Experiences of women in prenatal, childbirth, and postpartum care during the COVID-19 pandemic in selected cities in Brazil: The resignification of the experience of pregnancy and giving birth

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Abstract

The COVID-19 pandemic has impacted public and private health systems around the world, impairing good practices in women’s health care. However, little is known about the experiences, knowledge, and feelings of Brazilian women in this period. The objective was to analyze the experiences of women, seen at maternity hospitals accredited by the Brazilian Unified Health System (SUS, acronym in Portuguese), regarding health care during pregnancy, childbirth, and postpartum periods, their interpersonal relationships, and perceptions and feelings about the pandemic. This was a qualitative, exploratory research, carried out in three Brazilian municipalities with women hospitalized in 2020, during pregnancy, childbirth, or postpartum period, with COVID-19 or not. For data collection, semi-structured individual interviews (in person, by telephone, or by digital platform) were conducted, recorded and transcribed. The content analysis of thematic modalities was displayed as per the following axes: i) Knowledge about the disease; ii) Search for health care in prenatal, childbirth, and postpartum periods; iii) Experience of suffering from COVID-19; iv) Income and work; and v) Family dynamics and social support network. A total of 46 women were interviewed in São Luís-MA, Pelotas-RS, and Niterói-RJ. Use of media was important to convey information and fight fake news. The pandemic negatively impacted access to health care in the prenatal, childbirth, and postpartum periods, contributing to worsening of the population’s social and economic vulnerabilities. Women experienced diverse manifestations of the disease, and psychic disorders were very frequent. Social isolation during the pandemic disrupted the support network of these women, who found social support strategies in communication technologies. Women-centered care–including qualified listening and mental health support–can reduce the severity of COVID-19 cases in pregnant, parturient, and postpartum women. Sustainable employment and income maintenance policies are essential to mitigate social vulnerabilities and reduce risks for these women.

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Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis

Barbara Chmielewska, Imogen Barratt, Rosemary Townsend … (2021)

Background The COVID-19 pandemic has had a profound impact on health-care systems and potentially on pregnancy outcomes, but no systematic synthesis of evidence of this effect has been undertaken. We aimed to assess the collective evidence on the effects on maternal, fetal, and neonatal outcomes of the pandemic. Methods We did a systematic review and meta-analysis of studies on the effects of the pandemic on maternal, fetal, and neonatal outcomes. We searched MEDLINE and Embase in accordance with PRISMA guidelines, from Jan 1, 2020, to Jan 8, 2021, for case-control studies, cohort studies, and brief reports comparing maternal and perinatal mortality, maternal morbidity, pregnancy complications, and intrapartum and neonatal outcomes before and during the pandemic. We also planned to record any additional maternal and offspring outcomes identified. Studies of solely SARS-CoV-2-infected pregnant individuals, as well as case reports, studies without comparison groups, narrative or systematic literature reviews, preprints, and studies reporting on overlapping populations were excluded. Quantitative meta-analysis was done for an outcome when more than one study presented relevant data. Random-effects estimate of the pooled odds ratio (OR) of each outcome were generated with use of the Mantel-Haenszel method. This review was registered with PROSPERO (CRD42020211753). Findings The search identified 3592 citations, of which 40 studies were included. We identified significant increases in stillbirth (pooled OR 1·28 [95% CI 1·07–1·54]; I 2=63%; 12 studies, 168 295 pregnancies during and 198 993 before the pandemic) and maternal death (1·37 [1·22–1·53; I 2=0%, two studies [both from low-income and middle-income countries], 1 237 018 and 2 224 859 pregnancies) during versus before the pandemic. Preterm births before 37 weeks' gestation were not significantly changed overall (0·94 [0·87–1·02]; I 2=75%; 15 studies, 170 640 and 656 423 pregnancies) but were decreased in high-income countries (0·91 [0·84–0·99]; I 2=63%; 12 studies, 159 987 and 635 118 pregnancies), where spontaneous preterm birth was also decreased (0·81 [0·67–0·97]; two studies, 4204 and 6818 pregnancies). Mean Edinburgh Postnatal Depression Scale scores were higher, indicating poorer mental health, during versus before the pandemic (pooled mean difference 0·42 [95% CI 0·02–0·81; three studies, 2330 and 6517 pregnancies). Surgically managed ectopic pregnancies were increased during the pandemic (OR 5·81 [2·16–15·6]; I 2=26%; three studies, 37 and 272 pregnancies). No overall significant effects were identified for other outcomes included in the quantitative analysis: maternal gestational diabetes; hypertensive disorders of pregnancy; preterm birth before 34 weeks', 32 weeks', or 28 weeks' gestation; iatrogenic preterm birth; labour induction; modes of delivery (spontaneous vaginal delivery, caesarean section, or instrumental delivery); post-partum haemorrhage; neonatal death; low birthweight (<2500 g); neonatal intensive care unit admission; or Apgar score less than 7 at 5 min. Interpretation Global maternal and fetal outcomes have worsened during the COVID-19 pandemic, with an increase in maternal deaths, stillbirth, ruptured ectopic pregnancies, and maternal depression. Some outcomes show considerable disparity between high-resource and low-resource settings. There is an urgent need to prioritise safe, accessible, and equitable maternity care within the strategic response to this pandemic and in future health crises. Funding None.

