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Moral and Mental Health Challenges Faced by Maternity Staff During the COVID-19 Pandemic

  • University of Lausanne and Lausanne University Hospital


The current COVID-19 pandemic places maternity staff at risk of engaging in clinical practice that may be in direct contravention with evidence; professional recommendations; or, more profoundly, deeply held ethical or moral beliefs and values, as services attempt to control the risk of cross-infection. Practice changes in some settings include reduction in personal contacts for tests, treatments and antenatal and postnatal care, exclusion of birth partners for labor and birth, separation of mother and baby in the immediate postnatal period, restrictions on breastfeeding, and reduced capacity for hands-on professional labor support through social distancing and use of personal protective equipment. These enforced changes may result in increasing levels of occupational moral injury that need to be addressed at both an organizational and a personal level. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Moral and mental health challenges faced by maternity staff during the Covid-19
Antje Horsch1,2*, Joan Lalor3 & Soo Downe4
1Institut of Higher Education and Research in Healthcare, University of Lausanne, Lausanne,
Switzerland. E-mail:
2Department Woman-mother-child, Lausanne University Hospital, Lausanne, Switzerland.
3Research School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland. E-mail:
4Faculty of Health, University of Central Lancashire, Preston, UK. E-mail:
*Corresponding author
Prof. Antje Horsch
Institute of Higher Education and Research in Healthcare
University of Lausanne
Route de la Corniche 10
1010 Lausanne
Horsch, A., Lalor, J. & Downe, S. (2020). Moral and mental health challenges faced by
maternity staff during the Covid-19 pandemic. Psychological Trauma: Theory, Research,
Practice, and Policy. DOI: 10.1037/tra0000629
The current COVID-19 pandemic places maternity staff at risk of engaging in clinical
practice that may be in direct contravention with evidence, professional recommendations, or,
more profoundly, deeply held ethical or moral beliefs and values, as services attempt to
control the risk of cross-infection. Practice changes in some settings include reduction in
personal contacts for tests, treatments and antenatal and postnatal care; exclusion of birth
partners for labour and birth; separation of mother and baby in the immediate postnatal
period; restrictions on breastfeeding; and reduced capacity for hands-on professional labour
support through social distancing and use of personal protective equipment. These enforced
changes may result in increasing levels of occupational moral injury that need to be addressed
both, at an organisational, as well as at a personal level.
The current Coronavirus 2019 (COVID-19) outbreak poses an important threat to public health
but also unique challenges to healthcare workers, for many reasons. The best way of treating
the infection is yet unknown, and healthcare workers fear for their own safety, the safety of
their patients, and that of their loved ones (Maunder, 2009). They are required to adapt their
practices, often without much time for reflection or evidence gathering. Research on previous
epidemics/pandemics shows the toll that caring for patients can have on the mental health of
staff, such as elevated levels of psychological distress, insomnia, alcohol/drug misuse, and
symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, burnout, anger, and
higher perceived stress (Vyas, Delaney, Webb-Murphy, & Johnston, 2016). These mental
health problems may negatively impact the way in which professionals interact with their
patients, including avoidance of infected patients (Fiksenbaum, Marjanovic, Greenglass, &
Coffey, 2006; Marjanovic, Greenglass, & Coffey, 2007).
While the evidence clearly shows a negative impact on the mental health of healthcare workers
in general, no specific data exists regarding its impact on staff caring for childbearing women
and their families. This group is particularly relevant, as pregnant women are usually healthy,
and medical interventions are usually kept to a minimum in maternity care. Face-to-face
psychological support is as important as physical checks, and good quality maternity care
requires a trusting relationship between professionals and families. Good eye contact, touch,
and tone are critical elements of care, particularly during labour. During a pandemic, the
restriction of face-to-face antenatal and postnatal care, the need for personal protective
equipment (PPE) that limits personal engagement, and the restriction on supportive touch may
be as distressing for staff to carry out, as it is for women and families to experience.
In the UK, there has been a mixed organisational response to COVID-19 in maternity services.
Some hospitals have closed community services and moved all care to centralised hospitals. In
Ireland, almost all maternity care services are centralised within hospital networks, so closure
of community provision is not an issue. However, face-to-face contacts have reduced, as a
significant proportion of antenatal care is now managed through virtual consultations and
antenatal education is being delivered online. Across both countries, limits have been placed
on the number of tests and treatments available in some settings, in both ante and postnatal
care, and birth companionship and postnatal visiting have been restricted.
