Of the 477 participants who responded to questions regarding their birthing experiences during the pandemic, a third completed the survey during one of the three national lockdowns (39.5%, 188), around half completed the survey during the period of easing of restrictions (51.5%, 245) and a small percentage were completed during the introduction of a tiered system (9%, 43) (see Fig. 1 for timeline).
In our sample two-thirds of expectant women gave birth via spontaneous vaginal delivery (SVD) (66.1%, 315), a third delivered via CS (32.6%, 155), and ‘other’ (1.3%, 6) (delivery method was classed as ‘other’ where participants selected other but did not provide any additional information with which to classify delivery method). Of the 155 participants who reported giving birth by CS, just under half (49.7%, 77) reported having an elective/planned CS, with the remainder (47.7%; 74) having an emergency CS (4 participants did not report on whether their CS was an elective or emergency procedure) (see Fig. 2).
A large proportion of respondents reported being uncertain about the restrictions relating to birthing partners (40.2%, 191), and a fifth reported that they were unaware prior to the birth whether birthing partners would be allowed to be present (14.9%, 71) (see Table 2 for questions). At time of birth the majority of participants reported having their partner or a family member present (96.2%, 459), whilst a small number reported not being able to have anyone present at the birth (3.8%, 18) with 2.3% of these being due to COVID-19 related restrictions between 23rd March 2020 - 29th March 2021.
The results of the sentiment analysis showed that of the total responses across all questions (n = 706), 33.2% expressed positive, 19.9% neutral and 46.9% negative sentiments. When observing sentiment in relation to the governmental guidance and restrictions (see Fig. 1 for timeline) participants’ responses consistently showed a higher negative sentiment towards their birthing experiences during the first national lockdown (56.9%), ease of governmental guidance and restrictions (43%), and tiered guidance system (42.6%). Relative to these periods, during the second and third national lockdowns, participants showed an almost equal number of negative (34.2%) and neutral (36.8%) sentiments during lockdown 2 and a more positive sentiment (50%) with regard to their birthing experiences during lockdown 3. This suggests as the pandemic progressed, there was a shift in the emotional perception associated giving birth during a time of imposed restrictions and limitations.
Of the 462 respondents who responded to the question ‘Was the way you delivered your baby as you wanted to in your birth plan, or did it change? 37.4% (172) reported no changes to their planned birth (although it should be noted that some of these responses suggested that no birth plan had been made as a result of the pandemic), 25% (115) reported changes to the planned birth due to COVID and 37.4% (172) reported changes due to other reasons (e.g., changes in birth plan due to fetus being breech). Parents’ experiences of the COVID-related changes are described below:
No changes to birth plan
Although many parents across the UK experienced difficulties and hardships whilst giving birth, some respondents to the survey reported their birthing experience going according to their birthing plan, with parents recalling positive experiences in relation to the birth of their child:
‘My birthing experience was exactly how I'd planned/hoped. I had a very basic idea of how I'd like to give birth but was very open to other options. I was lucky enough to have a straight forward water birth with no complication’
And
‘It was the way I wanted to. The birth experience was the most normal thing in the whole pregnancy’
Some participants described feeling supported and informed at the time of giving birth:
‘…. My birth plan was followed in that I was able to do and use the things I wanted and the staff knew that I was flexible should I need to be dependent on the situation that arose at the time.’
Another participant referred to additional support offered due to previous birthing trauma:
‘Went exactly has[sic] planned and everyone was very calm and friendly due to previous birth trauma the year before.’
However, a number of participants stated that there were no changes because birthing plans were not being made during national restrictions:
‘I was informed by my midwife that they were not making birthing plans during lockdown so I didn't have a plan.’
While this was experienced well by some women -‘I had no birth plan so it all went how I would of liked it’- other statements suggest that some women felt less clear about the impact of this:
‘I didn't really make a birth plan, my labour was led completely [b]y the midwife at the time. I decided it was best to go with the flow and not really make a plan. It was slow and long which ended in an emergency caesarean.’
COVID related changes to birth
One of the most notable COVID-related changes reported was the suspension of home births and birthing pools:
‘Planned home water birth. All home births cancelled. All water births cancelled’
‘Big changes. I was induced, had an epidural [….], where I had wanted a water birth. My husband wasn't allowed to attend until my waters had been manually burst, which did influence me to say yes so that he could join me.’
‘Husband unable to attend induction or stay with baby & I after birth. Rushed hospital discharge, no visitors, PPE used by staff & I had to wear it whilst in labour too.
This respondent went on to describe the feeling of being rushed and of having no control:
Felt impersonal, rushed, somewhat out of control & birth options v limited (no access to birth centre or home birth). V[sic] different to what we had planned!’
A number of respondents described being alone, and in one case, the cancellation of plans that had been developed to help prevent the reoccurrence of her postnatal depression:
‘No one read my birth plan. I was alone for the majority of my labour. My birth partner was only allowed to join me right at the end.’
