Table 1 Studies included in the scoping review
From: Effects of the Covid-19 pandemic on maternity staff in 2020 – a scoping review
No. | Author, Year | Title | Type of Article | Topic | Country of focus | Participants | Conclusion |
|---|---|---|---|---|---|---|---|
1 | Aksoy & Koçak, July 2020 | Psychological effects of nurses and midwives due to COVID-19 outbreak: The case of Turkey | Cross-sectional study peer reviewed | Mental health | Turkey | 758 nurses and midwives | The respondents were afraid, especially of infecting their relatives, and were unsure how to deal with each other. But they are also proud of their work. |
2 | Alfieri et al., November 2020 | COVID-19 does not stop obstetrics: what we need to change to go on safely birthing. The experience of a University Obstetrics and Gynecology Department in Milan | Commentary Peer reviewed | Structural changes | Italy | / | To ensure continual care and safety of mothers and newborns, organizational changes were made within the maternity ward. |
3 | Aust, April 2020 | Corona, der erste April - und was das mit uns macht [Corona, the first April - and what it did to us] | Non-scientific interview | Personal experiences Staff shortage and restructuring Personal Protective Equipment and tests Switch to virtual communication | Germany | Midwife in independent practices | Despite changes in working conditions, and lack of protective equipment and disinfectant, there was a wave of solidarity and mutual support. |
4 | Aziz et al., July 2020 | Adaptation of prenatal care and ultrasound | Report Peer reviewed | Personal Protective Equipment and tests Switch to virtual communication Dealing with infected women | USA | A maternity hospital with annually ca. 4600 pregnant women | The intervals between prenatal examinations and the number of ultrasonic sounds changed. Some necessary interventions for genetical diagnostics and fetal therapy were postponed and some appointments were switched to telehealth. |
5 | Aziz et al., May 2020 | Telehealth for High-Risk Pregnancies in the Setting of the COVID-19 Pandemic | Description Peer reviewed | Switch to virtual communication | USA | Hospital group in New York with 2 clinics and 6900 births | The number and implementation of prenatal care examinations were changed and telehealth for high-risk pregnancies were described in detail. |
6 | Bahat et al., August 2020 | Evaluating the effects of the COVID-19 pandemic on the physical and mental well-being of obstetricians and gynecologists in Turkey | Cross-sectional study Peer reviewed | Mental health | Turkey | 253 obstetricians and gynecologists | Many respondents were anxious about contact with infected pregnant women, reported feeling desperate, and isolated themselves from their families. At the same time, their perception of their work changed for the better and they had the feeling were able to take adequate care of mothers and their newborns. |
7 | Bailey & Nightingale, June 2020 | Navigating maternity service redesign in a global pandemic: A report from the field | Report Peer reviewed | Staff shortage and restructuring Personal Protective Equipment and tests Switch to virtual communication Dealing with infected women Exclusion of accompanying persons | UK | A large teaching hospital with 6000 births | Report on pandemic-related staffing and spatial changes of obstetric teams and necessary adjustments to meet individual and governmental requirements. |
8 | Baumann et al., December 2020 | Adaptation of independent midwives to the COVID-19 pandemic: a national descriptive survey | Cross-sectional study Peer reviewed | Personal Protective Equipment and tests Switch to virtual communication | France | 1517 midwives in independent practice, 20% of all midwives in independent practice in France | 91% of these midwives changed the services they offered. They cancelled home visits and course meetings and increased phone calls. Some closed their practices. |
9 | Baumgarten, June 2020 | Hebammen sind systemrelevant [Midwives are relevant to the system] | Non-scientific interview | Staff shortage and restructuring Personal Protective Equipment and tests Switch to virtual communication Exclusion of accompanying persons | Germany | Advisory Council of the German Association of Midwives | In some federal states in Germany, independent midwives were not initially included in essential professions. They received no protective clothing, lost a large portion of their earnings, and had no designated contact person. |
10 | Becker, June 2020 | „Die Coronakrise zeigt uns die Lücken im System“ ["The Corona crisis shows us the gaps in the system"] | Non-scientific interview | Personal experiences | Germany | 2 midwives and the president of the German Association of Midwives | Maternity staff had to cope with changes in their daily professional life and with their own worries. But they also described positive effects. |
11 | Bender et al., July 2020 | The Psychological Experience of Obstetric Patients and Health Care Workers after Implementation of Universal SARS-CoV-2 Testing | Cross-sectional study Peer reviewed | Mental health | USA | 158 persons from maternity staff | The staff's anxiety and job satisfaction were worse than before the pandemic, but routine testing showed positive effects. Staff also worried about the increased distress of mothers who were separated from their newborns. |
