key: cord-1013094-ipt16fqi authors: van den Berg, L. M. M.; Akooji, N.; Thomson, G.; de Jonge, A.; Balaam, M.-C.; Topalidou, A.; Downe, S.; team, the ASPIRE COVID-19 research title: Making maternity and neonatal care personalised in the COVID-19 pandemic: results from the Babies Born Better Survey in the UK and the Netherlands date: 2022-04-16 journal: nan DOI: 10.1101/2022.04.11.22273702 sha: 168a328ef2462d23da54abf414d5636bd23bf520 doc_id: 1013094 cord_uid: ipt16fqi Background: The COVID-19 pandemic had a severe impact on womens birth experiences. To date, there are no studies that use both quantitative and qualitative data to compare womens birth experiences before and during the pandemic, across more than one country. Aim: To examine womens birth experiences during the COVID-19 pandemic and to compare the experiences of women who gave birth in the United Kingdom (UK) or the Netherlands (NL) either before or during the pandemic. Method: This study is based on analyses of quantitative and qualitative data from the online Babies Born Better survey. Responses recorded by women giving birth in the UK and the NL between June and December 2020 have been used, encompassing women who gave birth between 2017 and 2020. Quantitative data were analysed descriptively, and chi-squared tests were performed to compare women who gave birth pre- versus during pandemic and separately by country. Qualitative data was analysed by inductive thematic analysis. Findings: Respondents in both the UK and the NL who gave birth during the pandemic were as likely, or, if they had a self-reported above average standard of life, more likely to rate their labour and birth experience positively when compared to women who gave birth pre-pandemic. This was despite the fact that those labouring in the pandemic reported less support and choice. Two potential explanatory themes emerged from the qualitative data: respondents had lower expectations during the pandemic, and they appreciated that care providers tried hard to personalise care. Conclusion: Our study implies that many women labouring during the COVID-19 pandemic experienced restrictions, but their experience was mitigated by staff actions. However, personalised care should not be maintained by the good will of care providers, but should be a priority in maternity care policy to benefit all service users equitably. pandemic in maternity care was somewhat different, with the NL having a more community-based 113 approach and the UK offering more hospital-centric care, but having greater structures in place for 114 service user organisations input [14] . A comparison between the two countries may give insight into 115 how different approaches to the pandemic are related to women's birth experiences. This study was undertaken as part of the ESRC/UKRI funded ASPIRE-COVID-19 study, is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 Data analysis 165 Participants were divided into 2 categories: 'pre-COVID' and 'COVID'. A participant belonged to the 166 'pre-COVID' category if they gave birth before 1 March 2020 and to the 'COVID' category if they 167 had a baby from 1 March 2020 onwards. Participants who did not record a date of birth of their baby 168 (n=5) were not included in the analysis. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101 doi: medRxiv preprint coding group, we then looked at the answers given by women who had given birth before or during the COVID-19 pandemic. The initial themes were developed by LB, and were reviewed and refined to be no infringement on the physical and/or psychological integrity of the participants. (UCLan) Committee for Ethics and Integrity (STEMH 449 Amendment_1Jun20). All the participants gave informed consent before they started the survey. The survey is 215 completely anonymous, so they were aware that they could not withdraw their data once they had 216 submitted their responses. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 A total of 2203 completed surveys from the UK and The NL were recorded between June and 220 December 2020. 1303 (60%) of responses were from the UK and 900 (40%) were from the NL. Overall, 31% (n=678) of respondents gave birth during the COVID-19 pandemic (March-December 222 2020); 36% (468) of all UK respondents, and 23% (n=210) of all respondents from the NL [ Table 1 ]. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. In the UK, 46% (n=380) reported pregnancy problems pre-COVID and 40% (n=193) during COVID. There was a weak statistically significant difference in the UK (X2 (1) = 4.2, p = .041) but no 241 difference was found in the NL [ Table 3 ]. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Educational level; n (%) Pre-COVID COVID All Pre-COVID COVID All No formal schooling 1 (0.1) 1 (0.2) 2 (0.2) 1 (0.2) 0 1 (0.1) Primary education 1 (0.1) 1 (0.2) 2 (0.2) 1 (0.2) 1 (0.5) 2 (0.2) The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.11.22273702 doi: medRxiv preprint COVID-19 pandemic compared to pre-COVID. No such difference was found in the NL, but the NL had a higher rate of homebirth overall among the respondents: 44% (n=399) compared to the UK; 18% 250 (n=230). 251 Table 4 Type of birth and birth setting of the included participants 252 253 Most of the described demographics are in line with the population numbers, but the home birth rate in 254 our sample is higher than in the overall population, for both the UK and the NL [25, 26] . Quantitative data 257 The NL had a higher percentage of women reporting a very good birth experience 65% (n=581) 258 compared to the UK 48% (n=624), which is a statistically significant difference between the two 259 countries (p-value < 0.01). No significant differences were found in either country for labour and birth 260 experiences pre and during the COVID-19 pandemic for the respondents as a whole [ . