| 1. Safety (physical and psychological) |
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Support women’s rights to bodily integrity.
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Devise ways to introduce oneself that overcome the barrier that personal protective equipment (PPE) presents (such as attaching a personal photo or writing your name on your protective hospital gown).
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Explain what will be done to keep women as safe as possible from the virus during care.
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Change prenatal visits to telehealth visits as possible to minimize women’s exposure to the virus (Fryer et al., 2020).
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Inform childbearing women about hospital policies relating to the presence of support people during labor and delivery; reassure them that at least one support person will be allowed to be present.
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Ensure adequate supplies of PPE and education about how to use PPE appropriately to help clinicians feel safe (Shanafelt et al., 2020).
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Consider minimizing assignments of those at higher risk of contracting COVID-19 (Black, Asian, or those with other ethnic or minority backgrounds) with women who are known to be positive for COVID-19 (Nguyen et al., 2020).
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| 2. Trustworthiness |
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Communicate transparently about what changes to care practices can be expected due to the pandemic, including practices around care of the childbearing woman and her newborn in the event that she is positive for COVID-19.
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Acknowledge women’s personal histories, especially around events that might cause heightened anxiety in the hospital or birth setting.
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Encourage families to make plans early to get their support systems in place for when they bring their newborns home.
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Refrain from pressuring women who have given birth to be discharged early; provide follow-up resources for care during the postpartum period, including for breastfeeding.
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Address clinicians’ specific anxieties and fears about their vulnerability and loss of control (Shanafelt et al., 2020).
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Provide frequent, timely, transparent, and bidirectional communications with clinicians when policies, procedures, and recommendations change in response to local and national data (Wang et al., 2020).
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| 3. Collaboration |
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Mutually create plans with women who have heightened anxiety to lessen their concerns.
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Involve women as partners in decision making about their own care, giving them choices when possible (as the pandemic has taken away some choices).
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Offer telehealth resources including medically reliable apps and/or Web sites that women can use to enhance their understanding of their pregnancy.
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Collaborate with clinicians when making decisions about policies and procedures, ensuring that their voices and expertise are included and respected.
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Increase the availability of support staff such as social workers and encourage their collaboration with perinatal clinicians to help nurses and midwives cope with challenging women and situations (Chen et al., 2020).
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| 4. Peer support |
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Offer opportunities to women with high-risk pregnancies and to those whose infants are anticipated to need admission to a neonatal intensive care unit to connect with peer mentors.
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Be proactive about providing outreach and peer support to people of color and others from disadvantaged communities because they may not readily ask for help.
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| 5. Empowerment |
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Provide respectful care to all women.
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Affirm with women that they can make good decisions; offer meaningful opportunities to make decisions to give women a sense of control that may otherwise be lacking during the pandemic.
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Empower women to use mental health services during pregnancy and the postpartum period, including telemental health, if they are ready to do so.
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Strive to destigmatize women’s use of mental health supports by normalizing that pregnancy and parenting during COVID-19 are particularly challenging experiences.
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Maintain awareness of and offer support to clinicians who are at increased risk for social problems as outlined in Table 2 or who are experiencing trauma or grief; empower them to access mental health and psychosocial support services, including a psychological assistance hotline and employee assistance programs.
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Hold debriefing sessions (including virtually), which may help clinicians resolve their emotions after difficult clinical situations have occurred and/or after co-workers or their family members have been affected by COVID-19 (Foreman, 2014).
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Institute Schwartz Rounds to provide a regular, structured time and safe place for clinicians to meet to share the emotional, psychological and social challenges of working in health care (Leamy et al., 2019).
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Empower clinicians by engaging them in online education programs on psychological skill development (Chen et al., 2020).
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| 6. Cultural sensitivity |
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Provide culturally effective care to all.
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Examine how one’s biases, both explicit and implicit, may affect care; endeavor to eliminate biases.
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Provide full support to clinicians who are stigmatized due to their race or ethnicity (Shanafelt et al., 2020).
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Understand the disproportionate effect of the pandemic on families of color and give clinicians of color permission to take care of themselves and their families as needed.
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