Yale University School of Nursing, Orange, Connecticut.
J Midwifery Womens Health. 2023 May-Jun;68(3):333-339. doi: 10.1111/jmwh.13481. Epub 2023 Mar 10.
Health care systems will continue to face unpredictable challenges related to climate change. The COVID-19 pandemic tested the ability of perinatal care systems to respond to extreme disruption. Many childbearing people in the United States opted out of the mainstream choice of hospital birth during the pandemic, leading to a 19.5% increase in community birth between 2019 and 2020. The aim of the study was to understand the experiences and priorities of childbearing people as they sought to preserve a safe and satisfying birth during the time of extreme health care disruption caused by the pandemic.
This exploratory qualitative study recruited participants from a sample of respondents to a national-scope web-based survey that explored experiences of pregnancy and birth during the COVID-19 pandemic. Maximal variation sampling was used to invite survey respondents who had considered a variety of birth setting, perinatal care provider, and care model options to participate in individual interviews. A conventional content analysis approach was used with coding categories derived directly from the transcribed interviews.
Interviews were conducted with 18 individuals. Results were reported around 4 domains: (1) respect and autonomy in decision-making, (2) high-quality care, (3) safety, and (4) risk assessment and informed choice. Respect and autonomy varied by birth setting and perinatal care provider type. Quality of care and safety were described in relational and physical terms. Childbearing people prioritized alignment with their personal philosophies toward birth as they weighed safety. Although levels of stress and fear were elevated, many felt empowered by the sudden opportunity to consider new options.
Disaster preparedness and health system strengthening should address the importance childbearing people place on the relational aspects of care, need for options in decision-making, timely and accurate information sharing, and opportunity for a range of safe and supported birth settings. Mechanisms are needed to build system-level changes that respond to the self-expressed needs and priorities of childbearing people.
医疗保健系统将继续面临与气候变化相关的不可预测的挑战。COVID-19 大流行考验了围产期保健系统应对极端中断的能力。在美国，许多产妇在大流行期间选择不选择主流的医院分娩方式，导致 2019 年至 2020 年社区分娩增加了 19.5%。本研究旨在了解产妇在大流行期间寻求安全和满意分娩时的经历和优先事项，当时医疗保健严重中断。
这项探索性定性研究从一项全国范围的网络调查的受访者样本中招募了参与者，该调查探讨了 COVID-19 大流行期间怀孕和分娩的经历。最大变异抽样法用于邀请考虑了各种分娩环境、围产期保健提供者和护理模式选择的调查受访者参加个人访谈。使用直接从转录访谈中得出的编码类别进行常规内容分析方法。
对 18 名参与者进行了访谈。结果报告围绕 4 个领域：（1）决策中的尊重和自主权，（2）高质量的护理，（3）安全性，以及（4）风险评估和知情选择。尊重和自主权因分娩环境和围产期保健提供者类型而异。护理质量和安全性以关系和物理术语描述。产妇在权衡安全性时，优先考虑与他们个人生育哲学相一致。尽管压力和恐惧水平升高，但许多人感到有能力考虑新的选择。
灾害准备和卫生系统加强应解决产妇对护理关系方面的重视、决策中的选择需求、及时准确的信息共享以及各种安全和支持的分娩环境的机会。需要建立机制来推动系统层面的变革，以满足产妇自我表达的需求和优先事项。
