Understanding the impact of covid-19 on pregnant women and new parents: The Born in Bradford 2020 Families Study

Lead Research Organisation: Bradford Teaching Hosp NHS Found Trust
Department Name: Bradford Institute for Health Research

Abstract

The COVID19 pandemic has dramatically changed how health care is delivered. Pregnant women have been identified as a vulnerable group to COVID19 and as a consequence, women have received much of their essential health care over the phone, and partners have not been able to attend maternity appointments including baby scans. After birth the usual social support offered by friends and family has been restricted due to social distancing. For women and their partners who are having a baby during this time there is concern that this could have an impact on their physical and mental wellbeing and the health and development of their babies.
The recovery from the COVID19 pandemic needs research information on the health, social and economic impacts on vulnerable populations to be made available quickly to key policy and decision makers so that they can develop and implement policies and interventions to reduce potential longer term impacts of the COVID19 pandemic.

The Born in Bradford (BiB) research programme (www.borninbradford.nhs.uk) is in a unique position to be able to provide such information on a key vulnerable population: pregnant women living in a highly deprived and ethnically diverse city. BiB have two ongoing birth cohort studies: Born in Bradford's Better Start (BiBBS) focussed on women living in ethnically diverse and deprived communities and BiB4All - a routine data linkage birth cohort study aiming to recruit all pregnant women booked to give birth at Bradford Teaching Hospitals NHS Foundation Trust. Participants give permission for follow-up via routine data from multiple agencies (e.g. GPs, maternity, health visiting, social care) and agree to be contacted for additional research projects with bespoke data collection.

The aim of our study is to understand the experiences of being pregnant, giving birth and caring for a baby during the COVID19 pandemic. We will adapt the data collection within our birth cohorts to collect additional quantitative survey data and qualitative interview data at 4 time points during pregnancy and during the first year after birth. This will allow us to:

a) understand how COVID19 has affected pregnant women (e.g., being identified as high risk by government, having changes to care or birth plans), and the short- and long-term impact these changes have had, for example on their expectations and experiences of care, their mental wellbeing, worries and concerns, birth outcomes;
(b) understand how the crisis is affecting wider aspects of pregnancy and the transition to
parenthood, for example peer-to-peer social support, support for breastfeeding and
parenting, family relationships and livelihoods;
(c) explore how these changes affect the partners of pregnant women during pregnancy
and in the postnatal period;
(d) inform practitioners, service providers and policy makers where intervention is needed
to reduce the adverse effects of the health and well being of women and their babies in the
short term and as part of recovery.

We will combine the findings of our surveys and qualitative work and use expert groups of key stakeholders and local parents to co-produce recommendations for practice. This research will significantly contribute to understanding the impact of COVID19 on
pregnant women and their partner's current and future health and the health and development of their children. It will also inform interventions to reduce the impacts of the pandemic. Bradford, like many other large UK cities, has high levels of deprivation and ethnic diversity, the findings from our study will therefore be scientifically valid and relevant to services and policy makers nationally. Our research team have connections to many other COVID19 research teams nationally and internationally as well as direct links into key national health organisations and policy makers. We will use these connections to ensure wide dissemination of our findings and ensure they are integrated in policy.

Technical Summary

We will produce robust evidence on the significant impact of the pandemic, and response
to it, on the health of pregnant women and their babies. This will inform immediate practice
and policy for the recovery period.
We will conduct a mixed methods study of pregnant women, postpartum mothers and
fathers. The core will be a quantitative telephone/online longitudinal survey of around 1800
pregnant women at four times points during pregnancy and postpartum. They will be
recruited from two large population-based studies with ongoing recruitment, supported by
the Born in Bradford infrastructure in Bradford. Data during pregnancy will be collected on
a range of demographic and socioeconomic factors as well as food, housing and income
security, self-reported physical and mental health and wellbeing, COVID-19 related
behaviours, access to maternity services, family relationships and social support, and
concerns related to COVID19 as well as infant feeding plans. Parallel diary and
exploratory qualitative studies will provide deeper understanding. Cortisol levels in hair
samples taken in the days after birth will be compared with historical control samples.
Rapid-cycle analysis of our survey and hair sample data linked with routine primary care,
maternity, health visiting social care and education data will provide timely information on
areas where action is needed. Longer-term follow up will be of major scientific and policy
significance.
Expert groups convened with the support from professional bodies and relevant agencies
will distill our findings and produce timely recommendations for practice, service
improvement and policy for immediate and also longer term implementation.
 
Description At the start of the pandemic, the NHS categorised pregnant women as high risk and implemented measures to keep women safe. The aim of this study was to identify the impact of these Covid-19 restrictions on the experiences of women in the perinatal period to inform practice and policy. We completed qualitative interviews at three time points during pregnancy and postnatally (~6 and 12 months) with women and their partners from a range of socio-economic and ethnic backgrounds in Bradford.
The findings from the qualitative work have now been achieved, the quantitative surveys are currently under analysis.
Key findings included:
Women expressed fear of being alone at critical points in their routine care (e.g. scans, labour and after birth).
Several women reported feeling a deterioration in their mental health during the pandemic.
Although women received their mandated visits from Health Visitors, they felt this support after birth was not enough.
The replacement of face-to-face visit with telephone phone calls negatively impacted on women's experiences, feeling they were less intimate, shorter and difficult to participate in.
There was inconsistent and insufficient information given about the risk of COVID-19 to them and their baby and resulted in women seeking info from elsewhere. This could increase the risk of misinformation informing women's decisions.
Exploitation Route A number of policy implications have been identified from this work:
There is a need for a balance between preventative measures and the mental wellbeing of women. Having a partner at scans, during labour and birth, and on the postnatal wards is very important to women.
Face to face appointments, not phone calls are very important to women. There is a risk that phone calls result in a lack of needed support and a failure to identify and address issues of concern.
Create a single source of consistent, accurate, up to date and understandable information on Covid-19 risks for midwives, health visitors and women. This is essential to avoid confusion and misinformation
Create a resource women can use to find information on managing after birth, and where to seek additional help for breastfeeding, perinatal mental health, parenting. This is essential whilst there are less face-to-face visits
Actively encourage services to creatively adapt as they did in the pandemic to allow for optimum results for each service
Sectors Healthcare