12 | Campbell et al., November 2020 | Consolidation of obstetric services in a public health emergency | Report Peer reviewed | Staff shortage and restructuring Personal Protective Equipment and tests Switch to virtual communication Dealing with infected women | USA | Two affiliated obstetric units in New York | Reports from three clinics about changes and new procedures to prevent infection, quick discharges, online triage, and staff shortage. Lack of equipment and new teams sparked fears that should be met with transparency to make the staff feel safer. |
13 | Chervenak et al., April 2020 | Expanding the concept of the professional integrity of obstetrics during a public health emergency | Report Peer reviewed | Staff shortage and restructuring | USA | A clinic in New York | The pandemic changed medical care targets and needs. Individual patient welfare was made secondary to preventing mortality and protecting the whole population. |
14 | Corbett et al., August 2020 | Anxiety and depression scores in maternity healthcare workers during the Covid-19 pandemic | Cross-sectional study Peer reviewed | Mental health | Ireland | 240 maternity healthcare workers (midwives/nurses, obstetricians, laboratory staff, clerical/administrative staff, support staff) | About a fifth of those interviewed had moderate to severe anxiety and depression scores. Younger, female administrative personnel were more severely affected. |
15 | Coxon et al., June 2020 | The impact of the coronavirus (COVID-19) pandemic on maternity care in Europe | Editorial | Staff shortage and restructuring Personal Protective Equipment and tests Switch to virtual communication Dealing with infected women Exclusion of accompanying persons | Europe | Practices in Europe | European countries maintained antenatal care differently during the pandemic. Some birthing centers closed down because emergency services had no more capacities; others were kept open so women do not have to go to the clinic. |
16 | Danvers & Dolan, July 2020 | Women's Health During the COVID-19 Surge in the Bronx: Reflections from Two OBGYNs on the Flatter | Commentary Peer reviewed | Personal experiences Switch to virtual communication | USA | / | Maternity wards were reorganized, but were still familiar to staff. They spoke of longer work days, anxiety and isolation, and also bonding between staff and, during virtual meetings, with women as well. |
17 | Davis-Floyd et al., July 2020 | Pregnancy, Birth and the COVID-19 Pandemic in the United States | Cross-sectional study Peer reviewed | Staff shortage and restructuring Personal Protective Equipment and tests Switch to virtual communication Dealing with infected women Exclusion of accompanying persons | USA | Maternity staff, 41 responses | The Covid-19 pandemic could change the responsibilities of certified nurse-midwives (CNMs) and certified professional midwives (CPMs) in the USA. |
18 | Dethier & Abernathy, June 2020 | Maintaining certainty in the most uncertain of times | Commentary Peer reviewed | Personal experiences | USA | Staff of the department of obstetrics and gynecology in 2 hospitals in Boston | The authors speak of a new reality in which one had to work against one's beliefs, wrapped in protective clothing, without any physical contact. |
19 | Dunne, September 2020 | Two in three members recovered from Covid-19 hit by post-viral fatigue | Newspaper article (Report on survey) | Mental health, physical effects | Ireland | 7068 nurses and midwives | Most respondents complained about effects on mental health. Personnel who had trouble procuring protective clothing were twice as likely to be infected. Infected personnel complained mainly of exhaustion. Their greatest fear was infecting members of their household. |
20 | Furuta, August 2020 | 2020 International Year of Midwifery - In the midst of a pandemic | Editorial Peer reviewed | Switch to virtual communication Dealing with infected women Exclusion of accompanying persons | Japan | / | Maternity staff cared for women who could not give birth as usual, with extended families present, because of travel restrictions. |
21 | González-Timoneda et al., December 2020 | Experiences and attitudes of midwives during the birth of a pregnant woman with COVID-19 infection: A qualitative study | Qualitative study Peer reviewed | Mental health | Spain | 14 midwives | Midwives reported on several factors reduced their ability to provide a safe and respectful environment (higher work demands, supply of protective equipment, support from employers and colleagues, reliable guidelines). Midwives reported feelings of anxiety, agitation, insecurity and discomfort. |
22 | Green et al., July 2020 | Providing women's health care during COVID-19: Personal and professional challenges faced by health workers | Editorial Peer reviewed | Exclusion of accompanying persons/women giving birth alone Personal protective equipment and tests Challenges due to less capacities (ethical dilemmas) Mental health | USA | / | Excluding accompanying persons put staff under more pressure to provide more emotional support. Medical staff could be victims of violence when they were seen as SARS-CoV-2 carriers. |
