Giving birth in a pandemic: women’s birth experiences in England during COVID-19

  1. Ezra Aydin
  2. Kevin A. Glasgow
  3. Staci M. Weiss
  4. Zahra Khan
  5. Topun Austin
  6. Mark H. Johnson
  7. Jane Barlow
  8. Sarah Lloyd-Fox

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Abstract

Background

Expectant parents worldwide have experienced changes in the way they give birth as a result of COVID-19, including restrictions relating to access to birthing units and the presence of birthing partners during the birth, and changes to birth plans. This paper reports the experiences of women in England.

Methods

Data were obtained from both closed- and open-ended responses collected as part of the national COVID in Context of Pregnancy, Infancy and Parenting (CoCoPIP) Study online survey ( n  = 477 families) between 15th July 2020 – 29th March 2021. Frequency data are presented alongside the results of a sentiment analysis; the open-ended data was analysed thematically.

Results

Two-thirds of expectant women reported giving birth via spontaneous vaginal delivery (SVD) (66.1%) and a third via caesarean section (CS) (32.6%) or ‘other’ (1.3%). Just under half (49.7%) of the CS were reported to have been elective/planned, with 47.7% being emergencies. A third (37.4%) of participants reported having no changes to their birth (as set out in their birthing plan), with a further 25% reporting COVID-related changes, and 37.4% reporting non-COVID related changes (e.g., changes as a result of birthing complications). One quarter of the sample reported COVID-related changes to their birth plan, including limited birthing options and reduced feelings of control; difficulties accessing pain-relief and assistance, and feelings of distress and anxiety. Under half of the respondents reported not knowing whether there could be someone present at the birth (44.8%), with 2.3% of respondents reporting no birthing partner being present due to COVID-related restrictions. Parental experiences of communication and advice provided by the hospital prior to delivery were mixed, with significant stress and anxiety being reported in relation to both the fluctuating guidance and lack of certainty regarding the presence of birthing partners at the birth. The sentiment analysis revealed that participant experiences of giving birth during the pandemic were predominately negative (46.9%) particularly in relation to the first national lockdown, with a smaller proportion of positive (33.2%) and neutral responses (19.9%).

Conclusion

The proportion of parents reporting birthing interventions (i.e., emergency CS) was higher than previously reported, as were uncertainties related to the birth, and poor communication, leading to increased feelings of anxiety and high levels of negative emotions. The implications of these findings are discussed.

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  1. Version published to 10.1186/s12884-022-04637-8
  2. ScreenIT

    SciScore for 10.1101/2021.07.05.21260022: (What is this?)

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

    Table 1: Rigor

    EthicsConsent: All participating parents gave informed consent to take part in the CoCoPIP online survey (tinyurl.com/CoCoPIP) (Aydin, Weiss, et al., 2021).
    IRB: Ethics approval for the survey was given by the University of Cambridge, Psychology Research Ethics Committee (PREC) (PRE.2020.077).
    Sex as a biological variableWomen who gave birth prior to the first national lockdown (23rd March 2020), were excluded from the final analysis.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    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:
    Limitations: As data were collected between July 2020 – March 2021, participants experiences reflect a period of fluctuating COVID-related government and healthcare restrictions, from the most severe national lockdown measures to a combination of severe to mild national/local restrictions. Due to the rapidly evolving nature of the governmental guidance related to the pandemic and regional variations in between national lockdowns it, was not possible to collect equal sample sizes at each timepoint. Furthermore, as a result of the fact that this study was conducted as a voluntary online survey, we cannot confirm independently that all responses were by expectant parents or exclude bias in respondents with either positive or negative experience of giving birth. Whilst we advertised this study nationally and specifically worked with national childbirth trusts (NCTs) with an emphasis on areas of low socio-economic status (SES), the majority of participants were white; therefore, the results cannot be generalised to a more ethnically diverse population. Furthermore, while our sample was fairly representative of the UK’s population, there was an underrepresentation of Asian and South Asian parents. This study is part of an ongoing longitudinal study observing the impact of COVID-19 on pregnancy, infant development and parental mental health and we hope we increase the diversity of our sample as recruitment continues. Another limitation is that, of the two questions posed, not every ...

    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.

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  3. Version published to 10.1101/2021.07.05.21260022v1 on medRxiv