Capturing experiences of pregnancy and birth during the pandemic
Researchers at King's College London surveyed over 1,700 women to find out about people's experiences of pregnancy and birth during the coronavirus pandemic.
We wanted to find out what it was like having a baby in the UK in the early days of lockdown, and how people were dealing with the changes to their care and/or plans.
We wanted to hear from all new or expectant parents, who had either had a baby since 9 March, or whose baby was due before 12 July in the UK. We picked these dates because 9 March was when people in the last trimester of pregnancy were added to the list of 'vulnerable people'.
What we did
We designed a short survey which would collect:
- demographic information
- a psychometric tool for measuring support and control in labour, and a psychometric tool for measuring postnatal anxiety (this section was only for those who had given birth)
- qualitative questions asking about what people's plans for antenatal care and birth had been before lockdown, how they had changed, and how people felt about this.
We used a survey with a lot of open questions because we wanted to hear about the changes that were important to expectant parents, rather than assume we knew which changes might have happened, and which had had an impact on parents. We also wanted to find out about how changes outside of the services offered by the NHS might have interacted with service changes.
The survey was entirely online. It was advertised through parenting forums, and through social media, including via Facebook, Twitter and Instagram. The advert contained a clickable link to the survey, and the advert text included a request to share the advert widely.
What worked well
The methods used, combined with the topic and the timing meant that a large volume of respondents participated. About 200 responses were anticipated, but 1,754 were received in 14 days. There were very few partially completed forms, suggesting that the length of the survey was appropriate.
Some participants emailed the researcher to thank her for asking about perinatal emotional health. Combined with the response rate, this suggests that the topic was well received.
By using open questions, we found out a lot about how changes to things other than NHS services had interacted with service changes. For example, for those who did not drive, changes to the availability of taxi firms had a big impact on birth choices. The availability of childcare for older children was also affected, including childminders, schools and nurseries, or parents who might be shielding. Participants also talked about other perinatal support that they were accessing, or were no longer able to access, including doulas, private antenatal classes and breastfeeding support organisations.
We also discovered that parents in different locations had experienced very different changes to the NHS maternity services they received.
The results are being turned into both presentations and papers. Presentations to date have included maternity conferences, academic conferences, and speaking at Maternity Voices Partnerships, where we have had enough data from one NHS Trust. We have been awarded a grant to hold our own event to talk about some of the headline findings in early November. This will be aimed at parents, midwives and obstetricians.
The research window was open from 10 to 24 April 2020, which was a few weeks into the pandemic. As participants were expectant parents, the decision was made that any in-person recruitment posed too great a risk. However, the survey being entirely online means that we will not have received any responses from those without access to the internet. This may well have excluded some of the most at-risk groups of parents.
Some participants questioned the relevance of the question about sexual orientation. However, analysis has showed that a statistically significant number of lesbian, gay, bisexual and pansexual women considered freebirth. Analysis has also showed that several lesbian co-mothers felt the care they and their partner had received during labour was poorer because they were lesbians. It therefore seems appropriate that we asked this question.
The length of the academic publishing cycle poses challenges when trying to disseminate learning about such a time-sensitive issue as pregnancy during a pandemic.
The COVID pregnancy project is funded via a Fellowship, granted by the ESRC, ES/T006099/1.
This project is also supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care.
Dr Mari Greenfield (Researcher, King's College London)