Covid-19 has provided many opportunities for implementation of change at pace and has also facilitated reflection and review of usual processes with a much sharper focus on priorities.
This is particularly relevant within the provision of maternity care and education of future midwives.
A model of group antenatal care and education entitled ‘Getting Ready for Baby’ was developed and introduced across maternity services in all Health and Social Care Trusts in Northern Ireland in 2017.
Research suggests that group antenatal care is received positively by women, provides opportunity to develop social connections, improves potential for women to attend antenatal care and is a satisfying model for midwives to work within (Hunter et al 2019; Sharma et al 2018; Teate et al 2011), however evidence of the impact on clinical outcomes is limited, particularly in NHS settings.
The ‘Getting ready for Baby’ model comprised of six group-based visits focusing on antenatal care and education and was ideally delivered by two midwives. The Solihull Approach was utilized as the underpinning philosophy which focuses on improving emotional health, wellbeing and relationships. The implementation of the model was evaluated by the APPLE Project (Queen’s University Belfast) and results suggested women, partners and midwives benefitted from the implementation.
When Covid-19 occurred, group-based care and education was no longer possible and as result, delivery of the model has been significantly affected. The provision of antenatal care relapsed to traditional options, however parental education was provided for women, partners and grandparents online through free access to Solihull Approach courses (‘Understanding pregnancy, labour, birth and your baby’ and ‘Understanding your Baby’ (postnatal course)).
The required revisions have highlighted three key factors which are crucial to the provision of antenatal care and the education of future midwives during Covid and beyond to ensure optimal outcomes for women, their families and the best start in life for newborn infants.
Firstly, with the demise of group-based care, the potential for women in NI to access continuity of midwifery carer was reduced. Continuity of midwifery care is supported by robust evidence (Sandall et al 2016) and can impact significantly on maternal outcomes; going forward this is an essential strategic direction for maternity care in NI, starting with solid foundations for midwifery students in their pre-registration programmes. To ensure midwives of the future value continuity of midwifery care and the potential benefits for women and their families, the experience gained as a student is crucial.
Secondly, from evaluations in NI and further afield, we know that group-based care has important social benefits for women in addition to many other positive outcomes. Opportunities for accessing support and developing networks during pregnancy and the early postnatal period have been severely affected during Covid with a potentially significant impact on parental mental health. Midwives can be proactive in facilitating access to support for women in the absence of the freedom offered in pre Covid circumstances. The most recent restrictions announced for England from 5th November 2020, facilitate holding support groups face to face, with new parents mentioned specifically.
Thirdly, the necessity of optimizing and supporting the way in which midwives work is essential. Midwives have adapted, transformed and displayed innovation with the onset of Covid, but the impact of change amidst challenging circumstances professionally and personally cannot be underestimated. The impact on physical and mental health and well-being is significant and going forward it is vital that midwives work in ways which are rewarding and satisfying including continuity models but also have access to support and self-care interventions to mitigate potential longer-term impact.
In conclusion, changes to the provision of maternity care and midwifery education were inevitable with the onset of Covid and with reflection, have afforded many opportunities to do things a little differently and with a flexibility that may not have been considered previously.
Irrespective of how Covid-19 will unfold over the following months, midwives have the often quoted ‘window of opportunity’ to work in partnership with women during pregnancy to optimize outcomes during pregnancy and beyond, which is particularly pertinent during current challenges experienced by families at the start of parenthood.
Hunter LJ, Da Motta G, McCourt C, Wiseman O, Rayment JL, Haora P, et al. Better together: a qualitative exploration of women’s perceptions and experiences of group antenatal care using focus groups and interviews. Women Birth. 2019;32(4):336–45.
Sandall J, Soltani H, Gates S, et al. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2016;4:CD004667 10.1002/14651858.CD004667.pub5
Sharma J,O’Connor M, Jolivet RR. Group antenatal care models in low- and middle-income countries: a systematic evidence synthesis Reprod Health. 2018; 15: 38.
Teate A, Leap N, Schindler Rising S, Homer CSE. Women’s experiences of group antenatal care in Australia – the centering pregnancy pilot study. Midwifery. 2011;27(2):138–45.
Dr Jenny McNeill spoke at our recent International Maternity Experience online conference discussing Online Teaching & Learning – students and academics learning in a new environment, watch the full presentation below.