Authors' objectives: During the COVID-19 pandemic, significant reconfigurations were made to maternity care, to deliver this essential service while minimising the risk of infection for pregnant/post partum women and their infants, initially considered to be more vulnerable.

Authors' results and conclusions: Work package 1 Among women of reproductive age (8 December 2020–15 February 2021), older age, white ethnicity and a lack of social deprivation were associated with higher vaccine uptake, although ethnicity exerted the strongest effect (Office for National Statistics data). Across pre-pandemic, pandemic with and pandemic without lockdowns, pregnancy outcomes, over time, largely followed pre-pandemic trends (record linkage, South London). However, virtual antenatal care in the second and third trimesters was associated with an excess of adverse pregnancy outcomes (and increased costs). Our findings suggest that maternity care provision, although altered substantially, largely preserved pregnancy outcomes, although experiences of care receipt and delivery were poorer. Costs may have been lower because less care was sought, although virtual (vs. face-to-face) care was more expensive. There is evidence to suggest that the current context of maternity care is of a demoralised and depleted workforce. Implementing a coproduction learning health system could offer needed solutions to improve maternity care delivery, experiences of care and workplace culture, building resilience to withstand future health system shocks.

Authors' methods: This mixed-methods study had three work packages. Work package 1 used quantitative methods to analyse pregnancy outcomes over time, considering service reconfiguration and inequalities, using routinely collected maternity and offspring data from three diverse South London trusts. Work package 2 involved in-depth interviews with a diverse sample of pregnant/post partum women, partners, healthcare professionals and policy-makers, and used thematic framework analysis. Systematic reviews were undertaken of women’s experiences of receiving maternity care during the pandemic, and healthcare professionals’ experiences of providing that care. Questionnaires (October–December 2021 and August–September 2022) were administered nationally via the King’s College London COVID Symptom Study Biobank, to evaluate vaccine uptake among women who were planning pregnancy, pregnant or post partum. Work package 3 engaged stakeholders within maternity systems through regional Listening Events and a national Policy Lab.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR134293

Year Published: 2025

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/HHTE6611

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/HHTE6611

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk