Women's experiences of maternity care in high-income countries during the pandemic health system shock: a follow-up systematic review and qualitative evidence synthesis

Introduction: COVID-19 disrupted healthcare systems globally, particularly challenging maternity services which continued to be operated as an essential service. Reconfigurations were implemented to continue providing care in a safe manner and in line with infection control restrictions. This systematic review of women's experiences of maternity care during the COVID-19 pandemic in high-income countries (HICs), aimed to synthesize published literature and inform future responses to global disasters. Material and methods: Electronic database of Scopus, MEDLINE, EMBASE, CINAHL PsychINFO, and the Cochrane COVID Study Register, were searched from June 2021- June 2024 to identify eligible records. Thematic synthesis was used to synthesise the data. Results: 79 studies were included with data from over 20,000 perinatal women, most were of moderate to high methodological quality. Data synthesis showed 11 themes across five main concepts related to maternity service reconfigurations, namely: (1) Care-seeking and care experience, (2) Virtual care, (3) Self-monitoring, (4) Vaccination, and (5) Ethical future of maternity care. Conclusions: Women predominantly viewed changes to maternity care negatively. Future strategies to ensure safeguarding of mothers and infants during crises should include enhancing service accessibility, emphasizing women-centered care, and prioritizing support systems for mothers and infants. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42022355948, identifier: CRD42022355948.