Letter to the Editor: Maternity Unit Metamorphosis and Response to the COVID-19 Epidemic: Implementation Science in Practice

Slovenia faced the first SARS-CoV-2 case on March 4, 2020, which demanded fast adaptation to the emerging health care crisis, not only on a doctor-patient level but also on the institutional level. The COVID-19 epidemic was declared on March 12, 2020 and lasted until May 31, 2020 (the first wave of the epidemic). On October 18, 2020, the government of the Republic of Slovenia declared an ongoing epidemic once again (the second wave of epidemic). ¹ We, as a tertiary-level department of perinatology, gained 3 valuable insights regarding implementation from adaptation to the COVID-19 pandemic.

First, at the beginning of the pandemic, nonessential services had to be eliminated in order to free up resources to meet the demands of the pandemic. ² As did our American colleagues, we quickly found that word “nonessential” in some instances had one meaning for us, the medical staff, and quite another for pregnant women, our patients. A perfect example was the question of partner presence during childbirth. The decision by medical staff to exclude a partner from the maternity ward during the first wave of the epidemic in order to reduce the risk of the virus spreading encountered strong opposition from pregnant women. Many pregnant women and societies representing their interests demanded that the Slovenian Ministry of Health revoke this decision. Indeed, in just a few weeks this decision was abandoned and not reestablished, even in much worse epidemiological conditions during the second wave of the COVID-19 pandemic. A similar conflict of policies occurred in New York during the pandemic in 2020 when the governor of New York issued an executive order to nullify the decision of Mayor De Blasio that prohibited all visitors to labor and delivery and postpartum units. ³ These events emphasized the importance of not forgetting the patient's perspective in the medical decision-making process during pandemic adaptation.

Second, in a pandemic environment, emergency procedures had to be completely redesigned. For example, transfer of an infected parturient from a COVID-19 designated area to the operating room demanded collaboration from obstetrical, neonatal, surgical nursery, midwifery, and anesthesiology teams. The feasibility of a proposed procedure was meticulously considered and a potential collision with the already existed procedures excluded. Defining every step of the process in writing was an easier part. Much harder was training the medical staff of 50 people to work in a new context and invite them to make suggestions for protocol improvements. ⁴ We wanted to proactively predict adverse events in the future and to be prepared for them in advance.

Finally, the hardest thing to implement was the introduction of routine testing for COVID-19 for all patients coming to the maternity ward during the second wave of the pandemic, which not only represented an additional burden for the medical staff from swab collection and frequent personal protective equipment exchanges, but also from monitoring the changing COVID-19 parturient status during labor.