Study finds a marked decline in women’s satisfaction with postnatal care during the COVID-19 pandemic, but many were satisfied with care during pregnancy and birth

Published on Thursday, 09 December 2021

Women who gave birth during the first COVID-19 lockdown faced added challenges with health and maternity care, Oxford Population Health-led study finds.

Today, results have been announced from a large-scale, nationally representative study on how health and maternity care were impacted for women who gave birth during the first COVID-19 lockdown. Researchers from NPEU surveyed over 4,600 women who gave birth in England in May 2020.

The study – You and Your Baby 2020 – is the latest in the series of national maternity surveys carried out by the NPEU since 1995. Women were asked about their health and experiences of care during pregnancy, birth and the postnatal period. The results from the survey were compared with those from pre-pandemic surveys in 2014 and 2018 to evaluate the impact of COVID-19.

Key results:

Pregnancy and birth

Over half of women experienced changes to their care during pregnancy and birth because of COVID-19. For instance:

• There was a change to the planned place of birth for one in ten women.
• Many birth partners were unable to attend all appointments (81%) and scans (60%) due to COVID-19 restrictions, and almost three-quarters (73%) faced restrictions around attending births.
• There was a marked decline in the proportion of women attending antenatal classes: 8% compared with over 30% before the pandemic.
• Fewer women always felt involved in decisions about their pregnancy care (54% - down from 70%).
• More women reported that they felt anxious during their pregnancy (22% compared to a pre-pandemic rate of 13%).

Nevertheless, despite women reporting changes to care and increased anxiety, overall levels of satisfaction with care during pregnancy and birth were high with over 84% of women reporting they were satisfied, only slightly lower than 88% before the pandemic. Furthermore, some aspects of care were seemingly unaffected by COVID-19 or were even better than in pre-pandemic years. For example, more women reported having a named midwife during their pregnancy and there was no evidence that mothers were separated from their babies immediately after birth.

Postnatal period

The study found that care after birth was particularly impacted by the pandemic and overall satisfaction with postnatal care fell to 53% (down from 77%). For instance:

• Around 63% of survey respondents reported that COVID-19 meant they received less support, including from family, friends and health care services.
• Half of women indicated that they wanted or needed more midwifery contact in the postnatal period - double the proportion in pre-pandemic years.
• Fewer women had a postnatal check-up at their GP surgery (84% - down from 91%).
• More women experienced poor mental health in the postnatal period, with increased numbers self-reporting anxiety (39%) and depression (22%), up from pre-pandemic rates of 29% (anxiety) and 16% (depression).

Encouragingly, the number of women who breastfed their baby remained high (85%) and there was even a small increase in the proportion of women still breastfeeding their baby at six months of age (48% - up from 45%). Potentially, lockdown restrictions may have enabled some women to breastfeed their babies for longer.

Study co-ordinator, Dr Siân Harrison (NPEU) said: 'A particular strength of this large-scale study is the availability of comparable data from our pre-pandemic surveys, which enables us to evaluate how women's experiences of pregnancy and childbirth were impacted – both positively and negatively – by COVID-19.'

Professor Maria Quigley (NPEU), who co-led the study said: 'Compared with pre-pandemic surveys, women were less satisfied with postnatal care whereas, perhaps surprisingly, levels of satisfaction with care during pregnancy and birth remained high. The disparity between the best and worst experiences of care suggests that there is much to be learnt from the women who gave birth during the pandemic.'

Professor Fiona Alderdice (NPEU), who also co-led the study, added: 'The COVID-19 pandemic introduced new challenges to maternity services, and also amplified existing problems in the maternity care system. Targeting resources to aspects of maternity services that are under pressure, in particular postnatal care, needs to be considered. Our findings will help policy-makers when making changes to care that can address the needs of women while keeping them and their families safe.'

You & Your Baby 2020 was funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217-21202.