As part of an EU-funded COST Action CA 18211 network, the authors set up a website
(CA18211, 2020) in response to calls from midwives and obstetricians on the frontline to have
a one-stop shop to access central resources and to capture how maternity care is being affected
by the current Covid-19 crisis. Examples submitted by maternity workers to the website include
a forced separation of mothers and babies for up to 14 days if mothers are confirmed or
suspected of being COVID-19 positive, a lack of opportunity to support mothers with
breastfeeding, and the prohibition on the admission of birth partners during labour or during
the postpartum hospital stay. Even more traumatic stories are emerging from some countries,
of women told they must have their labour induced or have a caesarean section against their
will, in contradiction to their human rights to consent to such interventions or not (Birthrights,
2020). Some women have to do this without companionship, where few staff are available, and
in hospitals full of patients with severe COVID-19 symptoms, being worried that they and/or
their baby may become infected. All of these practices are potentially both physically and
psychologically damaging for mothers and babies. All are in direct contravention of COVID-
19 recommendations from relevant organisations, such as the World Health Organisation,
International Confederation of Midwives, and International Federation of Gynecology and
When local organisational imperatives and clinical practice are in direct contravention with
evidence, professional recommendations, or, more profoundly, deeply held ethical or moral
beliefs and values, this can give rise to increasing levels of occupational moral injury (Litz et
al., 2009). In extreme cases, staff can feel that they have become the instruments of inhumane
treatment of women and babies the active perpetrators of psychological and physical harm,
in complete violation of their moral norms and practice standards. Central to the concerns of
many maternity workers is the disruption of their relationship with the women caused by the
introduction of pandemic-related measures. This is exacerbated by the fact that, in parallel with
a sense of moral injury, for many staff, there may also be a sense of relief that they are protected
from infection by the use of PPE and other security measures that have been imposed. Because
of the unprecedented and relentless work pressure, even a strong sense of ethical and moral
duty can, understandably, be dulled, leading to emotional distancing for self-preservation.
However, later reflection on the attitudes and behaviours that result from such necessary
disciplining may re-traumatise health care providers and make them more vulnerable to
developing mental health problems, such as PTSD, depression, and suicidal ideation
(Williamson, Stevelink, & Greenberg, 2018). In turn, this may lead to reduced working hours
and increased turnover (Maunder et al., 2006).
Several approaches may help maternity staff to counteract the negative effects of the current
pandemic on their morale and mental health. Managers should ensure that time and space is
given to help staff reflect on and make sense of the morally difficult decisions they must take.
One such approach may be Schwartz rounds (Flanagan, Chadwick, Goodrich, Ford, &
Wickens, 2020) organised by team leaders, which could also be carried out in a virtual format.
Schwartz rounds follow a structured format that allows healthcare professionals to discuss and
reflect on the emotional work-related challenges of their day-to-day practice, in a safe and
confidential space (Flanagan et al., 2020). In addition, a peer support programme that is
available to all staff could be offered, including a discussion about moral injury and early
warning signs to look out for (Greenberg, Docherty, Gnanapragasam, & Wessely, 2020). Staff
reporting high and persistent levels of psychological distress or mental health problems should
be identified early and offered appropriate specialist support.
In conclusion, the unique challenges that the current COVID-19 pandemic poses place
maternity staff at risk of engaging in changed practices that may be in direct contravention with
evidence, professional recommendations, or, more profoundly, deeply held ethical or moral
beliefs and values. This may result in increasing levels of occupational moral injury that need
to be addressed, both at an organisational, and at a personal level. Health services should begin
offering psychosocial support for staff to protect their mental wellbeing if they are to continue
to provide high quality care.
Antje Horsch, Joan Lalor, and Soo Downe are management committee members of COST
Action CA18211.
CA18211, C. (2020). MATERNITY CARE DURING COVID19. Retrieved from
Fiksenbaum, L., Marjanovic, Z., Greenglass, E. R., & Coffey, S. (2006). Emotional exhaustion and
state anger in nurses who worked during the sars outbreak: The role of perceived threat and
organizational support. Canadian Journal of Community Mental Health, 25(2), 89-103.
Flanagan, E., Chadwick, R., Goodrich, J., Ford, C., & Wickens, R. J. J. o. I. C. (2020). Reflection for
all healthcare staff: A national evaluation of Schwartz Rounds. 34(1), 140-142.
Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. J. B. (2020). Managing mental
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Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. J. C. p. r. (2009).
Moral injury and moral repair in war veterans: A preliminary model and intervention strategy.
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Marjanovic, Z., Greenglass, E. R., & Coffey, S. (2007). The relevance of psychosocial variables and
working conditions in predicting nurses' coping strategies during the SARS crisis: an online
questionnaire survey. Int J Nurs Stud, 44(6), 991-998.
Maunder, R. G. (2009). Was SARS a mental health catastrophe? General Hospital Psychiatry, 31(4),
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... In some cases these responses are in direct contraversion of COVID-19 recommendations from relevant organizations. These practices may affect negatively, both physically and psychologically, mothers along with their infants as well as medical staff caring for childbearing women and their families (50)(51)(52)(53). 3 According to Bodenmann's Systemic-Transactional Model of dyadic coping (48), dyadic stress is observed when partners are affected by a stressor and the source of stress is defined as common. In order to cope against dyadic stress, partners initiate a dyadic coping process. ...
... These restrictions have a negative effect on mother's mood, selfesteem, self-confidence and confidence in their abilities related to their infant's care. Standard precautions (such as hand hygiene, use of medical mask, routine disinfection) applied by mothers with suspected, or confirmed COVID-19, who must take care of their infants by themselves, may impose psychological demands on new mothers and may complicate the early mother-infant relationship (51)(52)(53)(54)(55)(56). ...
... In addition, NICU staff members experience a sudden and continuous environmental stressor since they are further affected by a number of factors that seem to increase even more their psychological stress such as: moral distress when limitations beyond their control make them unable to take decisions according to their own values, the values of the patient's family, or the values of FCC; and difficulties in finding a balance between meeting the emotional needs of hospitalized infants and their families while also safeguarding their own health (52,54,68). ...
