Strengthening community provision
Further innovation strengthened the provision of both primary and
community care. The aim of these innovations was primarily to reduce the
volume of patients within hospitals, in order to minimise capacity
problems and infection risk for both service users and staff. Examples
included the increased use of methods to enable early labour at home
after induction of labour , unless there were complications requiring
hospital attendance. Women booked for hospital birth were also advised
to remain at home during early labour. In the UK, the pre COVID-19 drive
for continuity of carer (CoC) continued, although some CoC projects were
temporarily discontinued. Some hospital Trusts established new CoC
provision during the pandemic.
Comment
The documents we reviewed highlight many innovations in maternity care
resulting from the COVID-19 pandemic. Some were completely new; others
had previously been used, but were rolled out rapidly as the need arose.
In addition to the more familiar technical innovations (e.g.,
telemedicine), we identified innovations relating to staff wellbeing,
resulting in a more resilient maternity care system and in strengthening
community care.
The innovations which were implemented during COVID-19, largely to
minimise infection risk, may be continued post-pandemic, due to the
benefits that have been observed for organisations, staff and
service-users. The benefits of fully embracing pre-existing guidelines
also became apparent, according to national documents. For example,
there was increased encouragement for women to remain at home during
early labour, with the support of a midwife, to reduce the impact on
hospital capacity as well as minimising infection risk. This guidance
was in place pre-pandemic because women who remain at home during early
labour have a lower risk of intervention, and support at home during
this phase of labour increases maternal satisfaction.4,
5
A resilient maternity care system requires the resources and capacity to
cope with largescale stressful events, such as natural disasters and
pandemics.6 Some of the innovations we identified are
directly linked to short-term challenges, such as the development of
escalation plans and digital storage of key documents needed to run a
midwifery practice and/or hospital department, in case of major capacity
problems. The pandemic also highlighted long-term challenges, such as
strengthening the workforce.7 This was particularly
apparent with the increased risk of anxiety, stress and burnout as a
result of working during COVID-19. These conditions decrease staff
quality of life and increase the potential for staff to leave the
profession or take early retirement.8 During the
pandemic, attempts were made to limit the risk of emotional exhaustion
and to increase staff wellbeing, via better rest and break facilities,
as well as psychological support. The continuation of these
psychological support mechanisms may contribute to a more positive work
environment, to lower staff attrition rates, and to improve outcomes for
women, birthing people, infants, and families.
All of these innovations (including the roll out of existing practices)
have potential ethical, governance, and organisational implications, for
maternity care specifically, and for health care in general. In contrast
to the idea of careful development and testing of new practices for
efficacy, effectiveness, feasibility, acceptability and equity, there
was no time for evaluation, and many new practices were implemented
almost overnight as solutions and work-arounds to emerging
problems.9 This has resulted in a dynamic and creative
space that has generated or catalysed valuable new approaches to
healthcare. Some of these changes (such as support for staff wellbeing)
are self-evidently beneficial. However, the rapid introduction of others
(such as telehealth) raises the potential for over-extension of
techniques that might not work for all; might not be affordable in the
longer-term; could disadvantage some; and that may have longer term
adverse effects. It is critical to invest time and resources to find out
what works, for whom, in what circumstances and why, and to ensure that
the use of new approaches is equitable, acceptable and
feasible.9 There are some studies addressing this
issue, particularly in relation to telehealth.10Extension of such analyses to other areas of innovation is especially
important in a context where pandemic innovations are already becoming
normalised in practice, as de-implementation can be more challenging
than implementation.11 The time has come to learn
which innovations worked best from a service-user, professional and
organisational perspective, and to use this knowledge to build
infrastructure and practices to enable resilient and sustainable
maternity care systems, both for a post-COVID-19 future, and in
anticipation of any future health care crisis.