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Amostragem e saturação em pesquisa qualitativa: consensos e controvérsias

MC Minayo, MCS Minayo, MCS MINAYO … (2017)

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The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review

Bethany Kotlar, Emily Gerson, Sophia Petrillo … (2021)

Introduction The Covid-19 pandemic affects maternal health both directly and indirectly, and direct and indirect effects are intertwined. To provide a comprehensive overview on this broad topic in a rapid format behooving an emergent pandemic we conducted a scoping review. Methods A scoping review was conducted to compile evidence on direct and indirect impacts of the pandemic on maternal health and provide an overview of the most significant outcomes thus far. Working papers and news articles were considered appropriate evidence along with peer-reviewed publications in order to capture rapidly evolving updates. Literature in English published from January 1st to September 11 2020 was included if it pertained to the direct or indirect effects of the COVID-19 pandemic on the physical, mental, economic, or social health and wellbeing of pregnant people. Narrative descriptions were written about subject areas for which the authors found the most evidence. Results The search yielded 396 publications, of which 95 were included. Pregnant individuals were found to be at a heightened risk of more severe symptoms than people who are not pregnant. Intrauterine, vertical, and breastmilk transmission were unlikely. Labor, delivery, and breastfeeding guidelines for COVID-19 positive patients varied. Severe increases in maternal mental health issues, such as clinically relevant anxiety and depression, were reported. Domestic violence appeared to spike. Prenatal care visits decreased, healthcare infrastructure was strained, and potentially harmful policies implemented with little evidence. Women were more likely to lose their income due to the pandemic than men, and working mothers struggled with increased childcare demands. Conclusion Pregnant women and mothers were not found to be at higher risk for COVID-19 infection than people who are not pregnant, however pregnant people with symptomatic COVID-19 may experience more adverse outcomes compared to non-pregnant people and seem to face disproportionate adverse socio-economic consequences. High income and low- and middle-income countries alike faced significant struggles. Further resources should be directed towards quality epidemiological studies. Plain English summary The Covid-19 pandemic impacts reproductive and perinatal health both directly through infection itself but also indirectly as a consequence of changes in health care, social policy, or social and economic circumstances. The direct and indirect consequences of COVID-19 on maternal health are intertwined. To provide a comprehensive overview on this broad topic we conducted a scoping review. Pregnant women who have symptomatic COVID-19 may experience more severe outcomes than people who are not pregnant. Intrauterine and breastmilk transmission, and the passage of the virus from mother to baby during delivery are unlikely. The guidelines for labor, delivery, and breastfeeding for COVID-19 positive patients vary, and this variability could create uncertainty and unnecessary harm. Prenatal care visits decreased, healthcare infrastructure was strained, and potentially harmful policies are implemented with little evidence in high and low/middle income countries. The social and economic impact of COVID-19 on maternal health is marked. A high frequency of maternal mental health problems, such as clinically relevant anxiety and depression, during the epidemic are reported in many countries. This likely reflects an increase in problems, but studies demonstrating a true change are lacking. Domestic violence appeared to spike. Women were more vulnerable to losing their income due to the pandemic than men, and working mothers struggled with increased childcare demands. We make several recommendations: more resources should be directed to epidemiological studies, health and social services for pregnant women and mothers should not be diminished, and more focus on maternal mental health during the epidemic is needed.

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Author and article information

Contributors

Zeni Carvalho Lamy:

ORCID: https://orcid.org/0000-0002-9332-0542

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Erika Barbara Abreu Fonseca Thomaz:

ORCID: https://orcid.org/0000-0003-4156-4067

Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Aluísio Gomes da Silva-Junior:

ORCID: https://orcid.org/0000-0003-2445-3963

Gisele Caldas Alexandre: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Maria Teresa Seabra Soares de Britto e Alves: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Ruth Helena de Souza Britto Ferreira de Carvalho: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Letícia Oliveira de Menezes: Role: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Sandro Schreiber de Oliveira:

ORCID: https://orcid.org/0000-0003-4150-4515

Maurício Moraes: Role: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Yasmim Bezerra Magalhães:

ORCID: https://orcid.org/0000-0002-0614-5644

Role: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Tatiana Raquel Selbmann Coimbra: Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Lely Stella Guzman-Barrera: Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing

Ivan Filipe de Almeida Lopes Fernandes: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Title: PLOS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 5 May 2023

Publication date Collection: 2023

Volume: 18

Issue: 5

Electronic Location Identifier: e0284773

Affiliations

[1 ] Public Health Department, Universidade Federal do Maranhão, São Luís, MA, Brazil