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This review aims to discuss the factors that may affect maternal mental health and infant development in COVID-19 pandemic condition. Toward this direction, the two objectives of this review are the following: (a) to discuss possible factors that may have affected negatively perinatal mental health through the pandemic-related restrictions; and (b) to present the implications of adversely affected maternal emotional wellbeing on infant development. We conclude that the pandemic may has affected maternal mental health with possible detrimental effects for the infants of the COVID-19 generation. We highlight the need for evidence-based interventions to be integrated within the health system for prenatal and postpartum care in an effort to promote maternal mental health and infant development.
... For example, fear of contracting the virus and its consequences presented a particular worry for pregnant women, who were initially considered more vulnerable to COVID-19 than the general population [28][29][30][31]. Furthermore, women faced uncertainty around perinatal care [7,30,32,33], Health Visitors were redeployed in some parts of the UK, and many families reported not experiencing the perinatal care that they had expected [33,34]. Lockdown instigated to limit transmission of the virus resulted in extended periods of physical and social isolation, preventing access to many forms of support, and leaving co-parents excluded from attending antenatal appointments or visiting mothers during postpartum hospital admissions [26,30,32,33]. ...
... Furthermore, women faced uncertainty around perinatal care [7,30,32,33], Health Visitors were redeployed in some parts of the UK, and many families reported not experiencing the perinatal care that they had expected [33,34]. Lockdown instigated to limit transmission of the virus resulted in extended periods of physical and social isolation, preventing access to many forms of support, and leaving co-parents excluded from attending antenatal appointments or visiting mothers during postpartum hospital admissions [26,30,32,33]. ...
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Background Rates of perinatal mental health difficulties (experienced during pregnancy and the 12-months postpartum) increased worldwide during the COVID-19 pandemic. In the UK, anxiety and depression were estimated to affect more than half of perinatal women during the first national lockdown. However, little is known about women’s qualitative experiences of distress. This study aimed to extend published quantitative findings resulting from the same data set (Harrison et al., Women Birth xxxx, 2021; Harrison et al., J Reprod Infant Psychol 1–16, 2021) to qualitatively explore: 1) the feelings and symptoms associated with maternal perinatal distress during the COVID-19 pandemic; and 2) the associated sources of distress. Methods As part of an online survey during May 2020, 424 perinatal women responded to an open-ended question regarding a recent experience of distress. Qualitative data were analysed using an initial content analysis, followed by an inductive thematic analysis adopting a realist approach. Data were explored in the context of self-reported perinatal anxiety and depression symptoms. Results Initial content analysis of the data identified twelve distinct categories depicting participants’ feelings and symptoms associated with psychological distress. Despite the high rates of probable depression in the sample, women’s descriptions were more indicative of anxiety and general distress, than of symptoms traditionally related to depression. In terms of the associated psychosocial stressors, a thematic analysis identified five themes: Family wellbeing; Lack of support; Mothering challenges; Loss of control due to COVID-19; and Work and finances . Unsurprisingly given the context, isolation was a common challenge. Additionally, psychological conflict between maternal expectations and the reality of pregnancy and motherhood, loss of autonomy and control, and fears surrounding family health, safety, and wellbeing underlay many of the themes. Conclusions This study presents an array of feelings and symptoms expressed by perinatal mothers which may be useful to consider in relation to perinatal wellbeing. Furthermore, our data highlights several common sources of distress, including multiple COVID-19 specific factors. However, many were related to more general perinatal/maternal experiences. Our findings also point to considerations that may be useful in alleviating distress in pregnancy and early motherhood, including social support, realistic perinatal/maternal expectations, and support for those with perceived perinatal trauma.
... 6 Maternity services globally reported screening and containment of COVID-19 in their workforce, 7,8 while facing high levels of staff burnout and negative mental health outcomes. [9][10][11][12] Staff shortages were caused by a myriad of SARS-CoV-2-related reasons. Some staff "shielded" due to their own vulnerability to infection or that of household members 13 while others self-isolated following SARS-CoV-2 infection or that of close contacts. ...
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The SARS‐CoV‐2 pandemic has devastated populations, posing unprecedented challenges for healthcare services, staff and service‐users. In the UK, rapid reconfiguration of maternity healthcare service provision changed the landscape of antenatal, intrapartum and postnatal care. This study aimed to explore the experiences of maternity services staff who provided maternity care during the SARS‐CoV‐2 pandemic to inform future improvements in care. A qualitative interview service evaluation was undertaken at a single maternity service in an NHS Trust, South London. Respondents (n = 29) were recruited using a critical case purposeful sample of maternity services staff. Interviews were conducted using video‐conferencing software, and were transcribed and analyzed using Grounded Theory Analysis appropriate for cross‐disciplinary health research. The focus of analysis was on staff experiences of delivering maternity services and care during the SARS‐CoV‐2 pandemic. A theory of “Precarity and Preparedness” was developed, comprising three main emergent themes: “Endemic precarity: A health system under pressure”; “A top‐down approach to managing the health system shock”; and “From un(der)‐prepared to future flourishing”. Maternity services in the UK were under significant strain and were inherently precarious. This was exacerbated by the SARS‐CoV‐2 pandemic, which saw further disruption to service provision, fragmentation of care and pre‐existing staff shortages. Positive changes are required to improve staff retention and team cohesion, and ensure patient‐centered care remains at the heart of maternity care. Maternity services are precarious, with many maternity professionals feeling their services are stretched. Retention‐related incentives and balance between service efficiency and patient‐centered care may help maternity staff to be better prepared for health system shocks in the future.
