Midwives’ perspectives on the provision of quality midwifery care during the COVID-19 pandemic in Malta

Abstract

Purpose: The global maternity care landscape has been greatly impacted by the coronavirus disease 2019 (COVID-19) pandemic. Swift and substantial modifications were introduced, causing midwives globally to experience anxiety and moral distress when unable to deliver quality, woman-centred care aligned with professional values. There is a dearth of research with large-scale data collection, hence this local study can inform policy-making and preparedness for a pandemic or similar emergencies. Aim: To explore the local midwives’ perspectives on the provision of quality midwifery care during the COVID-19 pandemic in different maternity care settings. Objectives: To seek midwives’ perspectives on altered provision of midwifery care during the COVID-19 pandemic and how this affected women and their families; to identify challenges encountered by midwives in balancing personal safety and well-being while maintaining quality midwifery care; and to identify strategies in addressing the challenges encountered that inform longer-term planning for essential elements of quality midwifery care. Methodology: A quantitative approach was adopted, non-experimental and crosssectional in nature, using a self-administered questionnaire, where 117 midwives working at the local general hospital were recruited through purposive sampling. Eighty-one responses (n=81) were returned, yielding a response rate of 69.2%. Analysis of the data collected was performed by descriptive and inferential statistical analysis for quantitative data, and by using thematic analysis for the qualitative data. Results: The COVID-19 pandemic led to significant changes in local midwifery care, impacting protective measures, delivery protocols, and postnatal practices. Midwives perceived rapid policy changes as mostly unclear and contradictory. Perceived emotional challenges for women and families included anxiety due to policy changes and limited time with their newborns. Positive outcomes revealed enhanced teamwork and increased awareness on infection control as well as an undisturbed postnatal period for parents and more opportunities for honest communication. Challenges encompassed organisational issues such as increased workload, staff shortages, lack of training, poor management and devaluation of the midwifery profession, and challenges in care provision, namely hindered communication with personal protective equipment (PPE), reduced in-person contact time, and lack of holistic care. Personal challenges for midwives included physical and psychological difficulties, job dissatisfaction and lack of recognition. The study emphasises the importance of ongoing education, support strategies, and organisational recognition. Midwives proposed strategies, including increased support, ongoing training, and care for the holistic well-being, contributing to long-term planning for quality midwifery care during the pandemic. Conclusion: In the context of a pandemic or an analogous emergency placed on the healthcare system, it is imperative to address and enhance the holistic well-being of midwives, as well as women and their partners. Recommendations from this study’s findings necessitate the provision of timely and evidence-based guidelines, along with appropriate resources, to support midwives in delivering respectful, family-centred midwifery care and maintaining the physiological nature of childbirth.