Maternity health care workers expressed anguish, questioned roles early in pandemic

In general, the challenges of being a health care provider and the risks for potential COVID-19 infection are acknowledged, but it's less clear how COVID risk mitigation strategies in hospitals impact maternity health care workers. 

To that end, researchers from the University of Michigan School of Nursing and the Obstetrics Initiative at Michigan Medicine asked nurses, physicians and midwives across Michigan, "How has COVID-19 impacted your work?" 

The answers showed deeper levels of anguish and fear than was anticipated and have implications for mental health and worker retention, said researcher Lisa Kane Low, a midwife and U-M professor of nursing. 

"It was just a single open-text question, meant to be answered with top-of-mind thinking," she said. "To have people respond with long, thoughtful answers about how distressed they were was really challenging to read, but did reflect the complex emotions being experienced by maternity care providers."  

Answers were collected April-June 2020.  Examples of provider comments include: 

• "Created some fear and anxiety when going to work to the point where I have considered medication for it." (RN)

• "I have been working much harder. I am exhausted." (MD)

• "It has taken the joy out of my work as I feel that I do not have anything to look forward to in the coming months. In the setting of an already stretched-thin workforce on the cusp of burnout, this is not good." (CNM)   

• "Ever-changing guidelines that contradict each other have compromised staff trust in management and hospitals' ability/desire to protect staff." (RN)

• "Every aspect of our job has been significantly affected: office, hospital work, surgeries. I worry about how long it will take to fully recover from this." (MD)

Five major themes emerged: provider health; patient care impact; burdens of personal protective equipment; decreased support during labor with visitor restrictions; and ethical challenges. Researchers added the COVID-19 question early in the pandemic to a study already underway at Michigan hospitals participating in the Obstetrics Initiative. 

Low said hospitals have acknowledged worker concerns, but she hasn't yet seen strategic plans to do a better job supporting health care workers through the trauma being caused by the pandemic. 

"It needs to start happening now. If you think about it, we're almost two years into this," Low said. "The impact of chronic stress is being superimposed onto the initial trauma caused at the onset of the pandemic and together these can cause other health problems. It's not a time to wait for resignations, it's a time to overhire, and that's a challenge. 

"Even in our unit we've seen a huge staff transition. People are moving from acute care to less acute settings, and also opting for early retirements." 

Needs go far beyond simple wellness initiatives. Low said it's important to be strategic and thoughtful about how trauma is internalized and how it builds upon other traumas. 

"We're not always thoughtful of the intersection between the personal and professional and how that's impacting people as well," she said. 

Low dealt with this intersection personally, when her daughter contracted COVID during her pregnancy. 

"She did fine overall, but it was all the anxiety that went into that, not knowing how COVID would impact her, the pregnancy and what it meant for her ongoing care," she said.

Another surprising finding of the survey was that while some maternity health care workers found the limited number of visitors challenging, some said it made their jobs easier. Nurses and physicians said patients got more rest, were more relaxed and benefited from less family drama. Providers also said it was easier to provide more focused care on patients with fewer visitors present. This is in contrast to the usual focus on maternity care as a healthy family event that may include multiple members. 

The findings appear in the Journal of Perinatal and Neonatal Nursing. Co-authors include Jill Brown, Kathryn Moore and Emma Keer of the Department of Obstetrics and Gynecology at Michigan Medicine. The Obstetrics Initiative is funded by Blue Cross Blue Shield of Michigan.