... Αδιαμφισβήτητα, η ψυχοσωματική βιοαπειλή της πανδημίας COVID-19 προκάλεσε πλήθος αρνητικών επιπτώσεων στους επαγγελματίες υγείας, με το προσωπικό των ΜΕΝΝ να έρχεται αντιμέτωπο με μια πρωτόγνωρα ψυχοπιεστική πραγματικότητα εξ αιτίας της μη πλήρους κατανόησης των επιδημιολογικών χαρακτηριστικών αυτής σε συνδυασμό με την αβεβαιότητα της ορθότητας των περιγεννητικών αποφάσεων διαχείρισης των περιστατικών Μαιευτικής και Νεογνολογίας, αλλά και των νέων δεδομένων κατά την προκαι μεταγεννητική περίοδο. 16,17 Έρευνα στη Σιγκαπούρη εντοπίζει τρεις φορές μικρότερη συχνότητα μετατραυματικού stress στο προσωπικό υγείας κατά την πανδημία COVID-19 σε σύγκριση με την αντίστοιχη συχνότητα του stress κατά την έξαρση του SARS. 18 Ωστόσο, αξίζει να τονιστεί ότι η εν λόγω έρευνα προσδιορίζει υψηλότερο επίπεδο του δείκτη SAS σε σχέση με μελέτη που διεξήχθη σε νοσηλευτές πρώτης γραμμής στη Wuhan της Κίνας. ...
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COVID-19 και οι στρατηγικές αντιμετώπισής της από τα υγειονομικά στελέχη ΣΚΟΠΟΣ Προσδιορισμός του αντίκτυπου της πανδημίας COVID-19 στο ιατρο-νοσηλευτικό προσωπικό, καθώς και των πρακτικών διαχείρισης που κινητο-ποιεί αυτό. ΥΛΙΚΟ-ΜΕΘΟΔΟΣ Η έρευνα διενεργήθηκε στο Γενικό Νοσοκομείο Θεσσαλονίκης «Ιπποκράτειο» από 3.3.2021-13.3.2021 με τη συμμετοχή 200 ερωτώμενων που ανήκαν στο ιατρονοσηλευτικό προσωπικό των δύο μονά-δων εντατικής νοσηλείας νεογνών. Το ερευνητικό εργαλείο αποτέλεσαν τα αυτοσυμπληρούμενα ερωτηματολόγια του Zung του 1971 και των Lazarus και Folkman του 1984, ενώ εφαρμόστηκαν μέθοδοι επαγωγικής στατιστικής ανάλυσης. ΑΠΟΤΕΛΕΣΜΑΤΑ Η έρευνα ανέδειξε ότι τόσο η κλίμακα συναισθημα-τικών αντιδράσεων όσο και η κλίμακα της σωματικής συμπτωματολογίας είχαν μέσους όρους και διάμεσους μικρότερους από το μέσο του διαστήματος μέσα στο οποίο λαμβάνουν τιμές. Επίσης, ο δείκτης SAS (Self-rating Anxiety Scale), ο οποίος υπολογίζεται ως το πηλίκο της βαθμολογίας του κάθε συμμετέχοντα διά 80, εκφρασμένο σε ποσοστό επί τοις εκατό, είχε ως μέσο όρο και διάμε-σο 45,94% και 43,75%, αντίστοιχα. Οι τρεις αυτές κλίμακες του εργασιακού stress/άγχους φάνηκε να επηρεάζονται από τα δημογραφικά χαρακτηριστικά του δείγματος και κυρίως από το φύλο, την ιδιότητα απασχόλησης και το μορφωτικό επίπεδο. Ως η πλέον εφαρμοζόμενη πρακτική αντιμετώπισης αναδείχθηκε η θετική επαναξιολόγηση, ενώ η ανάλυση συσχέτισης μεταξύ εργασιακού stress/άγχους και στρατηγικών αντιμετώπισης ανέδειξε ασθενείς θετικές συσχετίσεις σε ορισμένες κατηγορίες στρατηγικών. ΣΥΜΠΕΡΑΣΜΑΤΑ Στην πανδημία COVID-19 τα υγειονομικά στελέχη έρχονται αντιμέτωπα με μια νέα πρόκληση που συνιστά μια άκρως ψυχοπιεστική πραγματικότητα, ιδιαίτερα για το προσωπικό πρώτης γραμμής το οποίο ανήκει στις ομάδες των γυναικών, της νοσηλευτικής ιδιότητας, και του χαμηλότερου μορφωτικού επιπέδου. Οι διοικήσεις λοιπόν των μονάδων υγείας και γενικά οι αρμόδιοι για τη λήψη αποφάσεων θα πρέπει να αναπτύξουν στοχευμένες προληπτικές ή διαχειριστικές υποστηρικτικές παρεμβάσεις προκειμένου να ενισχυθεί το προσωπικό και η παραγωγικότητά του. Abstract at the end of the article Υποβλήθηκε 19.6.2021 Εγκρίθηκε 18.7.2021 Λέξεις ευρετηρίου Εργαζόμενοι στον τομέα υγείας Εργασιακό stress/άγχος Πανδημία COVID-19 Στρατηγικές αντιμετώπισης Τα τελευταία έτη, σε παγκόσμιο επίπεδο, τα συστήμα-τα υγείας έρχονται αντιμέτωπα με πλήθος προκλήσεων, περιλαμβανομένης της νέας βιοαπειλής που αφορά στην πανδημία COVID-19 και η οποία οδήγησε τον Παγκόσμιο Οργανισμό Υγείας (ΠΟΥ) να χαρακτηρίσει το έτος 2020 ως έτος «αναθεώρησης», θέτοντας ως απόλυτο στόχο την ενδυνάμωση ενοποιητικών δράσεων για την αντιμε-τώπιση παγκόσμιων κοινών κρίσεων και κινδύνων. 