23 | Holton et al., October 2020 | Psychological well-being of Australian hospital clinical staff during the COVID-19 pandemic | Cross-sectional study Peer reviewed | Mental health | Australia | 668 hospital clinical staff (nurses, midwives, doctors and allied health staff) | Midwives and nurses had higher depression, anxiety, and stress scores than other groups in the health system. The scores were higher for those with less clinical experience, poorer health, and more concerns about Covid-19. |
24 | Horsch et al., June 2020 | Moral and mental health challenges faced by maternity staff during the COVID-19 pandemic | Commentary | Mental health | Switzerland, Ireland, UK | / | Pandemic requirements that conflict with evidence, professional recommendations, and ethical and moral values may lead to professional moral impairment. Staff can feel like instruments of inhumane treatment and can become desensitized to preserve themselves. |
25 | Jeganathan et al., November 2020 | Adherence and acceptability of telehealth appointments for high-risk obstetrical patients during the coronavirus disease 2019 pandemic | Longitudinal study Peer reviewed | Switch to virtual communication | USA | 33 surveys of maternity staff | Positive balance for risk pregnancies via telehealth but half of providers want to return to face-to-face meetings when the pandemic is over. |
26 | Johnson et al., December 2020 | COVID-19 Testing, Personal Protective Equipment, and Staffing Strategies Vary at Obstetrics Centers across the Country | Letter to the editor (report on surveys) | Personal Protective Equipment and tests | USA | Online survey at 315 obstetric centers | Different standards apply though infections increased. Use of N95 masks increased only slightly over time; use was not nationwide, possibly because of small budgets and poor access to protective equipment in municipal facilities. |
27 | Khot & Kumar, August 2020 | Flattening the anxiety curve: Obstetricians' response to the COVID-19 pandemic in Victoria | Letter to the editor (small pilot study; semi-structured interviews) | Physicians' experiences | Australia | 12 practitioners providing private maternity care | Physicians have many anxieties but also a strong feeling of belonging. Collegial relationships make it possible for them to cope with a rapidly changing situation and adapt to change. |
28 | Kiefer et al., December 2020 | High frequency of posttraumatic stress symptoms among US obstetrical and gynecologic providers during the coronavirus disease 2019 pandemic | Cross-sectional study Peer reviewed | Mental health | USA | 558 physicians, certified nurse midwives and nurse practitioners | Female gender, previous trauma, high perceived Covid-19 risk, and greater anxiety about Covid-19 increase the likelihood of posttraumatic stress symptoms in maternity staff. |
29 | Kumaraswami et al., September 2020 | Response of an Obstetric Unit during the Coronavirus Disease of 2019 (COVID-19) Pandemic: Experiences from a Tertiary Care Center | Case report Peer reviewed | Structural changes | USA | / | To ensure staff and women's safety, health care workers devise different strategies and adjust clinical practice. |
30 | Lauer et al., October 2020 | PPE during a pandemic: The experience of obtaining PPE and lessons learned from a department of obstetrics and gynecology in New York city | Report Peer reviewed | Personal Protective Equipment and tests | USA | / | There were reports of concern about obtaining respiratory masks when the number of Covid-19 positive women increased; there is still too little protective clothing. Competition for protective clothing and uncertainty about the pandemic lead possibly to unnecessary or too sparing use of protective clothing. |
31 | Liu et al., December 2020 | Psychological impact in non-infectious disease specialists who had direct contact with patients with COVID-19 | Cross-sectional study Peer reviewed | Mental health | China | 2126 obstetricians and midwives | Higher risk of infection tracks higher depression and anxiety scores and sleep disturbance incidence. Protective equipment and training that prepares staff to deal with Covid-19 have a protective effect. |
32 | Madden et al., June 2020 | Telehealth Uptake into Prenatal Care and Provider Attitudes during the COVID-19 Pandemic in New York City: A Quantitative and Qualitative Analysis | Quantitative and qualitative study Peer reviewed | Switch to virtual communication | USA | 36 providers of prenatal care (mainly medical doctors) | Telehealth can be quickly implemented and is evaluated positively by the staff. Before the pandemic, less than half the staff wanted to use Telehealth. During the pandemic, nearly 90% of participants wanted to use it. |
33 | Murtada et al., July 2020 | Managing an obstetrics and gynaecology department in time of COVID pandemic: safety and efficacy first at Foch hospital | Brief report Peer reviewed | Structural changes | France | / | Obstetrical care is adapted: important consultations are maintained, follow-up examinations are carried out via telehealth, and women with positive Covid-19 are treated separately. Lack of protective equipment at the start of the pandemic caused most infections in personnel. |