[2 ] Universidade Federal Fluminense, Niterói, RJ, Brazil

[3 ] Universidade Católica de Pelotas, Pelotas, RS, Brazil

[4 ] Universidade Federal do Rio Grande, Pelotas, RS, Brazil

[5 ] Centro Universitário do Planalto Central Apparecido dos Santos, Uniceplac, Brasília, DF, Brazil

[6 ] Pan American Health Organization / World Health Organization (PAHO/WHO), Brasília, DF, Brazil

Federal University of ABC, BRAZIL

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: erika.barbara@ 123456ufma.br

Author information

Zeni Carvalho Lamy https://orcid.org/0000-0002-9332-0542

Erika Barbara Abreu Fonseca Thomaz https://orcid.org/0000-0003-4156-4067

Aluísio Gomes da Silva-Junior https://orcid.org/0000-0003-2445-3963

Sandro Schreiber de Oliveira https://orcid.org/0000-0003-4150-4515

Yasmim Bezerra Magalhães https://orcid.org/0000-0002-0614-5644

Article

Publisher ID: PONE-D-22-19394

DOI: 10.1371/journal.pone.0284773

PMC ID: 10162534

PubMed ID: 37146073

SO-VID: 35d499dc-94a0-4957-b5c2-1a671b8eb504

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 9 July 2022

Date accepted : 6 April 2023

Page count

Figures: 1, Tables: 5, Pages: 17

Funding

Funded by: funder-id http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;

Award ID: INV-017424

Funded by: funder-id http://dx.doi.org/10.13039/100011893, Pan American Health Organization;

Award ID: CON20-00012173

Funded by: funder-id http://dx.doi.org/10.13039/501100003593, Conselho Nacional de Desenvolvimento Científico e Tecnológico;

Award ID: 306592/2018-5

Award Recipient :

ORCID: https://orcid.org/0000-0003-4156-4067

Erika Barbara Abreu Fonseca Thomaz

Funded by: funder-id http://dx.doi.org/10.13039/501100003593, Conselho Nacional de Desenvolvimento Científico e Tecnológico;

Award ID: 314939/2020-2

Award Recipient :

ORCID: https://orcid.org/0000-0002-9332-0542

Zeni Carvalho Lamy

Funded by: funder-id http://dx.doi.org/10.13039/501100003593, Conselho Nacional de Desenvolvimento Científico e Tecnológico;

Award ID: 311479/2020-2

Award Recipient : Maria Teresa Seabra Soares de Britto e Alves

Funded by: funder-id http://dx.doi.org/10.13039/501100003593, Conselho Nacional de Desenvolvimento Científico e Tecnológico;

Award ID: 308917/2021-9

Award Recipient :

ORCID: https://orcid.org/0000-0003-4156-4067

Erika Barbara Abreu Fonseca Thomaz

Funded by: funder-id http://dx.doi.org/10.13039/501100002322, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior;

Award ID: Finance Code 001

The authors are grateful to the Bill and Melinda Gates Foundation [INV-017424], World Health Organization (WHO), Pan American Health Organization (PAHO) [ZCL, EBAFT, AGSJ, GCA, MTSSBA, RHSBFC, LOM, SSO, MM, YBM, TRSC, LSGB], National Council for Scientific and Technological Development (CNPq, acronym in Portuguese) [processes 306592/2018-5 (EBAFT), 314939/2020-2 (ZCL), 311479/2020-2 (MRSSBA), and 308917/2021-9 (EBAFT)], the Coordination for the Improvement of Higher Education Personnel (CAPES, acronym in Portuguese) [finance code 001] (EBAFT, MTSSBA, RHSBFC, ZCL), and Foundation for the Support of Scientific and Technological Research and Development of Maranhão (FAPEMA) for supporting scientific publication. We would also like to thank the Universidade Federal do Maranhão, Universidade Federal Fluminense, Universidade Federal of Rio Grande, Universidade Católica de Pelotas, Municipal Health Departments of São Luís, Niterói e Pelotas, the State Health Departments of Maranhão, Rio de Janeiro and Rio Grande do Sul. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Data Availability Because this is a qualitative research, with in-depth interviews, addressing sensitive issues from the point of view of identifying women, and, considering that the statements that support our findings and conclusions were made available in the manuscript, we believe that the availability of the entire transcription of the interviews can violate the ethical precepts of guaranteeing the secrecy and privacy of the participants. So, we did not make available all the data (transcription of all speeches), but we have inserted several excerpts from the speeches of the women (de-identified) throughout the manuscript. The entire data can be accessed upon request through e-mail to a non-author contact: Sandra Santos, Pan-American Health Organization – PAHO, E-mail: sandra@ 123456paho.org , Phone: +55 61 32519513).

Experiences of women in prenatal, childbirth, and postpartum care during the COVID-19 pandemic in selected cities in Brazil: The resignification of the experience of pregnancy and giving birth

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Novel Coronavirus Disease COVID-19

Most cited references 60

Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis

Amostragem e saturação em pesquisa qualitativa: consensos e controvérsias

The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review

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