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      ‘There's only so much you can be pushed’: Magnification of the maternity staffing crisis by the 2020/21 COVID‐19 pandemic

      letter
      Author(s): 1 , 2 , , 1 , 3 , the ASPIRE‐COVID 19 Collaborative Group
      Publication date (Electronic):
      Journal: Bjog
      Publisher: John Wiley and Sons Inc.

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          This article includes Author Insights, a video abstract available at: https://vimeo.com/bjogabstracts/authorinsights17203

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          Burnout, well-being and defensive medical practice among obstetricians and gynaecologists in the UK: cross-sectional survey study

          Tom H. Bourne, Harsha Shah, Nora Falconieri … (2019)
          Objectives To determine the prevalence of burnout in doctors practising obstetrics and gynaecology, and assess the association with defensive medical practice and self-reported well-being. Design Nationwide online cross-sectional survey study; December 2017–March 2018. Setting Hospitals in the UK. Participants 5661 practising obstetrics and gynaecology consultants, specialty and associate specialist doctors and trainees registered with the Royal College of Obstetricians and Gynaecologists. Primary and secondary outcome measures Prevalence of burnout using the Maslach Burnout Inventory and defensive medical practice (avoiding cases or procedures, overprescribing, over-referral) using a 12-item questionnaire. The odds ratios (OR) of burnout with defensive medical practice and self-reported well-being. Results 3102/5661 doctors (55%) completed the survey. 3073/3102 (99%) met the inclusion criteria (1462 consultants, 1357 trainees and 254 specialty and associate specialist doctors). 1116/3073 (36%) doctors met the burnout criteria, with levels highest amongst trainees (580/1357 (43%)). 258/1116 (23%) doctors with burnout reported increased defensive practice compared with 142/1957 (7%) without (adjusted OR 4.35, 95% CI 3.46 to 5.49). ORs of burnout with well-being items varied between 1.38 and 6.37, and were highest for anxiety (3.59, 95% CI 3.07 to 4.21), depression (4.05, 95% CI 3.26 to 5.04) and suicidal thoughts (6.37, 95% CI 95% CI 3.95 to 10.7). In multivariable logistic regression, being of younger age, white or ‘other’ ethnicity, and graduating with a medical degree from the UK or Ireland had the strongest associations with burnout. Conclusions High levels of burnout were observed in obstetricians and gynaecologists and particularly among trainees. Burnout was associated with both increased defensive medical practice and worse doctor well-being. These findings have implications for the well-being and retention of doctors as well as the quality of patient care, and may help to inform the content of future interventions aimed at preventing burnout and improving patient safety.
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            Effects of the Covid-19 pandemic on maternity staff in 2020 – a scoping review

            Nadine Schmitt, Elke Mattern, Eva Cignacco … (2021)
            In the spring of 2020, the SARS-CoV-2 virus caused the Covid-19 pandemic, bringing with it drastic changes and challenges for health systems and medical staff. Among the affected were obstetricians and midwives, whose close physical contact with pregnant women, women who recently gave birth, and their children was indispensable. In the obstetric setting, births cannot be postponed, and maternity staff had to adapt to assure obstetric safety while balancing evidence-based standards with the new challenges posed by the pandemic. This scoping review gives a comprehensive overview of the effecs the Covid-19 pandemic had on maternity staff. We followed the evidence-based approach described by Arksey & O’Malley: we searched several databases for English and German articles published between January 2020 and January 2021 that discussed or touched upon the effects the pandemic had on maternity staff in OECD countries and China. We found that structural challenges caused by the crisis and its subjective effects on maternity staff fell into two main topic areas. Structural challenges (the first main topic) were divided into five subtopics: staff shortages and restructuring; personal protective equipment and tests; switching to virtual communication; handling women with a positive SARS-CoV-2 infection; and excluding accompanying persons. The pandemic also strongly affected the staff’s mental health (the second main topic.) Attempting to meet challenges posed by the pandemic while afraid of contamination, suffering overwork and exhaustion, and struggling to resolve ethical-moral dilemmas had severe negative subjective effects. Several studies indicated increased depression, anxiety, stress levels, and risk of post-traumatic stress symptoms, although the crisis also generated strong occupational solidarity. Care for pregnant, birthing, and breast-feeding women cannot be interrupted, even during a pandemic crisis that requires social distancing. Maternity staff sometimes had to abandon normal standards of obstetric care and were confronted with enormous challenges and structural adjustments that did not leave them unscathed: their mental health suffered considerably. Researchers should study maternity staff’s experiences during the pandemic to prepare recommendations that will protect staff during future epidemics. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07377-1.
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              State of the World’s Midwifery

              (2021)
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                Author and article information

                Contributors
                Gill Moncrieff:
                ORCID: https://orcid.org/0000-0001-7142-9953
                gmoncrieff1@uclan.ac.uk
                Journal
                Journal ID (nlm-ta): BJOG
                Journal ID (iso-abbrev): BJOG
                Journal ID (doi): 10.1111/(ISSN)1471-0528
                Journal ID (publisher-id): BJO
                Title: Bjog
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 1470-0328
                ISSN (Electronic): 1471-0528
                Publication date (Electronic): 26 May 2022
                Publication date (Print): July 2022
                Volume: 129
                Issue: 8 ( doiID: 10.1111/bjo.v129.8 )
                Pages: 1408-1409
                Affiliations
                [ 1 ] School of Community Health and Midwifery, THRIVE Centre University of Central Lancashire Preston UK
                [ 2 ] Research in Childbirth and Health Group, THRIVE Centre University of Central Lancashire Preston UK
                [ 3 ] School of Medicine University of Central Lancashire Preston UK
                Author information
                https://orcid.org/0000-0001-7091-9141
                https://orcid.org/0000-0001-7142-9953
                Article
                Publisher ID: BJO17203 Other ID: BJOG-22-0440.R1
                DOI: 10.1111/1471-0528.17203
                PMC ID: 9321880
                PubMed ID: 35544311
                SO-VID: afcc3cdc-5076-46e5-b74d-80e006de4fb7
                Copyright © © 2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date revision received : 25 April 2022
                Date received : 28 March 2022
                Date accepted : 26 April 2022
                Page count
                Figures: 1, Tables: 0, Pages: 2, Words: 978
                Categories
                Subject: Research Letter
                Subject: Research Letter
                Custom metadata
                source-schema-version-number 2.0
                cover-date July 2022
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.7 mode:remove_FC converted:26.07.2022

                ScienceOpen disciplines: Obstetrics & Gynecology
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology

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