Findings

Published articles

• Maternity Care Preferences for Future Pregnancies Among United States Childbearers: The Impacts of COVID-19

  • Summary: The COVID-19 pandemic has impacted maternity care decisions, including plans to change providers or delivery location due to pandemic-related restrictions and fears. A relatively unexplored question, however, is how the pandemic may shape future maternity care preferences post-pandemic. Here, we use data collected from an online convenience survey of 980 women living in the United States to evaluate how and why the pandemic has affected women’s future care preferences. We hypothesize that while the majority of women will express a continued interest in hospital birth and OB/GYN care due to perceived safety of medicalized birth, a subset of women will express a new interest in out-of-hospital or “community” care in future pregnancies. However, factors such as local provider and facility availability, insurance coverage, and out-of-pocket cost could limit access to such future preferred care options. Among our predominately white, educated, and high-income sample, a total of 58 participants (5.9% of the sample) reported a novel preference for community care during future pregnancies. While the pandemic prompted the exploration of non-hospital options, the reasons women preferred community care were mostly consistent with factors described in pre-pandemic studies, (e.g. a preference for a natural birth model and a desire for more person-centered care). However, a relatively high percentage (34.5%) of participants with a novel preference for community care indicated that they expected limitations in their ability to access these services. These findings highlight how the pandemic has potentially influenced maternity care preferences, with implications for how providers and policy makers should anticipate and respond to future care needs.
  • Keywords: maternity care; community birth
  • A corresponding policy brief summarizing the study results and policy implications can be found here: COVID-19 Future maternity care preferences policy brief.
•  Exercise routine change is associated with prenatal depression scores during the COVID-19 pandemic among pregnant women across the United States
  • Summary: This article investigates how the COVID-19 pandemic has affected risk for depression among pregnant women across metro and non-metro areas. To explore the potentially beneficial health effects of moderate exercise on mental health, the paper tests 1) whether a change in exercise routines during the pandemic is associated with higher depression scores, and 2) whether women living in metro areas are more likely to report exercise changes compared to those living in non-metro areas, potentially due to having limited indoor exercise space and/or relative difficulty exercising outside in highly-populated areas. Using data from the CARE study, the paper finds that women who reported exercise changes during the pandemic exhibited significantly higher depression scores compared to those reporting no changes. Additionally, individuals living in metro areas of all sizes were significantly more likely to report exercise changes compared to women living in non-metro areas. The results support previous findings of the beneficial effects of exercise on mental health in pregnancy. Providers should consider pandemic-related exercise changes as a risk factor for depression, and there should be effort to recommend exercise tailored to living conditions and physical health.
  • Keywords: Perinatal depression; coronavirus; pregnancy; mental health; physical activity
•  Maternal and child health during the COVID-19 pandemic: Contributions in the field of human biology
  • Summary: This article focuses on how the COVID-19 pandemic is currently disrupting maternity care, affecting pregnant women’s well-being, and potentially increasing the risk of poor maternal and child outcomes. The COVID-19 and Reproductive Effects (CARE) project is a case study on the complex COVID-19-linked factors impacting prenatal care and birth experiences. Further research is needed to document the downstream health effects of the pandemic on pregnant women and their children. Human biology studies are well suited to understanding the biocultural impacts of the pandemic across populations in the short-term and long-term. This information will help to better address the continuing consequences of the COVID-19 pandemic and to prepare for future global health challenges. 
• COVID-19-related financial stress associated with higher likelihood of depression among pregnant women living in the United States 

• • • Summary: Here we evaluated whether COVID-19-associated financial stress was associated with increased likelihood of a clinically-significant depression score among pregnant women living in the United States during the COVID-19 pandemic. The COVID-19 pandemic has led to unprecedented levels of unemployment and financial strain, particularly impacting pregnant women, for whom added financial stress may be particularly impactful due to the costs associated with prenatal care and providing for a newborn. Financial stress has been previously associated with elevated depression symptoms among pregnant women, which could have significant impacts on birth outcomes and long-term offspring health. Results from an online survey found that COVID-19-related financial stress was significantly associated with increased likelihood of a clinically significant depression score, even after adjusting for other factors like participant education and income. Financial stress caused by the COVID-19 pandemic is associated with more than double the likelihood of depression during pregnancy, which could impact birth outcomes and long-term offspring health. 

