“There’s only so much you can be pushed”: a commentary on the magnification of the maternity staffing crisis by the 2020/21 COVID-19 pandemic

Sarah Cordey RM, School of Community Health and Midwifery, THRIVE Centre, University of Central Lancashire, Preston, UK Gill Moncrieff RM, Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, UK Joanne Cull RM, School of Community Health and Midwifery, THRIVE Centre, University of Central Lancashire, Preston, UK Arni Sarian, School of Medicine, University of Central Lancashire, Preston, UK Deborah Powney, MSc, Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, UK Dr Carol Kingdon, PhD, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK Dr Claire Feeley, PhD, Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, UK Professor Soo Downe PhD, Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, UK On behalf of the ASPIRE Covid-19 Team (see Appendix A1) Corresponding Author: Sarah CordeyOver the past two decades there has been a developing staffing crisis in British maternity services (1). A 2021 Health and Social Care Committee Expert Panel report described “persistent gaps in all maternity professions” and proposed that “current recruitment initiatives do not consider the serious problem of attrition in a demoralised and overstretched workforce and do not adequately value professional experience and wellbeing” (2). Reduced staff capacity and excessive workload can have a profoundly detrimental impact on safety for women and babies (3,4). The ongoing impact of the COVID-19 pandemic on the National Health Service (NHS) has led to discussion around the long-term effects on staff from acute staffing shortages, the moral distress of being unable to provide the desired level of care, and the heavy emotional labour of being a front-line healthcare worker during a pandemic. (5)This commentary explores the impact of these factors on maternity staff during the COVID-19 pandemic and reflects on the implications for the future of maternity services design and delivery. The discussion relates to a thematic analysis (6) and NVivo word frequency analysis of in-depth interviews with 28 maternity staff (20 midwives, seven medical staff and one student midwife), 28 heads of service, and 26 women who gave birth during the pandemic, from seven NHS trusts across England. The interviews took place between November 2020 and October 2021 and were collected as part of the Achieving Safe and Personalised maternity care In Response to Epidemics (ASPIRE COVID-19) study. The overall aim of ASPIRE COVID-19 is to determine what worked to provide safe and personalised care maternity during the pandemic, both to optimise care under usual circumstances, and to improve the response to future crises. The analysis resulted in one overarching theme, and three sub-themes, as illustrated in Figure 1. Supporting quotes are shown in Figure 2 and Table S1.