1 Ο ιός SARS-COV-2 αποτελεί έναν νέο κορωνοϊό που προκαλεί οξύ αναπνευστικό σύνδρομο και πρωτοεμφανίστηκε στις 31.12.2019 στη Wuhan της Κίνας, ενώ χαρακτηρίζεται από ήπια πορεία νόσου για το 80% των ασθενών, από κρίσιμη πορεία για το 6% και πολύ κρίσιμη για το 14% των νοσού-ντων. 2 Η επικινδυνότητά του οφείλεται στην ταχύτατη μετάδοσή του και στην ύπαρξη πολλαπλών μεταλλάξεων. Και ενώ δυσοίωνα σενάρια νόσησης του 60% του παγκό-σμιου πληθυσμού προέβλεπαν 50 εκατομμύρια θανάτους διεθνώς, νέες μελέτες υποστηρίζουν ότι η ανοσοποίηση του πληθυσμού πιθανόν να συμβάλλει στον περιορισμό αυτών σε 1,58-8,76 εκατομμύρια θανάτους μέχρι το έτος 2024. 3 Η πανδημία COVID-19 έχει έναν αδιαμφισβήτητο αντί-κτυπο σε όλες τις εκφάνσεις της κοινωνικής, της οικονο-μικής και της πολιτιστικής ζωής των πολιτών με μέγιστες ψυχοσωματικές προεκτάσεις. Ωστόσο, ιδιαίτερο είναι το
... When the enterprise cares for employee's benefits and provides training opportunities for employees, employees may conduct different intrarole and extrarole behaviors for the enterprise, such as improving their performance and safeguarding the interests of the enterprise. Social learning theory believes that people often intentionally or unintentionally imitate the behavior of the model around them, and take the model's behavior as a goal to make corresponding adjustments and changes to their behavior [11][12][13][14]. ...
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This work intends to combine neural network technology with occupational therapy to fully acquire employees’ emotional information by constructing an effective emotion recognition network. Firstly, the psychological state of employees is discussed from three aspects of leadership narcissism, organizational identification, and the emotional contagion effect, and the corresponding model is implemented. Secondly, based on the convolutional neural network technology, the facial feature recognition and the body feature recognition are combined, and the employees’ emotions can be accurately identified by establishing a multilearning emotion recognition network. Finally, a questionnaire survey is carried out on the employees of enterprises in the coastal areas of Zhejiang. Descriptive statistical analysis, reliability and validity analysis, correlation analysis, regression analysis, mediation effect tests, and other methods are used to analyze the questionnaire data. The results reveal that leadership narcissistic organizational identification plays a mediating role in the process of employees’ emotional contagion perception affecting employees’ psychology. Compared with younger employees, older employees have better psychological quality and mental health. There are also significant differences in emotion and work enthusiasm among employees with different educational backgrounds and positions. Employees’ perception of emotional contagion to pretending expressions, indifferent expressions, contempt expressions, and sincere expressions has an obvious positive impact on the psychological impact of other employees. The classification accuracy and regression error rate of the constructed multilearning emotion recognition network are 28.5% and 9.8%, respectively, which can accurately identify the emotional performance of employees. This work helps enterprises better understand the mental health of their employees.
... We were unable to assess any impact of the changes we observed on outcomes for women and babies, but in terms of interventions and outcomes, in England one study has reported evidence of increased rates of obstetric intervention, including induction and Caesarean section, but little evidence of impact on adverse outcomes ( Gurol-Urganci et al., 2022 ). The impact on maternity staff was also beyond the scope of the surveys reported here, but is important to consider ( Horsch et al., 2020 ). ...