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.11.22273702 doi: medRxiv preprint In the UK, similar rates of women reporting average and below standard of life had positive 269 labour and birth experiences pre-COVID 64% (n=233) compared to during the COVID-19 pandemic 270 (65%, n=132). Women reporting a higher standard of life were non-significantly more likely to report 271 better experiences if they gave birth during the pandemic than those who gave birth before COVID (71% vs 65%). In the NL, similar patterns were seen, with the more positive birth experience for women who 274 gave birth during the pandemic reaching statistical significance for women self-reported higher 275 standard of life (94% vs 84%) [ Table 6 ]. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 Qualitative data 280 Given that the findings that the experiences of women were similar or better during Covid than pre- Covid are in direct contrast to many other studies in this area, we examined the responses to two open 282 questions to try to identify reasons for our unexpected results. Our thematic analysis identified two 283 themes underpinning negative experiences: 1) Lack of support; 2) Limits placed on freedom of choice. Two further themes might explain why some reported experiences were more positive than . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.11.22273702 doi: medRxiv preprint Furthermore, some respondents experienced limitations in other parts of their birth experience, including the possibility to choose a water birth: is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 Efforts of staff to give individualised care, despite the rules 361 Many women in both groups, pre-COVID and COVID, valued the importance of known, competent, . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 In this multi-method study we compared the childbirth experiences of UK and NL women responding 387 to the international B3 survey who gave birth before and during the COVID-19 pandemic. In general, women giving birth in the NL were much more likely to rate their care as positive than women giving 389 birth in the UK, at both time points, and across all self-report standard of life categories. In each 390 country, women who gave birth during the COVID-19 pandemic were, on average, at least as positive 391 about their childbirth experiences as women who gave birth before the COVID-19 pandemic. Moreover, the NL women who self-reported an above average standard of life were even more 393 positive about their birth experiences if they gave birth during the COVID-19 pandemic, and while 394 this trend was also seen in the UK data, it did not reach statistical significance. This is despite the fact 395 that many women labouring during the pandemic reported having less support, choice and control than 396 those in the pre-pandemic period. Based on the qualitative analyses, two mitigating factors appeared to 397 contribute to this unexpected finding: women seemed to have lower expectations during the pandemic, and they appeared to appreciate that care providers tried hard to personalise care, sometimes despite 399 the rules they were supposed to be following. for homebirth and community services, before and during the pandemic. A study in the United States . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 . It could also be that, in a crisis situation where resources and emotional capacity are limited, staff respond even more to those who are most able to articulate their need for individualised care compared to non-crisis situations [43] . Personalisation should continue to be an 437 important part of general policy in maternity care, and therefore of care provision at all levels of the . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.11.22273702 doi: medRxiv preprint women having home births tend to be more positive in their responses, so the over-representation of 466 home births in the UK suggests that, with a representative sample from both countries, these 467 differences would have been even greater. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) should be part of general policy in maternity care and routine implementation in actual practice to 481 benefit all service users, rather than being maintained for some, and, even then only through the 482 willingness of staff to go 'above and beyond'. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.11.22273702 doi: medRxiv preprint . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 Data availability statement 510 The Babies Born Better survey data will be available from the Data Services (ReShare data repository) and DOIs will be provided on paper acceptance. Funding 513 The authors declare that they have no competing interests. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.11.22273702 doi: medRxiv preprint COVID-19 pandemic on pregnant women: A systematic review with meta-analysis. Asian 549 journal of psychiatry. 2021;56:102533. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.11.22273702 doi: medRxiv preprint Better Than That? Analysis of the Babies Born Better Survey for Greece. 2020. 2020;0(1):60. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101 https://doi.org/10. /2022 The lived experiences of pregnant women during COVID-19 527 pandemic: a descriptive phenomenological study Experiences and 530 expectations in the first trimester of pregnancy: a qualitative study. 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