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An Exploration of Changes to the Provision of Postnatal Care During COVID-19

Leads: Prof Sara Kenyon, Dr Beck Taylor, Dr Laura Quinn (Meths)

Throughout the project, the team are working in partnership with public contributors linked to ARC WM's Maternity theme.

Dates: January 2020 - January 2024

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 wellbeing, and health inequalities [Bick et al. Better Births - But why not better postnatal care? Midwifery. 2020; 80: 102574]. COVID-19 infection control measures have resulted in significant changes to the way postnatal care is delivered in the NHS (fewer face to face contacts with health professionals), and less support for women and babies in the community [Jardine J et al. Maternity services in the UK during the COVIDÔÇÉ19 pandemic: a national survey of modifications to standard care. BJOG. 2020]. 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 the concern is that some of the changes to care will be continued post-pandemic without evidence of their effect [Bick D, et al. Maternal postnatal health during the COVID-19 pandemic: Vigilance is needed. Midwifery. 2020; 88: 102781]. To our knowledge this is the first and only study in the UK that is focused on the impact of the COVID-19 pandemic on the immediate postnatal clinical care period. We will use electronic patient records (EPRs) collated by BadgerNet (Clevermed). BadgerNet is a widely used EPR System for maternity and neonatal services and is used in 30 NHS Trusts nationally (26% of NHS sites across the UK). This is one of the largest maternity datasets in the UK with over 140,000 births annually and contains more granular and detailed information from maternity services than is collected by the national maternity data held by NHS Digital (Hospital Episode Statistics). We will include data on women with singleton pregnancies, >37 weeks gestation, with no known foetal abnormalities and explore the effect of changes in postnatal clinical care for women who gave birth either between March 2019-February 2020 (pre-pandemic) or March 2020-February 2022 (post-pandemic) using quantitative data available through this EPR. We will also undertake qualitative exploration using interviews/ focus groups, from four purposefully selected sites, with healthcare practitioners, service managers, financial directors and women to explore how postnatal care has changed for women and their infants and what this impact this has had.

Policy and Practice Partners:

Routine data collected by Hospital Episode Statistics (HES) - NHS Digital in England and Information Services Division in Scotland.

Clevermed: Maternity units who use the electronic patient record system BadgerNet and agree for their data to be included.

Co-Funding Partners:

None

Aims and Objectives:

  1. To identify whether changes to postnatal care provision have affected maternal and neonatal morbidity using quantitative methods.
  2. To explore in four purposefully selected maternity units the experiences of healthcare professionals and women using qualitative methods.
  3. Provide evidence to inform postnatal care planning and recovery post-pandemic.

Methods:

Mixed methods, involving analysis of routine NHS quantitative data and qualitative interviews with NHS staff and mothers in the postnatal period.

Main Results:

We are currently developing the quantitative work by working closely with Clevermed to establish data access and extraction. This includes the establishment of bespoke data, liaison with multiple NHS sites to obtain their participation and finalisation of the data fields we intend to extract from the final dataset. Our current intention is to purchase space on their data hub. Our primary outcome is likely to be postnatal re-admission rates in the first 14 days post-birth but this is to be explored as the data captured within BadgerNet Maternity may not capture all hospital admissions of this nature. The qualitative work is currently paused due to the unprecedented pressure being experienced by the NHS workforce due to the second and third wave of the COVID-19 pandemic.

Conclusions:

Forthcoming.

Implications for Implementation:

We will feedback findings to practice to inform future changes in postnatal care.