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Background : The COVID-19 pandemic required all healthcare systems to adapt quickly. There is some evidence about the impact of the pandemic on United Kingdom maternity services overall, but little is known about the impact on midwifery-led services, including midwifery units and home birth services. Objective : To describe changes to midwifery-led service provision in the United Kingdom and the Channel Islands during the COVID-19 pandemic. Design : Three national surveys were circulated using the United Kingdom Midwifery Study System (UKMidSS) and the Royal College of Midwives (RCM) Heads and Directors of Midwifery Network. The UKMidSS surveys took place in wave 1 (April to June 2020) and in wave 2 (February to March 2021). The RCM survey was conducted in April 2020. Findings : The response rate to the UKMidSS surveys was 84% in wave 1 and 70% in wave 2, while 48% of Heads and Directors of Midwifery responded to the RCM survey. Around 60% of midwifery units reported being open as usual in wave 1, with the remainder affected by closures. Fewer unit closures (15%) were reported in the wave 2 survey. Around 40% of services reported some reduction in home birth services in wave 1, compared with 15% in wave 2. The apparent impact of the pandemic varied widely across the four nations of the United Kingdom and within the English regions. Conclusions : The pandemic led to increased centralisation of maternity care and the disruption of midwifery-led services, especially in the first wave. Further research should focus on the reasons behind closures, the regional variation and the impact on maternity care experience and outcomes.
... This study highlighted that 43% and 61% of mothers were experiencing clinically relevant depression and anxiety, respectively; alarmingly higher than pre-pandemic studies using the same measures [11]. These findings are likely attributable to the numerous extraordinary stressors that perinatal women faced during the pandemic -namely reduced social support, restricted birth options, and some maternity care being provided virtually [12][13][14][15]. Most COVID-19 research relating to maternal and parental mental health has focused on negative impacts [5,6,[8][9][10]. ...
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Most perinatal research relating to COVID‐19 focuses on its negative impact on maternal and parental mental health. Currently, there are limited data on how to optimise positive health during the pandemic. We aimed to bridge this knowledge gap by exploring how women have adapted to becoming a new parent during the pandemic and to identify elements of resilience and growth within their narratives. Mothers of infants under the age of 4 months were recruited as part of a wider UK mixed‐methods study. Semi‐structured interviews with 20 mothers elicited data about how COVID‐19 had influenced their transition to parent a new infant, and if and how they adapted during the pandemic, what strategies they used, and if and how these had been effective. Directed qualitative content analysis was undertaken, and pre‐existing theoretical frameworks of resilience and post‐traumatic growth (PTG) were used to analyse and interpret the data set. The findings show evidence of a range of resilience and PTG concepts experienced during the pandemic in this cohort. Salient resilience themes included personal (active coping, reflective functioning, and meaning‐making), relational (social support, partner relationships, and family relationships), and contextual (health and social connectedness) factors. There was also evidence of PTG in terms of the potential for new work‐related and leisure opportunities, and women developing wider and more meaningful connections with others. Although further research is needed, and with individuals from diverse socioeconomic backgrounds, these findings emphasise the significance of social support and connectivity as vital to positive mental health. Opportunities to increase digital innovations to connect and support new parents should be maximised to buffer the negative impacts of further social distancing and crisis situations.
... These findings are consistent with a global survey [25], and also align with a 2020 survey of maternity providers in Lagos which found 87.2% had experienced burnout since COVID-19 [26]. Evidence shows that providers have been vulnerable to significant mental stress during COVID-19 [39,40]. Psychological interventions could be used to reduce anxiety, cultivate resilience, and support mental wellbeing of health workers during highly stressful events such as pandemics [41]. ...
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Background The COVID-19 (coronavirus disease 2019) pandemic challenges provision and access to essential maternity care in low-resilience health systems. The aim of this study was to explore maternity healthcare workers’ experiences of, and perceptions about providing maternity care during the COVID-19 outbreak in Lagos State, Nigeria. Methods This qualitative study conducted individual, remote, semi-structured interviews with midwives and traditional birth attendants (TBAs). Eligible participants spoke English, and provided maternity care during COVID-19 in Lagos, Nigeria. Participants were recruited via purposive and snowball sampling, from primary health facilities in seven Local Government Areas of Lagos State. Interview transcripts were analysed thematically following the framework method. Results Sixteen midwives ( n = 11) and TBAs ( n = 5) were interviewed from March to April 2021. Two overarching themes were identified from the data. ‘Maternity care workers’ willingness and ability to work during the COVID-19 pandemic’ outlined negative influences (fear and uncertainty, risk of infection, burnout, transport difficulties), and positive influences (professional duty, faith, family and employer support). Suggestions to improve ability to work included adequate protective equipment, training, financial support, and workplace flexibility. ‘Perceived impact of COVID-19 on women’s access and uptake of maternity care’ highlighted reduced access and uptake of antenatal and immunisation services by women. Challenges included overstretched health services, movement and cost barriers, and community fear of health facilities. Participants reported delayed healthcare seeking and unattended home births. Midwives and TBAs identified a need for community outreach to raise awareness for women to safely access maternity services. Participants highlighted the responsibility of the government to improve staff welfare, and to implement public health campaigns. Conclusions Despite disruption to maternity care access and delivery due to COVID-19, midwives and TBAs in Lagos remained committed to their role in caring for women and babies. Nevertheless, participants highlighted issues of understaffing and mistrust in Lagos’ underfunded maternity care system. Our findings suggest that future resilience during outbreaks depends on equipping maternity care workers with adequate working conditions and training, to rebuild public trust and improve access to maternity care.
