Table 5.

GRADE-CerQUAL summary results

Finding	Contributing records	Methodological limitations	Coherence	Adequacy	Relevance	Overall confidence
Analytical theme 1: Altered Maternity Care (women)
Alterations to maternity care, overall, were unsettling for women, causing increased stress, anxiety, worry, uncertainty, or dissatisfaction	38, 40, 41, 46, 49, 50, 52, 54–56, 57	Minor concerns	No or very minor concerns	Minor concerns	Minor concerns	High
Uncertainty and inconsistencies surrounding maternity care were a considerable source of stress, anxiety, frustration, and dissatisfaction for women	2, 34, 37, 39, 42, 44, 49, 56, 79	Minor concerns	Minor concerns	Minor concerns	Minor concerns	High
Cancelled or postponed maternity care appointments were commonly experienced leaving women feeling confused, worried, fearful, and abandoned	2, 34, 35, 39, 43, 45–47, 49–52	Minor concerns	No or very minor concerns	Moderate concerns	Minor concerns	Moderate
Telehealth was noted to confer some benefits; overall, however, telehealth was problematic for women and was favoured less than in-person care	2, 33, 34, 39, 42, 45–48, 52, 54, 55, 74, 75, 79	Minor concerns	No or very minor concerns	Minor concerns	Minor concerns	High
Analytical theme 2: COVID related restrictions
Restrictions on partner attendance throughout the maternity care continuum evoked a wide array of emotions for women including intense feelings of being alone, isolated, and lonely	2, 38–39, 42–44, 46, 47, 49, 52, 55, 56, 58, 76	Minor concerns	No or very minor concerns	Moderate concerns	Minor concerns	Moderate
Isolation and separation from friends and the wider family affected women in various ways (disappointment, loneliness, fear, anxiety, overwhelmed), although the wider visiting restrictions in hospital beyond partner visiting, was a positive experience for some women	2, 34, 36–38, 40–44, 47, 49, 50, 51, 55, 56	Minor concerns	Minor concerns	Moderate concerns	Minor concerns	Moderate
Analytical theme 3: Infection prevention and risk
Fear of contracting COVID-19 was prominent for women, with many fearful, worried, and wary of visiting the maternity care facility for fear of contracting the virus	34–36, 39, 41, 43, 44, 47, 48, 50, 52, 55, 57, 75, 77	Minor concerns	No or very minor concerns	Moderate concerns	Minor concerns	Moderate
The interplay between balancing fear of contracting COVID-19 and the risk of not attending for care was a source of emotional conflict	39, 46, 77	No or very minor concerns	No or very minor concerns	Moderate concerns	Minor concerns	High
Women were complementary and appreciative of efforts in maternity care settings to minimise virus transmission and felt reassured by these	2, 34, 40, 44–46, 52, 58, 75	Minor concerns	No or very minor concerns	Moderate concerns	Minor concerns	Moderate
Analytical theme 4: “The lived reality” – navigating support systems
Information support was affected by a lack of consistent messaging, conflicting information or a lack of clear guidance surrounding the virus and how this affected women’s care, which left women feeling lost, confused, or helpless	37, 39, 42, 46, 49, 51, 53, 55, 56	Minor concerns	No or very minor concerns	Moderate concerns	Minor concerns	Moderate
Women viewed dedicated formal support from maternity care professionals as essential for their psychosocial wellbeing; however, these supports were largely diminished or lacking	2, 34, 36, 37, 41, 42, 44, 45, 49, 51, 55, 56, 74	Minor concerns	No or very minor concerns	No or very minor concerns	Minor concerns	High
In navigating information support, many women resorted to alternative sources, mainly social media, television, and online sources, as well as friends, although women recognised that these alternative sources could be unreliable which caused stress and fear	34, 38–40, 44, 47, 50, 52, 53, 55, 56	Minor concerns	No or very minor concerns	Minor concerns	No or very minor concerns	High
Women self-implemented solutions as a means of coping, including adjusting their plans, exploring other options for care or self-advocating to achieve the maternity care they desired or needed	2, 37, 39, 47, 56	Minor concerns	Minor concerns	Moderate concerns	No or very minor concerns	Moderate
Analytical theme 5: Interactions with maternity services
