7.1 Progress to Date
To date (May 2024), we have completed all in-depth interviews. The data collected have been transcribed, cleaned, and checked for accuracy, and uploaded to the relevant software (NVivo or Microsoft Word) for analysis. Data were first broadly coded into the five core RESILIENT Study concepts, before undertaking more granular coding according to the relevant methodology. Additional analyses have been proposed where results have rendered findings unexpected. Relevant members of the PPIE-AG and the TAG have been approached to participate as authors on each manuscript, ensuring both accountability and representation of expert voices outside The RESILIENT Study research team.
7.2 Strengths & Limitations
The RESILIENT Study as a whole and the qualitative arm of the study have many strengths. To date it is the only nationally-funded study to undertake work on post-pandemic maternity care and represent of all four UK nations. The diversity and breadth of participants recruited for in-depth interviews was achieved using a maximum variation sampling frame; this ensures a more representative set of findings can be derived, and deviates from the usual demographic often recruited to maternity care studies (e.g. White, middle-class, well-educated women; see Lovell et al., 2023; Silverio, Varman, et al., 2023). Furthermore, the range of expertise and experience on the team has ensured we could design and carry out a high-quality study, with rigorous findings, which can feed directly into policy and practice.
7.3 Interpretation in light of current literature
Since the initiation of The RESILIENT Study, as the pandemic has continued, evidence has mounted that despite best intentions, reconfiguration of maternity services has been detrimental to the maternity experience (Coxon et al., 2020; Dasgupta et al., 2024; Flaherty et al., 2022). Negative consequences have included: reduced access to maternity care services (Greenfield, Payne-Gifford, & McKenzie, 2021; Jackson et al., 2022; 2024; Silverio et al., 2024); separation of women from chosen birthing partners (Keely, Greenfield, & Darwin, 2023; Thomson et al., 2022); precarity amongst healthcare staff working in maternity services (De Backer et al., 2022); care perceived as unsafe or sub-optimal (Neal et al., 2023) by women (George-Carey et al., 2024; Montgomery et al., 2023) and staff (Silverio et al., 2023); and increasingly prevalent perinatal mental health problems (Dickerson et al., 2022; Fallon et al., 2021), marring pregnancy and the puerperium by poor psychological health and support (Jackson et al., 2021; 2023; Peterson et al., 2024; Riley et al., 2021; Sanders & Blaylock, 2021). Importantly, these issues have highlighted specific problems and concerns facing these minoritised groups, including minority ethnic women (Pilav et al., 2022) and sexual minorities (Greenfield & Darwin, 2024; Mamrath et al., 2024), as well as non-White healthcare professionals (Silverio et al., 2022). Evidence has been synthesised and new collaborative networks formed (e.g., The PIVOT-AL National Collaborative for Maternal and Child Health Research during the Pandemic (The PIVOT-AL National Collaborative, 2023). Recommendations have been made for: positive change to maternity care broadly (Flaherty et al., 2022; Dasgupta et al., 2024), particularly for women living with social complexity and disadvantage, health inequities, and ethnic diversity (Fernandez Turienzo et al., 2021); as well as innovation in care provision (Hinton et al., 2022) and improvement in surveillance (Mashayekh et al., 2023; Silverio et al., 2021) as well as access and provision (Jackson, Greenfield, et al., 2024). To perinatal mental healthcare.
7.4 Conclusion
Our findings about the experiences of care receipt, provision, and planning during the pandemic will complement existing literature. Manuscripts will be submitted for publication to relevant journals across medicine, public health, and the social sciences relating to health and healthcare services. We will disseminate our results through established networks of local, regional, and national stakeholders, to feed directly into national policy and practice for maternity care services across the UK. Our strategy includes engagement events across the four nations, virtual engagement via webinars and social media, and publication of a bespoke plain-language and scientific website and report. Our impact will be broad, on: individual patients (to improve care quality, effectiveness, safety and experience), NHS maternity providers (to strengthen evidence to inform service reconfiguration and support vaccination); NHS Long Term Plan (to address maternal and fetal/newborn death and morbidity and support implementation of digitally-enabled care); and wider society (through innovation to commercialise and decrease direct and indirect societal costs).