Nearly half of women who gave birth during New Zealand's lockdown last year left hospital sooner than they wanted - primarily due to a lack of support on the postnatal ward that left a number of mums feeling "alienated" and "depressed".
A new report by the Waitematā District Health Board (DHB), which runs both Waitākere and North Shore Hospital, has summarised the experiences of women who gave birth at a major DHB during alert level 3 and alert level 4 restrictions.
Of the women surveyed, 46 percent said they left hospital sooner than they wanted. More than half said they left early to get the necessary support at home, while 9 percent cut their hospital stay short due to fear of COVID-19.
A lack of support on the postnatal ward has been identified as a key factor in early discharge decisions, with 53 percent of women reporting that visitor restrictions negatively impacted the quality of their stay. Fifty-three percent of women surveyed said their stay would have been more enjoyable if support people were permitted at the time.
"I had planned a C-section and everything was well organised and supported, but afterwards I had no family support," one of the women said in her survey.
"I felt alienated. Depressed and stressed. I cried the whole night. Alone in the ward. Felt like I was a prisoner. No support at all. This whole experience of giving birth was traumatic."
"So, so disappointed with our experience and as a result, [I am] seeking [psychological] help to manage the trauma of it," said another.
"My husband missed out this critical experience, also meaning his mental health was not the best as a result."
The report also attributed an increased rate of readmission to early discharge, with 7 percent of mothers and/or babies readmitted to hospital with complications.
Most of the mothers believed this could have been avoided, the report said.
"Both of us were readmitted. Me due to pain from the C-section and baby due to being 8 percent below her birth weight at two-weeks-old. If we both had received checks like we would normally have or support with feeding, I firmly believe [that] baby wouldn't have had any issues with weight gain," one woman said.
The report concluded that a lack of support on the postnatal ward was "a key factor" in early discharge decisions.
"There was clear evidence that some women found the restrictions incredibly difficult, and this resulted in heartbreaking comments about feeling abandoned, alone and devastated," the report said.
"The lack of support people on the postnatal ward was a key factor in early discharge decisions made by women, which also resulted in an increased readmission rate.
"Any future restrictions on support people should be considered in light of the harms this causes for postnatal recovery and maternal mental health."
DHB leaders intend to write to the Minister of Health, Andrew Little, to request a wide-ranging review into how the COVID-19 outbreak disrupted varying health services - in the hopes the evaluation will identify lessons learnt by the health sector in the event of a future pandemic.
As New Zealand began to record more and more cases of COVID-19 last year, the Government swiftly implemented an alert level framework in response to the worsening outbreak. Alert level 4 was enacted on March 26, 2020 in a bid to stamp out transmission of the virus in the community. The restrictions, which required Kiwis to remain in their homes aside from essential reasons, also saved hospital's from becoming overwhelmed with cases, as seen widely across Europe and America.
However, the lockdown also imposed stringent restrictions on visitation to prevent transmission within hospitals and to protect vulnerable patients. The measure was implemented under national guidelines during the first lockdown, and was revisited in the second lockdown in August.
Of the roughly 890 women who gave birth during this period, 190 surveys were returned, giving a response rate of 21 percent.
Overall, the majority of women were satisfied with the care they received during this period, the report found, with 67 percent saying they felt supported during and after birth.
A number of women praised DHB staff for their "kindness" and "support", with one new mum noting that staff often had a positive attitude despite the challenges.
In a recent meeting, the Waitematā DHB's hospital advisory committee noted the "mixed feedback" centred primarily on mums being denied a support person during delivery.
In a statement to NZME, Little confirmed that health services and its workforce "are under considerable stress" and our system is "complex and fragmented".
Little said the Government had committed to the "broad direction of travel" outlined by the Health and Disability System Review - a two-year review released last June that made a number of recommendations, including cutting the number of DHBs.
"We do want to take what the system has learned from COVID-19 to inform the changes. However, I would have to receive the DHB's letter and ensure it is properly considered before forming a view about the best way to do this."
A spokesperson for Waitematā DHB told Newshub there were concerns regarding the possible impact of lockdown restrictions on birthing mothers, despite the measures being necessary under the pandemic response.
"The survey was undertaken to gain a better understanding of the impact on women's experiences of giving birth under those circumstances, and to look for solutions that take into consideration the needs of the mother should hospital visiting need to be severely restricted again," the spokesperson said on Monday morning.
"Our staff continued to deliver the highest possible standard of care throughout the various alert levels when visiting restrictions were in place - providing bed-side pastoral support wherever possible and encouraging women to use options such as Zoom to connect with their support people.
"Post-natal support was also provided in all cases - including those where women chose to discharge themselves earlier in order to return home to their families."