Women recounted being unable to contact or experienced fewer interactions with their care providers which led women, in general, to view their care as inadequate, sub-par, disrespectful or of poorer quality	2, 36, 37, 39, 41, 43–47, 49, 52, 53, 74, 75	Minor concerns	No or very minor concerns	Moderate concerns	Minor concerns	Moderate
Some women who were positive for COVID-19 experienced what they perceived as nonprofessional and inappropriate interactions	39, 44, 46, 47, 52, 55, 56, 77	Minor concerns	No or very minor concerns	Minor concerns	Minor concerns	High
Women experienced unmet expectations arising from interactions with their maternity care providers source which affected their ability to prepare properly for the arrival of their new baby	39, 40–42, 44, 56	Minor concerns	No or very minor concerns	Moderate concerns	Minor concerns	Moderate
Analytical theme 6: Altered Maternity Care (maternity care providers)
A feeling of uncertainty was dominant across providers, largely influenced by the uncertainty surrounding care protocols and the speed at which these changed, although this uncertainty lessened over time as national guidelines became available and communication of care protocols improved	17, 60–63, 65, 66, 68, 70, 72–74	Minor concerns	No or very minor concerns	No or very minor concerns	No or very minor concerns	High
The pandemic was considered to have exacerbated existing inequalities in maternity care	61, 64,67–69, 71, 72, 74	Minor concerns	No or very minor concerns	No or very minor concerns	Minor concerns	High
The lack of access to adequate resources and training on safe practices resulted in providers limiting their interactions with women as they feared being infected and/or acting as a vector of infection	17, 63, 65, 66, 70, 74, 77	Minor concerns	No or very minor concerns	Minor concerns	No or very minor concerns	High
A move to telehealth was viewed positively by some as it enabled continuation of care in a safe environment, although it was not without its limitations	64, 67–69, 71	Minor concerns	Minor concerns	Moderate concerns	Minor concerns	Moderate
Analytical theme 7: Professional and Personal Impact
The pandemic had resulted in an increased workload for maternity care providers, due to staff shortages, additional tasks, and more frequent and longer appointments	17, 59, 62, 64–66, 68, 69, 73	Minor concerns	Moderate concerns	Minor concerns	Minor concerns	Moderate
Relationships with colleagues improved as maternity care providers supported each other through the uncertainty, although the pandemic also deepened divisions due to perceived staff hierarchies and disconnect between management and providers involved in direct care	15, 59–63, 65, 66, 69, 70, 72, 74, 76, 77	Moderate concerns	Minor concerns	Minor concerns	No or very minor concerns	Moderate
Maternity care providers isolated themselves or restricted their interactions with family due to a fear of transmitting the virus to others, which carried a significant emotional burden	17, 59, 61, 65, 66, 68, 69, 73, 77, 78	Minor concerns	No or very minor concerns	Minor concerns	Minor concerns	High
The pandemic had a negative financial impact for some providers due to reduced service demand and inadequate reimbursement for alternative services, such as telehealth	64, 68, 73	No or very minor concerns	No or very minor concerns	Moderate concerns	Moderate concerns	Moderate
Analytical theme 8: Broader structural impact
Restrictions were considered by some to have a negative impact on future health outcomes for parents and babies, while others worried that certain restrictions would be retained, and these would negatively influence future maternity care	59, 69, 72, 76	Moderate concerns	No or very minor concerns	Minor concerns	No or very minor concerns	High
The pandemic was viewed as an opportunity to improve maternity care, including addressing inequalities, and implementing changes that supported parents and their babies	15, 59, 61, 69, 73, 76, 78	Moderate concerns	No or very minor concerns	No or very minor concerns	Minor concerns	High
The pandemic prompted some maternity care providers to take a different perspective of their role and considered it an opportunity for professional growth	59, 61, 66, 68, 69, 76	Minor concerns	No or very minor concerns	Minor concerns	Minor concerns	High