The pandemic may have accentuated the fear of childbirth in Portuguese pregnant women. Ana Paula Prata, a researcher at CINTESIS – Center for Health Technology and Services Research/Nursing School of Porto (ESEP), has explained this fact in an refelction paper published in the Revista Brasileira de Enfermagem.
“With the COVID-19 pandemic, fear and uncertainty have taken on an unprecedented dimension in the negative way that many pregnant women have anticipated and experienced childbirth”, she says.
The specialist in Maternal and Obstetric Health Nursing has based her conclusions on testimonies collected in different health institutions, in the media, and on social media throughout 2020, in Portugal and Brazil.
According to Ana Paula Prata, the rate of “severe fear of childbirth” may be close to 10%. A percentage that has increased in the last few months. The researcher points out several reasons for the increased fear of childbirth during the pandemic, such as “the uncertainty and unpredictability about the future, exposure to danger or insecurity, loss of autonomy in decision-making, the impossibility of making personal choices, paternalism and the feeling of lack of control”.
“There was a big change in obstetric practices and almost a general disorientation about what would be the best care for pregnant women and women in labor. Suddenly, several rights that had been won by women, such as that of autonomy or informed consent, went down the drain,” she says.
According to Ana Paula Prata, “the first impulse was to protect pregnant women and women in labor, but in this desire for protection, there were unnecessary c-sections, inductions of labor ahead of time, suspension of the right to have a companion during delivery and postpartum, discouragement of skin contact and breastfeeding, especially in cases of suspected infection or positive. We have many women complaining that their rights have not been respected”.
“A First Aid Kit for Pregnant Women in Pandemic Times”
To face the fear of childbirth, particularly during the pandemic, the researcher proposes a support tool that can be provided to pregnant women during face-to-face or online care, which she calls “First Aid Kit”. It is essentially a set of steps that must be followed and that include information, a birth plan, healthy routines, relaxation, and affections.
“Women must be informed throughout the pregnancy. Information and preparation for childbirth must be maintained, as well as encouraging healthy routines and maintaining affection. The birth plan is an extraordinarily important tool because it helps women to reflect on what they consider necessary to have a positive experience and to overcome their fears”, explains Ana Paula Prata.
Maternity Care Units
Fear of childbirth, accentuated by the pandemic, may have other consequences. In the opinion of Ana Paula Prata, it could, for example, lead many women to choose to have their children at home.
In order to respond to these women, Ana Paula Prata is part of a group that defends the opening of maternity care units (UCM), within the scope of the network “Midwifery Unit Network” and “Midwifery Unit Standard”, that is translated into Portuguese.
“All the scientific evidence supports that home birth is safe. The problem is home birth without professional assistance! These units are places where obstetric care is provided to healthy women, with uncomplicated, low-risk pregnancies, managed by specialist nurses in Maternal and Obstetric Health. They are based on a biopsychosocial model, of continuity of care, centered on women. These units can be located outside hospitals or adjacent to an obstetric unit”, notes the specialist.
The idea is for UCM to be implemented in the National Health Service and to be accessible to all women. In Portugal, there are no such units yet, but they are very common in other countries, namely in England and in the Nordic countries, and are being implemented throughout Europe.
In addition to being the year marked by the declaration of the COVID-19 pandemic, 2020 was also the International Year of Nurses and Midwives or Nurses Specialist in Maternal and Obstetric Health. The World Health Organization (WHO) estimates that nine million more nurses and midwives are needed worldwide to achieve the goals of universal health coverage by 2030.