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      Lessons from past epidemics and pandemics and a way forward for pregnant women, midwives and nurses during COVID-19 and beyond: A meta-synthesis

      review-article
      , PhD, RN, RM a , * , , BSc (Hons) b , 1
      Midwifery
      Elsevier Ltd.
      COVID-19, Epidemic, Midwives, Nurses, Pandemic

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          HIGHLIGHTS

          • The experiences of pregnant women from past epidemics and pandemics were consolidated.

          • Midwives’ and nurses’ perceptions of epidemics and pandemics were explored.

          • Individualized and contextualized educational support is needed.

          • Culturally congruent care and emotional and financial support need to be prioritized.

          • Healthcare professionals can consider technology-based and community-led supportive programs.

          Abstract

          Objective

          To consolidate qualitative research studies that examined the experiences and needs of pregnant women, midwives, and nurses of maternity units to provide a way forward for future research and practices during the current pandemic and future epidemics and pandemics.

          Design

          Qualitative systematic review and meta-synthesis.

          Data Source

          Four electronic databases—PubMed, Scopus, PsycINFO, and Cumulative Index to Nursing and Allied Health (CINAHL).

          Review Methods

          Qualitative studies with samples of pregnant women, midwives, and/or nurses of maternity units who experienced epidemics and/or pandemics were searched from 1 January 2000 to 4 April 2020. The included studies were critically appraised using the ten-item Critical Appraisal Skills Programme (CASP) tool.

          Findings

          Eight studies were included in this review. Four themes emerged from the synthesis: (1) psychological responses, (2) challenges faced, (3) coping strategies, and (4) sources of support and support needs.

          Key conclusions

          Pregnant women, midwives, and nurses experienced negative psychological responses during epidemics and pandemics. Challenges, such as limited available information and public stigma, were faced. Various coping strategies, such as actively looking for more information and seeking solace in religions, were practiced by pregnant women, midwives, and nurses. Families were both sources of support and stress and they expressed needs for more informational, emotional, and financial support during pandemics.

          Implications for practice

          More culturally diverse research in the future that includes the development of technology-based programs, trained community volunteer-led programs, psychosocial interventions, and anti-stigma and awareness initiatives are needed to combat the current pandemic and future public health crises.

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          Most cited references38

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          Using thematic analysis in psychology

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            Presumed Asymptomatic Carrier Transmission of COVID-19

            This study describes possible transmission of novel coronavirus disease 2019 (COVID-19) from an asymptomatic Wuhan resident to 5 family members in Anyang, a Chinese city in the neighboring province of Hubei.
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              Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

              Summary Background Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. Limited data are available for pregnant women with COVID-19 pneumonia. This study aimed to evaluate the clinical characteristics of COVID-19 in pregnancy and the intrauterine vertical transmission potential of COVID-19 infection. Methods Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for nine pregnant women with laboratory-confirmed COVID-19 pneumonia (ie, with maternal throat swab samples that were positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from Jan 20 to Jan 31, 2020. Evidence of intrauterine vertical transmission was assessed by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples. Breastmilk samples were also collected and tested from patients after the first lactation. Findings All nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia (<1·0 × 10⁹ cells per L). Three patients had increased aminotransferase concentrations. None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in newborn babies. All nine livebirths had a 1-min Apgar score of 8–9 and a 5-min Apgar score of 9–10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus. Interpretation The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy. Funding Hubei Science and Technology Plan, Wuhan University Medical Development Plan.
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                Author and article information

                Contributors
                Role: Assistant Professor; Data Search; Data Extraction and Review of Articles; Manuscript preparation
                Role: Research Assistant; Data Search; Data Extraction and Review of Articles; Manuscript preparation
                Journal
                Midwifery
                Midwifery
                Midwifery
                Elsevier Ltd.
                0266-6138
                1532-3099
                20 August 2020
                20 August 2020
                : 102821
                Affiliations
                [a ]Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore; National University Health System, Singapore
                [b ]Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597 Singapore
                Author notes
                [* ]Corresponding author. Shefaly Shorey, Ph.D., RN, RM, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597 Singapore, Tel: (65) 66011294; Fax: (65) 67767135 nurssh@ 123456nus.edu.sg
                [1]

                Tel: (65) 93651877

                Article
                S0266-6138(20)30193-5 102821
                10.1016/j.midw.2020.102821
                7438224
                32847770
                57c0c865-dfbf-4171-ae35-d4d84aa3b39e
                © 2020 Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 28 April 2020
                : 14 August 2020
                : 17 August 2020
                Categories
                Article

                Obstetrics & Gynecology
                covid-19,epidemic,midwives,nurses,pandemic
                Obstetrics & Gynecology
                covid-19, epidemic, midwives, nurses, pandemic

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