34 | Onwuzurike et al., June 2020 | Examining Inequities Associated With Changes in Obstetric and Gynecologic Care Delivery During the Coronavirus Disease 2019 (COVID-19) Pandemic | Commentary | Switch to virtual communication | USA | / | Pandemic-related changes in the care of pregnant women discriminate against women of colour. |
35 | Peahl et al., October 2020 | Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic | Modelling evaluation Peer reviewed | Switch to virtual communication Dealing with infected women | USA | A small town clinic with 150 maternity care providers (including 63 resident physicians) | Weekly prenatal examinations are cut by 16.1%, virtual meetings increase 32.5%; 53.3% of women and 62.1% of professional carers confirm virtual meetings do not endanger the safety of mother and child. |
36 | Peña et al., May 2020 | A Survey of Labor and Delivery Practices in New York City during the COVID-19 Pandemic | Cross-sectional study Peer reviewed | Personal Protective Equipment and tests Dealing with infected women Exclusion of accompanying persons | USA | Senior consultants in 4 urban hospitals in New York | At first, accompanying persons were not allowed. Later, a screened or tested person was allowed to be present in the delivery room. Staff recommended women have a PDA so they would not require full anesthetic for a section in an emergency. Rooming-in and breastfeeding were always possible. Women were discharged as quickly as possible and continued to receive care at home via telephone. |
37 | Perrine et al., November 2020 | Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 - United States, July 15-August 20, 2020 | Cross-sectional study | Dealing with infected women | USA | 1344 hospitals | In case of possible Covid-19 infection, skin contact was discouraged in 14% of clinics surveyed and prohibited in 16.5%. Rooming-in was discouraged in 37.8% of the clinics if an infection was suspected or diagnosed and prohibited in 5.3%. Women received less support for breastfeeding and were discharged more quickly. |
38 | Pietrasanta et al., May 2020 | Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context | Report Peer reviewed | Structural changes Personal Protective Equipment and tests Dealing with infected women Exclusion of accompanying persons | Italy | 5 hub centers designated to centralise all cases of infected pregnant mothers | Hospital management faced challenges and reacted by restructuring several maternity wards. |
39 | Pluym et al., September 2020 | Obstetrical Unit Response to the COVID-19 Pandemic: OUR Study | Cross-sectional study Peer reviewed | Personal Protective Equipment and tests | USA | Obstetrical unit response | A survey in 301 clinics in 48 US states found inadequate protective clothing and testing capacity. Municipal clinics in particular remained inadequately equipped over time. |
40 | Reforma et al., November 2020 | A multidisciplinary telemedicine model for management of coronavirus disease 2019 (COVID-19) in obstetrical patients | Implementation study Peer reviewed | Switch to virtual communication Dealing with infected women | USA | Prenatal and postnatal care in 3 community centers with 5 satellite offices and 3 practices | A multidisciplinary telemedicine surveillance model was adopted to care for women who might be infected with Covid-19 during pregnancy and after birth. Video-calls might be used to recruit women who would otherwise not be reached (e.g., because the journey was too long, or if they didn't have time or lacked childcare). |
41 | Rochelson et al., May 2020 | The care of pregnant women during the COVID-19 pandemic – response of a large health system in metropolitan New York | Report Peer reviewed | Staff shortage and restructuring Personal Protective Equipment and tests Switch to virtual communication Dealing with infected women Exclusion of accompanying persons | USA | 10 large obstetric departments in New York with an annual total of 30,000 births | Systemic changes in the care procedures for pregnant women, women giving birth, and postpartum women reduced direct contact and number of examinations and increased e-health. |
42 | Saiman et al., November 2020 | Infection prevention and control for labor and delivery, well baby nurseries, and neonatal intensive care units | Report Peer reviewed | Structural changes Personal Protective Equipment and tests Switch to virtual communication Dealing with infected women Exclusion of accompanying persons | USA | / | Various restructuring measures were taken to prevent infections in staff, patients, and accompanying persons. Guidelines and procedures have been developed for obstetric staff. |
43 | Semaan et al., June 2020 | 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 | Cross-sectional study Peer reviewed | Structural changes Mental health Personal Protective Equipment and tests Switch to virtual communication Dealing with infected women Exclusion of accompanying persons | Worldwide | 714 persons from maternity staff | Findings on subjective effects show higher stress, greater workload due to staff shortages, frequent changes in schedules, and exhaustion. The experiences of various professional groups that come into contact with potentially infected pregnant women and postpartum women were documented. |
