Leads: Dr Beck Taylor, Prof Sara Kenyon, Dr Laura Quinn (Meths), Ms Fiona Cross-Sudworth
Publications: Cross-Sudworth F, Taylor B, Kenyon S. Community postnatal care delivery in England since Covid-19: A qualitative study of midwifery leaders’ perspectives and strategies. Women and Birth. 2023.
Dates: September 2022 – January 2025
Background:
Prior to the COVID-19 pandemic, experts had highlighted gaps and concerns about postnatal care provision, and its impact on long term health and well-being, and health inequalities [Better Births – But why not better postnatal care?]. COVID-19 infection control measures have resulted in significant changes to the way postnatal care is delivered in the NHS (e.g. fewer face to face contacts with health professionals), and less support for women and babies in the community [Maternity services in the UK during the COVID‐19 pandemic: a national survey of modifications to standard care]. There is a risk that these changes in care may reduce the quality or quantity of care and fail to detect and treat problems, and there is concern that some of the changes to care will be continued post-pandemic without evidence of their effect [Maternal postnatal health during the COVID-19 pandemic: Vigilance is needed]. To our knowledge this is the first and only study in the UK focused on the impact of the COVID-19 pandemic on the immediate postnatal clinical care period.
There are three programmes of work incorporated into this project including:
1. A multi-site retrospective cohort study using routine national data in England (Hospital Episode Statistics) to explore maternal and neonatal postnatal re-admissions during COVID-19.
2. A multi-site retrospective cohort study of maternal and neonatal outcomes using routine data from selected maternity units in the West Midlands using the BadgerNet electronic patient record (EPR).
3. Qualitative interviews with midwifery leaders.
Policy and Practice Partners:
Routine data collected by Hospital Episode Statistics (HES) – NHS Digital in England and Information Services Division in Scotland.
Clevermed: Five maternity units who use the electronic patient record system BadgerNet and agree for their data to be included.
Aims:
Programme 1:
To explore whether there were changes in the rates of unplanned maternal and neonatal re-admissions in the 30 days post birth during the COVID-19 pandemic.
To explore changes in clinical severity of cases for maternal and neonatal re-admissions in the 30 days post birth during the Covid-19 pandemic.
Programmes 2 & 3:
To identify how COVID-19 has impacted on postnatal care processes and selected outcomes.
Methods:
Throughout the project, the team are working in partnership with public contributors linked to ARC WM’s Maternity theme.
Programme 1:
A retrospective cohort design using routine clinical data obtained from electronic patient records to undertake a service evaluation. Data from de-identified electronic patient records from maternity services (mothers and neonates) will be used for this study. We will specifically look at the postnatal period (birth to 30 days post-partum) prior to (March 2015-March 2020) and during the COVID-19 pandemic (March 2020-March 2022). Data will be obtained from NHS England.
Programme 2:
A retrospective cohort design using routine clinical data obtained from electronic patient records on Badgernet Maternity in selected maternity units.
De-identified data will be obtained from mothers and babies who give birth in five regional maternity units in the West Midlands who use BadgerNet Maternity (Clevermed) as their Electronic Patient Record (EPR) system. We will specifically look at community care during the postnatal period (birth to maximum 28 days post-partum) prior to (October 2018-March 2020) and during the COVID-19 pandemic (March 2020-March 2022).
Programme 3:
Qualitative interviews with community midwifery matrons from each of the 13 NHS trusts across the West Midlands.
Main Results:
Programme 3:
Eleven out of 13 midwifery leaders participated. Three main themes were identified:
- Changes to postnatal care (strategic response, care on the ground).
- Impact of postnatal care changes (staff and women’s experiences).
- Drivers of postnatal care changes (COVID-19, workforce issues).
Programme 1 & 2 are ongoing.
Conclusions:
Programme 3:
Changes to postnatal care during the COVID-19 pandemic included introduction of virtual care, increased role of Maternity Support Workers, and moving away from home visits to clinic appointments. This has largely continued without evaluation. The number of care episodes provided for low- and high-risk families appears to have changed little. Those requiring additional support but not deemed highest risk appear to have been most impacted. Staffing levels influenced amount and type of care provided.
Programme 1 & 2 are ongoing.
Implications for Implementation:
Programme 3:
Changes to postnatal care provision introduced more efficient working practices. However, evaluation is needed to ensure ongoing safe, equitable and individualised care provision post pandemic within limited resources.
Programme 1 & 2 are ongoing.
Publications:
Cross-Sudworth F, Taylor B, Kenyon S. Community postnatal care delivery in England since Covid-19: A qualitative study of midwifery leaders’ perspectives and strategies. Women and Birth. 2023.