... It should be stressed at this point that perinatal care provided by midwives to women and their families is based on a unique relationship built on trust. Eye contact, touch, or tone of voice are very important elements of this care, and during the SARS-CoV-2 pandemic they have been greatly hampered, as highlighted by [2,14,15]. Moreover, in their paper on the provision of maternal health services in the pandemic, but also regardless of it, Renfrew et al. highlight that in order to develop high-quality solutions for COVID-19, one needs an active strategy based on scientific evidence and collaboration with healthcare workers, pregnant women, and their families [2]. ...
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Introduction: The outbreak of the SARS-CoV-2 pandemic necessitated rapid and unexpected changes in the health care system, including maternity care. Aim of the study: To evaluate changes in maternity care in Poland as perceived by midwives working in the SARS-CoV-2 pandemic. Material and methods: This cross-sectional study involved 100 midwives. This was a preliminary study conducted in April 2020. The data were obtained using an online questionnaire (CAWI method). The questionnaire link was distributed by the snowball sampling technique. Results: Risk assessment using a 10-point visual analogue scale demonstrated that the study participants had a moderately high overall level of perceived risk due to the pandemic. The highest level of concern was recorded in connection with the perceived burden at work caused by the pandemic (mean = 7.42, SD = 1.99). The smallest concern, although still quite high, was related to the fear of contracting the virus or developing COVID-19 (mean = 5.62, SD = 2.14). Conclusions: The study demonstrated that the need for support, conversation, and presence was the most frequent topic in requests made to midwives. The outbreak of the pandemic did not unequivocally affect interdisciplinary cooperation, cooperation with women, and the interest in maternity services provided outside the hospital. The research should be continued to obtain a larger sample size and analyse the trends developing in maternity services during the SARS-CoV-2 pandemic.
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Introduction Significant changes in routine maternity care have been introduced globally in response to the COVID-19 pandemic to reduce infection risk, but also due to lack of medical facilities, staff shortages and the unpredictable nature of the disease. However, it is yet to be established if specialised perinatal mental health (PMH) services have been similarly affected. As a Task Force in PMH and COVID-19 pandemic within Riseup-PPD COST Action, this study aims to identify changes in PMH practices, policies and protocols during the COVID-19 pandemic in Europe. Methods and analysis An online survey of experts in the PMH who are members of the COST Action ‘Riseup-PPD’ and the COST Action ‘’DEVOTION” across 36 European countries will be conducted. A questionnaire on changes in PMH care practices during the COVID-19 Pandemic will be administered. It consists of open-ended questions, checklists and ratings on a 7-point scale addressing seven domains of interest in terms of PMH: (1) policies, guidelines and protocols; (2) PMH care practices at a national level; (3) evidence of best practice; (4) barriers to usual care; (5) resources invested; (6) benefits of investment in the policies and (7) short-term and long-term expectations of the policies. Data will be collected using Qualtrics. Descriptive statistics will be reported and differences between countries will be examined using the χ ² statistic or Student’s t-test. Ethics and dissemination Ethical approval was obtained from The Ethics Committee for Research in Life and Health Sciences of the University of Minho (Portugal) to undertake an anonymous online survey. The findings will be disseminated to professional audience through peer-review publication and presentations and shared widely with stakeholders, policy-makers and service user groups. A position paper will be developed to influence policy-making at a European level to alleviate the adversities caused by COVID-19. Trial registration number NCT04779775 .
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The emotional toll of working in healthcare is widely recognised, but staff rarely have time to reflect on their experiences. Schwartz Rounds provide an opportunity for all staff in a healthcare organisation to meet regularly and reflect on the human connections made with patients and the emotional impact of their work. They are now running in over 200 organisations across the UK & Ireland. In the first evaluation of a national sample in the UK, we review feedback received from a large sample of 402 Schwartz Rounds in a total of 47 organisations, including acute and non-acute NHS trusts and hospices. Analyses were undertaken to explore self-reported experiences of the Rounds, and differences between the proportions of professional staff groups attending. The overall experience of Schwartz Rounds was very positive across all settings. In particular, staff reported that Rounds helped them to gain insight into the working lives of their colleagues. There were no differences between the responses of clinical and non-clinical staff, indicating that all staff value a reflective space regardless of background. Healthcare staff value an opportunity to reflect on the emotional impact of their work. In increasingly overstretched and hurried services, it is a priority to provide this.
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Background Many people confront potentially morally injurious experiences (PMIEs) in the course of their work which can violate deeply held moral values or beliefs, putting them at risk for psychological difficulties (e.g. post-traumatic stress disorder (PTSD), depression, etc.). Aims We aimed to assess the effect of moral injury on mental health outcomes. Method We conducted a systematic review and meta-analysis to assess the association between work-related PMIEs and mental health disorders. Studies were independently assessed for methodological quality and potential moderator variables, including participant age, gender and PMIE factors, were also examined. Results Thirteen studies were included, representing 6373 participants. PMIEs accounted for 9.4% of the variance in PTSD, 5.2% of the variance in depression and 2.0% of the variance in suicidality. PMIEs were associated with more symptoms of anxiety and behavioural problems (e.g. hostility), although this relationship was not consistently significant. Moderator analyses indicated that methodological factors (e.g. PMIE measurement tool), demographic characteristics and PMIE variables (e.g. military v. non-military context) did not affect the association between a PMIE and mental health outcomes. Conclusions Most studies examined occupational PMIEs in military samples and additional studies investigating the effect of PMIEs on civilians are needed. Given the limited number of high-quality studies available, only tentative conclusions about the association between exposure to PMIEs and mental health disorders can be made. Declaration of interest None.