44 | Shah et al., August 2020 | Mental health amongst obstetrics and gynaecology doctors during the COVID-19 pandemic: Results of a UK-wide study | Cross-sectional study Peer reviewed | Mental health | UK | 207 obstetricians and gynaecologists | During the pandemic, obstetricians and gynaecologists had worse mental health than the general public because they had to cope with continually changing guidelines, the pandemic, and their fear of infection. |
45 | Sögüt et al., June 2020 | The relationship between COVID-19 knowledge levels and anxiety states of midwifery students during the outbreak: A cross-sectional web-based survey | Cross-sectional study Peer reviewed | Mental health | Turkey | 972 midwifery students | No connection was found between anxiety and knowledge about Covid-19. Anxiety scores were higher for midwifery students whose parents were chronically ill or who were deployed in clinics again after the lockdown. |
46 | Steppat, May 2020 | Blitzlichter aus dem Klinikalltag in Corona-Zeiten [Flashes from everyday hospital life in Corona times] | Report | Exclusion of accompanying persons | Germany | Maternity staff from several hospitals | The situation is characterized by constant innovation and staff waiting for Covid-19 positive women. Prenatal classes were suspended. Although women were more often alone in the delivery room and there was more peace and quiet, they did not receive 1:1 care. |
47 | Teubner, August 2020 | Veränderungen im Hebammenalltag durch die Corona-Krise [Changes in the everyday life of midwives during the corona crisis] | Report | Switch to virtual communication Exclusion of accompanying persons | Germany | / | Video-calls were perceived as a good alternative. The maternity ward is quieter and more peaceful and breastfeeding as needed was more acceptable. |
48 | Uytenbogaardt, June 2020 | COVID-19's effect on midwives' mental health | Editorial | Mental health | UK | 4036 midwives and nurses | The ICON study (Impact of COVID-19 on the Nursing and Midwifery workforce) found that the greatest fear of the staff was of infecting family members. Only 1% of midwives used the online mental health forum provided by the National Health System. |
49 | Uzun et al., May 2020 | Psychological and social effects of COVID-19 pandemic on obstetrics and gynecology employees | Cross-sectional study Peer reviewed | Mental health | Turkey | 13 doctors, 52 midwives and 38 nurses | There were no significant mental health differences between age groups or genders across the three professions (doctors, midwives, nurses). |
50 | Vierlinger et al., June 2020 | Have you got any (digital) solutions on how to best reach women and families under Covid-19? | Report | Switch to virtual communication | Germany | 5 midwives | Online events reached women who would not have been able to attend face-to-face sessions (e.g., due to preterm labor, childcare). Midwives wre proud that they could offer videos and online courses. |
51 | Wegrzynowska et al., October 2020 | Polish maternity services in times of crisis: in search of quality care for pregnant women and their babies | Secondary analysis and expert interviews Peer reviewed | Switch to virtual communication Exclusion of accompanying persons | Poland | 6 healthcare professionals including midwives and midwives in management positions; 1 pregnant woman | Prenatal care was organized outside the clinic to protect against infection but births took place in the clinic as usual. |
52 | Wilson et al., June 2020 | Caring for the carers: Ensuring the provision of quality maternity care during a global pandemic | Report Peer reviewed (ahead of print) | Mental health | Australia | / | The workload increased in the pandemic. Stress factors included the need to adhere to constantly changing guidelines, reassure patients and family members, cope with their own worries, and continue working normally. |
53 | Yates et al., July 2020 | The Response to a Pandemic at Columbia University Irving Medical Center's Department of Obstetrics and Gynecology | Report Peer reviewed | Staff shortage and restructuring Personal Protective Equipment and tests Switch to virtual communication Dealing with infected women Exclusion of accompanying persons | USA | A gynecological hospital in New York | Daily virtual meetings of clinic employees created solidarity and a feeling of fighting Covid-19 together as a team. Contact with women shifted to video-calls. |
54 | Yörük & Güler, October 2020 | The relationship between psychological resilience, burnout, stress, and sociodemographic factors with depression in nurses and midwives during the COVID-19 pandemic: A cross-sectional study in Turkey | Cross-sectional study Peer reviewed | Mental health | Turkey | 377 nurses and midwives | A third of midwives suffered depression caused by higher stress levels and emotional exhaustion. A high resilience score had a protective effect. Risk of depression was higher in midwives than in nurses, by a factor of 1.92. |