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Navigating uncertainty alone: A grounded theory analysis of women's psycho-social experiences of pregnancy and childbirth during the COVID-19 pandemic in London

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)e106-e117
JournalWomen and Birth
Volume36
Issue number1
Early online date17 May 2022
DOIs
Accepted/In press5 May 2022
E-pub ahead of print17 May 2022
Published1 Feb 2023

Bibliographical note

Funding Information: Sergio A. Silverio, Abigail Easter, Kaat De Backer, & Jane Sandall (King’s College London) are currently supported by the National Institute for Health Research Applied Research Collaboration South London [NIHR ARC South London] at King’s College Hospital NHS Foundation Trust. Kaat De Backer (King’s College London) is also currently supported by the National Institute for Health Research Applied Research Collaboration East of England [ NIHR ARC East of England ] at Cambridgeshire and Peterborough NHS Foundation Trust. Sergio A. Silverio is also in receipt of a personal Doctoral Fellowship awarded by the NIHR ARC South London Capacity Building Theme and Jane Sandall is also an NIHR Senior Investigator [Award Number: NIHR200306 ]. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Funding Information: This project was funded by the King’s College London King’s Together Rapid COVID-19 Call, successfully awarded to Laura A. Magee, Sergio A. Silverio, Abigail Easter, & colleagues (grant reference:- 204823/Z/16/Z ) as part of a rapid response call for research proposals. The King’s Together Fund is a Wellcome Trust funded initiative. The funders had no role in the recruitment, data collection and analysis, or write-up associated with this work. Funding Information: The present study was part of a larger project called: ‘The King’s Together Fund (KTF) Changing Maternity Care Study’, funded by the King’s College London King’s Together Rapid COVID-19 Call for rapid response research into the COVID-19 pandemic. The present study engaged women who had received their maternity care and given birth in South London, in semi-structured interviews about their experiences of care during the COVID-19 pandemic. Both study methods and analysis followed a Classical Grounded Theory Analysis methodology [26] . Funding Information: This project was funded by the King's College London King's Together Rapid COVID-19 Call, successfully awarded to Laura A. Magee, Sergio A. Silverio, Abigail Easter, & colleagues (grant reference:- 204823/Z/16/Z) as part of a rapid response call for research proposals. The King's Together Fund is a Wellcome Trust funded initiative. The funders had no role in the recruitment, data collection and analysis, or write-up associated with this work.We would like to acknowledge the women who participated in this study, and all those who navigated uncertainty of pregnancy and childbirth alone during the COVID-19 pandemic. Our thanks are also extended to Ms. S. Gibson (NIHR ARC South London), Mr. N. Sarson and Mrs. M. Harris-Tafri (King's College London), for their assistance in the designing the final figure. Sergio A. Silverio, Abigail Easter, Kaat De Backer, & Jane Sandall (King's College London) are currently supported by the National Institute for Health Research Applied Research Collaboration South London [NIHR ARC South London] at King's College Hospital NHS Foundation Trust. Kaat De Backer (King's College London) is also currently supported by the National Institute for Health Research Applied Research Collaboration East of England [NIHR ARC East of England] at Cambridgeshire and Peterborough NHS Foundation Trust. Sergio A. Silverio is also in receipt of a personal Doctoral Fellowship awarded by the NIHR ARC South London Capacity Building Theme and Jane Sandall is also an NIHR Senior Investigator [Award Number: NIHR200306]. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The KTF Changing Maternity Care Study was discussed at a National Institute for Health Research [NIHR] Applied Research Collaboration [ARC] South London, Patient and Public Involvement and Engagement [PPIE] meeting for maternity and perinatal mental health research in July 2020 (which focuses on co-morbidities, inequalities, and maternal ethnicity); an NIHR ARC South London Work in Progress Meeting in October 2020 (focused on maternity and perinatal mental health research); and at an NIHR ARC South London Public Seminar in February 2021 (focused on COVID-19 rapid response research). From these fora, we sought advice on the design of the study, how best to recruit participants, and on our interpretation of the findings. We also requested support from delegates (both lay and expert stakeholders) at these events to share the details of the study within the local community. These stakeholders included members of the local community, experts by experience, health and social care professionals, researchers, and policy makers. Publisher Copyright: © 2022 The Authors

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Abstract

PROBLEM: Maternity care underwent substantial reconfiguration in the United Kingdom during the COVID-19 pandemic.

BACKGROUND: COVID-19 posed an unprecedented public health crisis, risking population health and causing a significant health system shock.

AIM: To explore the psycho-social experiences of women who received maternity care and gave birth in South London during the first 'lockdown'.

METHODS: We recruited women (N = 23) to semi-structured interviews, conducted virtually. Data were recorded, transcribed, and analysed by hand. A Classical Grounded Theory Analysis was followed including line-by-line coding, focused coding, development of super-categories followed by themes, and finally the generation of a theory.

FINDINGS: Iterative and inductive analysis generated six emergent themes, sorted into three dyadic pairs: 1 & 2: Lack of relational care vs. Good practice persisting during the pandemic; 3 & 4: Denying the embodied experience of pregnancy and birth vs. Trying to keep everyone safe; and 5 & 6: Removed from support network vs. Importance of being at home as a family. Together, these themes interact to form the theory: 'Navigating uncertainty alone'.

DISCUSSION: Women's pregnancy and childbirth journeys during the pandemic were reported as having positive and negative experiences which would counteract one-another. Lack of relational care, denial of embodied experiences, and removal from support networks were counterbalanced by good practice which persisted, understanding staff were trying to keep everyone safe, and renewed importance in the family unit.

CONCLUSION: Pregnancy can be an uncertain time for women. This was compounded by having to navigate their maternity journey alone during the COVID-19 pandemic.

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