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Objective: To examine the potential psychological impact of deploying in support of the U.S. response to Ebola in west Africa by systematic review and meta-analysis. Methods: Peer-reviewed articles published between January 2000 and December 2014 were identified using PubMed, PsycINFO, and Web of Science. Thirty-two studies involving 26,869 persons were included in the systematic review; 13 studies involving 7,785 persons were included in the meta-analysis. Pooled standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. Results: Reflecting the sociodemographics of the military, those who are younger, single, not living with family, have fewer years of work experience, lower education, and lower income are at increased risk for psychological distress, alcohol/drug misuse, post-traumatic stress disorder (PTSD), depression, and/or anxiety as a result of their perceived risk of infection. Effect sizes for post-traumatic stress disorder, depressive, and anxiety symptoms were considered small (SMD = 0.12, 95% CI = -0.23 to 0.47), moderate (SMD = 0.40, 95% CI = 0.24-0.51), and small (SMD = 0.08, 95% CI = -0.09 to 0.25), respectively; however, only the effect size for depressive symptoms was statistically significant. Conclusions: Deployed service members may return with clinically significant problems, the most notable of which is depression. Delivering resilience training and fostering altruistic acceptance may protect service members from developing mental health disorders.
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The present study tests a psychosocial model of factors predicting emotional exhaustion and state anger in 333 nurses who worked during the severe acute respiratory syndrome (SARS) outbreak. Predictors included working conditions, feedback, risk of contracting SARS, and perceived organiza- tional support. Results of path analysis revealed that working conditions contributed significantly to an increase in perceived SARS threat, which led to increased emotional exhaustion and state anger. Positive feedback was directly and positively related to organizational support. Higher levels of or- ganizational support predicted lower perceived SARS threat, emotional exhaustion, and state anger. Implications for health-care providers are discussed.
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Healthcare workers (HCWs) found the 2003 outbreak of severe acute respiratory syndrome (SARS) to be stressful, but the long-term impact is not known. From 13 to 26 months after the SARS outbreak, 769 HCWs at 9 Toronto hospitals that treated SARS patients and 4 Hamilton hospitals that did not treat SARS patients completed a survey of several adverse outcomes. Toronto HCWs reported significantly higher levels of burnout (p = 0.019), psychological distress (p<0.001), and posttraumatic stress (p<0.001). Toronto workers were more likely to have reduced patient contact and work hours and to report behavioral consequences of stress. Variance in adverse outcomes was explained by a protective effect of the perceived adequacy of training and support and by a provocative effect of maladaptive coping style and other individual factors. The results reinforce the value of effective staff support and training in preparation for future outbreaks.
DA - 20090626 IS - 1873-7714 (Electronic) IS - 0163-8343 (Linking) LA - eng PT - Comment PT - Editorial PT - Review SB - IM
Throughout history, warriors have been confronted with moral and ethical challenges and modern unconventional and guerilla wars amplify these challenges. Potentially morally injurious events, such as perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in the long-term, emotionally, psychologically, behaviorally, spiritually, and socially (what we label as moral injury). Although there has been some research on the consequences of unnecessary acts of violence in war zones, the lasting impact of morally injurious experience in war remains chiefly unaddressed. To stimulate a critical examination of moral injury, we review the available literature, define terms, and offer a working conceptual framework and a set of intervention strategies designed to repair moral injury.
The purpose of this investigation was to examine the relationship between psychosocial variables and working conditions, and nurses' coping methods and distress in response to the severe acute respiratory syndrome (SARS) crisis in Canada. PARTICIPANTS AND PROCEDURE: The sample consisted of 333 nurses (315 women, 18 men) who completed an Internet-mediated questionnaire that was posted on the Registered Nurses' Association of Ontario (RNAO) website between March and May 2004. The questionnaire was restricted to respondents who had to authenticate their RNAO membership with a valid username and password before accessing the questionnaire. This served a dual purpose: to ensure that only RNAO nurses completed the questionnaire and thereby safeguarding the generalizability of the findings; and second, to prevent any one nurse from contributing more than once to the overall sample. Correlational analysis yielded several significant relationships between psychosocial variables and working conditions, and the traditional correlates of burnout and stress. Three multiple regression analysis revealed that the model we evolved--including higher levels of vigor, organizational support, and trust in equipment/infection control initiative; and lower levels of contact with SARS patients, and time spent in quarantine--predicted to lower levels of avoidance behavior, emotional exhaustion, and state anger. By employing models of stress and burnout that combine psychosocial variables and working conditions, researchers can account for significant amounts of variance in outcomes related to burnout. These findings highlight the importance of vigor and perceived organizational support in predicting nurses' symptoms of burnout. For healthcare administrators, this means that a likely strategy for assuaging the negative outcomes of stress should address nurses' psychosocial concerns and the working conditions that they face during novel times of crisis.