Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic

Objective

To prospectively document experiences of frontline maternal and newborn healthcare providers during the COVID-19 pandemic.

Design

Cross-sectional study via an online survey disseminated through professional networks and social media in 12 languages. We analysed responses using descriptive statistics and qualitative thematic analysis disaggregating by low- and middle-income countries (LMICs) and high-income countries (HICs).

Setting

81 countries, between March 24 and April 10, 2020.

Participants

714 maternal and newborn healthcare providers.

Main outcome measures

Preparedness for and response to COVID-19, experiences of health workers providing care to women and newborns, and adaptations to 17 outpatient and inpatient care processes during the pandemic.

Results

Only one third of respondents received training on COVID-19 from their health facility and nearly all searched for information themselves. Half of respondents in LMICs received updated guidelines for care provision compared with 82% in HICs. Overall, only 47% of participants in LMICs, and 69% in HICs felt mostly or completely knowledgeable in how to care for COVID-19 maternity patients. Facility-level responses to COVID-19 (signage, screening, testing, and isolation rooms) were more common in HICs than LMICs. Globally, 90% of respondents reported somewhat or substantially higher levels of stress. There was a widespread perception of reduced use of routine maternity care services, and of modification in care processes, some of which were not evidence-based.

Conclusions

Substantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19. Formal information sharing channels for providers must be established and mental health support provided. Surveys of maternity care providers can help track the situation, capture innovations, and support rapid development of effective responses.

Key Messages

What is already known

• In addition to lack of healthcare worker protection, staffing shortages, heightened risk of nosocomial transmission and decreased healthcare use described in previous infectious disease outbreaks, maternal and newborn care during the COVID-19 pandemic has also been affected by large-scale lockdowns/curfews.

• The two studies assessing the indirect effects of COVID-19 on maternal and child health have used models to estimate mortality impacts.

• Experiences of frontline health professionals providing maternal and newborn care during the COVID-19 pandemic have not been empirically documented to date.

What this study adds

• Respondents in high-income countries more commonly reported available/updated guidelines, access to COVID-19 testing, and dedicated isolation rooms for confirmed/suspected COVID-19 maternity patients.

• Levels of stress increased among health professionals globally, including due to changed working hours, difficulties in reaching health facilities, and staff shortages.

• Healthcare providers were worried about the impact of rapidly changing care practices on health outcomes: reduced access to antenatal care, fewer outpatient visits, shorter length-of-stay in facilities after birth, banning birth companions, separating newborns from COVID-19 positive mothers, and postponing routine immunisations.

• COVID-19 illustrates the susceptibility of maternity care services to emergencies, including by reversing hard-won gains in healthcare utilisation and use of evidence-based practices. These rapid findings can inform countries of the main issues emerging and help develop effective responses.