• • • Keywords: coronavirus, stress, pregnancy, mental health

• Birth plan alterations among American women in response to COVID‐19

• • Summary: This article explores the impact of the pandemic on maternity care. We use an online convenience survey to examine how women’s birth plans (e.g. intended labour support and delivery location) have changed in response to the COVID‐19 pandemic. Overall, 45.2% of respondents reported changing some aspect of their birth plans because of COVID‐19, due in part to their own concerns, their partner's concerns, the concerns of friends or family members and comments from medical providers. Commonly provided COVID‐related birth plan changes s largely fell into three categories: (i) modifying an existing hospital birth plan (ie shortening the hospital stay, altered pain management strategies and accommodating new policies like wearing a mask while labouring); (ii) changing birth locations and/or providers (ie opting for an out of hospital birth, forced provider/location change because pandemic has limited availability, selecting hospital birth because of fear complications); and (iii) other COVID‐related concerns (ie having fewer support people at birth, visitors not permitted following birth, care disrupted because moved in response to shelter‐in‐place orders). Notably, the women in this sample exhibited a much higher preference for out of hospital births than the national average before the COVID‐19 pandemic (5.4% vs. 1.6%, respectively). This suggests that part of this increase in out of hospital births is likely attributable to the COVID‐19 pandemic.
• Maternal and child health during the COVID-19 pandemic: Contributions in the field of human biology

• • Summary: This article focuses on how the COVID-19 pandemic is currently disrupting maternity care, affecting pregnant women’s well-being, and potentially increasing the risk of poor maternal and child outcomes. The COVID-19 and Reproductive Effects (CARE) project is a case study on the complex COVID-19-linked factors impacting prenatal care and birth experiences. Further research is needed to document the downstream health effects of the pandemic on pregnant women and their children. Human biology studies are well suited to understanding the biocultural impacts of the pandemic across populations in the short-term and long-term. This information will help to better address the continuing consequences of the COVID-19 pandemic and to prepare for future global health challenges. 
• US Policies Are Failing Women - COVID-19 and Childbirth - SAPIENS 

• • Summary: This publicly accessible article explores how the CARE study reveals profound and amplified problems with the United States’ maternity system. The newest guidelines released by the U.S. Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists (ACOG) that recommend separating women with suspected or confirmed COVID-19 from their newborns is emblematic of the U.S. healthcare system’s overly-medicalized approach to most pregnancies and births. The CARE study sheds light on several issues surrounding U.S. maternity care during the pandemic: these include the disempowerment of women in hospital-based birthing procedures, the structural limitations to receiving alternatives to hospital birth, and the favoring of more technology, medicine, and intervention over individual women’s preferences and risk. Healthcare should work to increase women’s education about and access to non-hospital alternatives to birth in the short term and long term, to benefit the mother and newborn’s well-being and to relieve pressure on the U.S. medical system.

Articles currently in review 

• Associations between COVID-19-Related Changes to Pregnant Women’s Work-Plans and Prenatal Depression

• • • Summary: This article investigates associations between COVID-19 related changes to pregnant women’s work-plans and prenatal depression. Pregnant workers may be especially affected by pandemic-related unemployment as they are over-represented in low-wage service and hospitality industries impacted by the pandemic. Through an online convenience sample survey, we explored whether COVID-19-related changes to how long women planned to work during their pregnancy, and uncertainty about these changes, were associated with prenatal depression. Survey results found that both COVID-19-related work-plan changes and uncertainty about the precise nature of these changes were associated with significantly higher odds of a clinically-significant depression score. Results demonstrate a need for immediate suspension of the eligibility requirements for the Family and Medical Leave Act and/or universal access to both paid family leave and prenatal depression screening. 
    • Keywords: Coronavirus, pregnant workers, perinatal depression screening, maternity leave, Family and Medical Leave Act (FMLA), paid family leave
  • Reported information sharing and satisfaction with maternity care providers during the COVID-19 pandemic: Associations with socioeconomic status and shifts to telehealth
    
    • Summary: This article investigates associations between patient demographics or disrupted care (e.g. cancelled appointments and rapid shift to telehealth) and whether patients report information sharing by providers, as well as associations between patient-reported information sharing or care disruptions and patient satisfaction with providers. Using surveys of 1,999 pregnant women in the US, thirty-eight percent of participants said their provider had not discussed how the pandemic would affect their care during pregnancy, labor, or delivery. There were also significant socioeconomic inequities in reported information sharing by providers, with less education, income, and more disrupted care associated with less information sharing. Lack of information sharing, increased telehealth appointments, and more disrupted care were associated with less provider satisfaction. Providers need to be proactive in information sharing about the COVID-19 pandemic and consider ways to maintain patient satisfaction, as poor communication and low satisfaction could worsen perinatal outcomes.
    • Keywords: patient-provider communication; coronavirus; prenatal care; patient satisfaction; birth disparities; telehealth

Podcasts

• • COVID Calls by Scott Knowles with Dr. Zaneta Thayer
    • Summary: In this podcast, Dr. Thayer discusses the impact of the COVID-19 pandemic on maternity care experiences drawing on information from the CARE study.
  • SoS 79 – Stress and Intergenerational Health with Dr. Zaneta Thayer June 15, 2020
    • Summary: In this podcast, Dr. Thayer discusses her many projects examining the intergenerational effects of stressful experiences during pregnancy. Dr. Thayer works primarily in New Zealand, where her research has documented links between experienced discrimination and poor birth outcomes. She also discusses her recent clinical brief examining the health effects of psychosocial stress among individuals using assisted reproductive technologies. Finally, Dr. Thayer is joined by her postdoc Dr. Gildner to discuss the CARE study, and how biocultural approaches can be used to study the impact of the pandemic on maternity care and well-being.