URL https://www.bradfordresearch.nhs.uk/family-and-community-impacts-of-covid-19/
 
Description Local dissemination to CCG/ICS
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Gave evidence to a government review
 
Description Pivotal
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
 
Description local dissemination midwives and hvs
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Contribution to new or Improved professional practice
Impact The impact was increased knowledge and awareness of the work and findings and influence on midwives practice.
 
Description COVID-19: Families, children aged 0-4 and pregnant women: vulnerabilities, resources and recovery in Tower Hamlets
Amount £322,568 (GBP)
Funding ID ES/V004891/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 05/2020 
End 12/2021
 
Description The Born in Bradford COVID-19 Research Study: An adaptive mixed methods longitudinal study of the impact of COVID-19 on health inequalities in families living in Bradford
Amount £198,680 (GBP)
Funding ID 2301201 
Organisation Health Foundation 
Sector Charity/Non Profit
Country United Kingdom
Start 02/2021 
End 03/2022
 
Description COVID-19: Families, children aged 0-4 and pregnant women: vulnerabilities, resources and recovery in Tower Hamlets (£ 322568; 2020 - 2021) 
Organisation University College London
Country United Kingdom 
Sector Academic/University 
PI Contribution Co-Investigator on complementary UKRI grant at UCL: Economic and Social Research Council: ES/V004891/1 -
Collaborator Contribution Mutual sharing and development of surveys, data, findings and interpretation of results
Impact n/a
Start Year 2020
 
Description Parent-Infant Covid organizational academic learning collaborative 
Organisation University of Central Lancashire
Country United Kingdom 
Sector Academic/University 
PI Contribution Born in Bradford have been part of this group since it was set up during the height of COVID. We have disseminated our findings to this collaborative. We have helped fund a meeting for us to work in person to help bring together our findings as a group. We are also helping to organise a policy meeting in April by being on the organising committee and as one of it's funders. We are helping to contribute to knowledge across the perinatal period and in turn, helping to produce outputs.
Collaborator Contribution Soo Downe, the lead of this group, set up the group and chairs most of the meetings. Everyone in this group contributes by sharing ideas and helping to plan and organise events to help facilitate change. Some members of the group are also on the organising committee and will help to synthesize, develop and share our findings to policy makers and key organisations.
Impact Group dissemination event chaired online by Jane Sandall. Purpose was to share the early insights from new research on maternity services to inform service COVID-19 recovery. Useful meeting to get our findings out there to key members ahead of the policy meeting in April.
Start Year 2020
 
Description 0-19 research network in Yorkshire and Humber presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Presented the summary findings and circulated links to the published qual reports. The impact was increased knowledge and awareness of the work and findings.
Year(s) Of Engagement Activity 2021
 
Description 3 workshops for the BaBi network, in Bradford, Wakefield and Doncaster 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Presented the summary findings and circulated links to the published qual reports at the workshops. There were more than 140 delegates across the three workshops, representing midwives, health visitors, public health leads, service commissioners, voluntary sector organisations and members of the public. The impact was increased knowledge and awareness of the work and findings and influence on the identification of local research priorities.
Year(s) Of Engagement Activity 2021
 
Description Born in Bradford Radio Broadcast to let people know about what Covid-19 research BIB is currently undertaking 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact To notify members of the public, other organizations and study participants what BIB are up to and our plans to research the impact of the pandemic on families across Bradford.
Year(s) Of Engagement Activity 2020
 
Description Community Soft Intelligence 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Dialogue with local communities and key stakeholders to develop priority research quesitons for this study
Year(s) Of Engagement Activity 2020
 
Description Community research advisory group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact We are aware of Covid research fatigue and used the workshop to discuss how to ensure good retention of our participants
Year(s) Of Engagement Activity 2021
 
Description Covid-19 impact communications 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact The URKI picked our project to feature in the UKRI communications about the impact of their research and innovation funding. They issued 12 regional emails to MPs, marking the 2nd anniversary of the first UK lockdown. Our summary was based on the practical steps Yorkshire took to support pregnant women during the pandemic. For example, that we found that the changes to the city' midwifery care, including pre, postnatal and breastfeeding support to improve birth outcomes and mental health.
Year(s) Of Engagement Activity 2022
 
Description Engagement of study participants via social media 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Social media post announcing some of our findings to our BiB participants
Year(s) Of Engagement Activity 2021
 
Description Engagement of study participants via social media 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Social media post on Facebook announcing we have over 500 women in our Covid pregnancy and new parent study.
Year(s) Of Engagement Activity 2020
 
Description Poster Presentation on recruitment strategies used for the postpartum 9-14 month wave 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Submitted a poster presentation for the CLOSER conference to discuss novel ways of recruitment and ways in which to retain a sample. I spoke about the use of token's of appreciation for retaining participants and the current results for whether it's best to donate on behalf of your participant or provide them with a £5 voucher, unconditional to them participating in the study.
Year(s) Of Engagement Activity 2022
 
Description Radio interview about Covid studies 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Radio interview on BBC radio Leeds about our Covid studies to spread information of what we are up to and what different studies are running at BiB at the moment, including the pregnancy and new mums study.
Year(s) Of Engagement Activity 2020