‘I was alone throughout the birthing experience. I couldn't have a water birth, couldn't have visitors. Most things planned to help reduce the reoccurrence of postnatal depression could not be put into place.’
One respondent reported having trouble accessing the desired pain relief and assistance during her labour:
‘It changed I was induced due to potential infection. And was unable to have the desired pain relief and staffing was low, and they didn't arrive in my very quick labour’
These changes and restrictions resulted in some parents feeling considerable distress and anxiety:
‘I wasn't allowed the birth I wanted because of covid. It was hugely traumatic […]’
Non-COVID related changes to birth
Whilst changes to delivery can be expected when giving birth (e.g., ‘I was induced due to potential infection’) women reported feelings of anxiety and distress with regard to these changes due to the lack of support and communication offered by hospitals:
‘My birth plan changed as the baby was in a difficult position but as I was the last in my pregnancy group to give birth and 5/7 of them had had a c-section I was very worried I would have to have a c-section. In hospital it felt like it was my only option’
These feelings were further exacerbated as a result of COVID-related restrictions to birthing support:
‘I would have like[d] a natural labour but my body didn't go into labour. I suffered from PTSD from my [eldest’s] birth where I was induced therefore it was advised I shouldn't be induced again. I spent a lot of time worrying about a situation where I might have had to be induced without my husband’s support’.
Some respondents who described changes to their birth appeared to adapt well to the changes as a result of feeling supported and informed throughout their journey:
‘Things did not go to plan, but I was kept informed, I was consulted on actions taken and my birth plan was considered throughout.’
‘Change of plan but staff in operation was amazing’.
Overall it is evident from the above responses that during the first year of the pandemic mixed experiences were had by parents, with almost equal numbers of participants reporting, COVID-related and non-COVID related changes to their birthing plans. To gain a better overview of participants experiences during childbirth, we asked also parents to reflect on the communication they had received from medical staff and/or the hospital prior to the birth of their baby regarding access to birthing partners during the delivery. We identified three key themes related to responses to this question (see Table 3, Q7, n = 250): (1) Communication, (2) Impact of fluctuating COVID-related guidance, (3) Anxiety and stress related to changing guidance.
Communication
The results revealed mixed responses in relation to communication from their hospital prior to the birth of their child. Some parents reported poor communication which added to feelings of anxiety:
‘Communication was unclear, causing anxiety. As we have no family in this country, I asked a friend to be a back-up birth partner in case my partner should be barred for such a reason.’
‘Literally no communication from the hospital so had very little idea what to expect’
Other parents reported having good communication from their hospital and midwives, in particular noting the use of social media platforms:
‘Communication about procedure for spontaneous labour was very clear- used the very helpful midwife - patient liaison Facebook group’
‘My local hospital held a webinar with their midwives discussing what to expect at the birth with the new restrictions so I new[sic] exactly what to expect at […]. They also answered any other worries or concerns I had on Facebook messenger. It was really helpful and reassuring.’
Impact of fluctuating COVID-related guidance
The constant changes to the guidance and restrictions in relation to giving birth during COVID-19 was a major theme within responses related to communication received from the hospital prior to the birth of their child:
‘It changed a lot in the build up to birth – as did restrictions on water birth etc. Was very aware that progress could be revoke[d] at any point’
‘Things were changing so quickly at the time midwives weren’t 100% sure’
Many parents related the constant and fast changing nature of guidance as causing feelings of distress:
‘The guidelines were changing almost daily. I felt scared and upset. On top of this I was unsure if anyone would be able to look after my son whilst I gave birth.’
‘Every time I asked the question I was told it could change right up until the morning of my c section - this made me very anxious’
In addition to the changing rules and guidance, parents highlighted differences between the NHS trusts around COVID guidance and birth:
‘As long as a positive test or symptoms aren't present. It was a concern that they wouldn't let my partner be present as restrictions were tighter than in other local hospitals’
Anxiety and stress related to changing guidance
Many parents reported feelings of anxiety and distress related to not being confident that they would be able to have a birth partner present for the duration of their labour and birth:
‘It was awful having no assurance that my partner could attend labour and post-labour. There's not much else to say except it was the #1 reason for my anxiety in the last few months of pregnancy.’
‘I was terrified my whole pregnancy that my husband wouldn't be able to be there...constant source of anxiety waiting for hospitals to update guidance’
‘Partner couldn’t come to induction. I found it a really frightening, lonely experience.’
However, the empathy with which this information was conveyed, appeared to have influenced at least one participant’s response to this:
‘At one point my midwife told me that I would have to be alone. This was a shock to me and I had a very emotional response. She was also upset by this. I appreciated that this was out of her control and that there was nothing she could do, I just really appreciated her empathic response, I felt less alone in that moment.’