Postpartum during a pandemic: Challenges of low-income individuals with healthcare interactions during COVID-19

Changes to the healthcare system due to COVID-19 have altered care delivery during birth and the postpartum period, a transitional time that requires intensive healthcare support and that is complicated by well-established health disparities. Our objective was to identify additional challenges to he...

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Bibliographic Details
Published in:PloS one 2022-05, Vol.17 (5), p.e0268698-e0268698
Main Authors: Gomez-Roas, Maria V, Davis, Ka'Derricka M, Leziak, Karolina, Jackson, Jenise, Williams, Brittney R, Feinglass, Joe M, Grobman, William A, Yee, Lynn M
Format: Article
Language:English
Subjects:
Ambulatory care
Birth
Child
Childbirth & labor
Consent
Coronaviruses
COVID-19
COVID-19 - epidemiology
COVID-19 diagnostic tests
COVID-19 Testing
Decision making
Delivery of Health Care
Female
Health aspects
Health care
Health care delivery
Humans
Income
Infant, Newborn
Interviews
Low income groups
Medicine and Health Sciences
Obstetrics
Pandemics
Participation
Patient satisfaction
Pediatrics
People and Places
Postpartum
Postpartum Period
Pregnancy
Pregnant women
Prenatal care
Psychological aspects
Puerperium
SARS-CoV-2
Telemedicine
United States
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Summary:Changes to the healthcare system due to COVID-19 have altered care delivery during birth and the postpartum period, a transitional time that requires intensive healthcare support and that is complicated by well-established health disparities. Our objective was to identify additional challenges to healthcare interactions that emerged for low-income postpartum individuals during the pandemic. This is a qualitative investigation of low-income postpartum individuals enrolled in a trial of postpartum care, who gave birth in the United States in the first three months of the COVID-19 pandemic. Participants completed in-depth semi-structured interviews that addressed healthcare experiences during and after birth, both for in-person and telemedicine encounters. Transcripts were analyzed using the constant comparative method. Of 46 eligible individuals, 87% (N = 40) completed an interview, with 50% identifying as non-Hispanic Black and 38% as Hispanic. Challenges were organized into three domains: unanticipated changes in the birth experience, delayed care, and perceived disadvantages of telemedicine. Changes in the birth experience addressed uncertainty about COVID-19 status, COVID-19 testing, separation from newborn, and visitor restrictions. Delayed care themes addressed logistical challenges, postpartum care, health maintenance, and pediatric care. Participants reported multiple telemedicine-related challenges, including difficulty establishing rapport with providers. Understanding the challenges experienced by low-income peripartum individuals as the COVID-19 pandemic evolves is critical to informing guidelines and diminishing inequities in healthcare delivery. Potential solutions that may mitigate limitations to care in the pandemic include emphasizing shared decision-making in care processes and developing communication strategies to improve telemedicine rapport.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0268698