancy and accessed UK maternity services during the pandemic and being able to speak English sufficiently to read and understand the study information and informed consent forms.
    Sex as a biological variableStudy Design: We used in-depth qualitative interview methods to elicit experiences and perspectives of 23 women using UK maternity services during the COVID-19 pandemic.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Experimental Models: Organisms/Strains
    SentencesResources
    (29) AM generated themes and subthemes with input from co-authors (AB and DF).
    AB
    suggested: RRID:BDSC_203)
    Software and Algorithms
    SentencesResources
    AB and AM checked transcripts for accuracy and anonymity before importing into Nvivo version 12.(27) AM led on data analysis with reference to reflexive thematic analysis (RTA) techniques (28,29) informed by critical realist ontology. (30) First, AM and AB independently coded three transcripts and met to discuss issues of importance identified in the transcripts.
    Nvivo
    suggested: (NVivo, RRID:SCR_014802)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Lack of continuity of care and trust has been reported by women prior to the COVID-19 pandemic when using UK maternity services (41), but participants in this study said that this was exacerbated by COVID-related restrictions, such as mandatory use of PPE, remote appointments, limitations to hands-on physical care, and staff shortages in their health service. Some also said that this disrupted connection with staff alongside partner and visitor restrictions left them feeling alone during childbirth and postnatal care. Participants in our study described the various ways in which their social ties were cut during the pandemic due to social distancing restrictions but also pandemic-related cancellations in parent groups and community services. These restrictions and cancellations compounded feelings of loneliness and isolation and ultimately mental health and wellbeing. Taken together with existing research,(42,43) these findings highlight the importance of peer support groups for parents in times of pandemics. Introduction of the support bubble system whereby one household could form a support network with one other household (44) was a key change in social policy that brought about noticeable differences for participants struggling with isolation, miscarriage, new motherhood, childcare demands and adverse mental health. For other groups, including domestic abuse survivors (45) and parents with young children (32) many have also gained important sources of social support resul...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.10.20.21265279 on medRxiv