Maternity Care Clinicians' Experiences Promoting Infant Safe Sleep and Breastfeeding During the COVID-19 Pandemic

Objective: To explore the phenomenon of clinicians' perceptions and experiences of promoting infant safe sleep (ISS) and breastfeeding during the COVID-19 pandemic. Design: Descriptive qualitative hermeneutical phenomenology of key informant interviews conducted as part of a quality improvement initiative. Setting: Maternity care services of 10 U.S. hospitals from April through September 2020. Participants: Ten hospital teams, including 29 clinicians. Intervention: Participants were part of a national quality improvement intervention focused on promoting ISS and breastfeeding. Participants were asked about challenges and opportunities promoting ISS and breastfeeding during the pandemic. Results: We identified four themes summarizing the experiences and perceptions of clinicians promoting ISS and breastfeeding in the COVID-19 pandemic: Strain on Clinicians Related to Hospital Policies, Coordination, and Capacity; Effects of Isolation for Parents in Labor and Delivery; Reevaluating Outpatient Follow-Up Care and Support; and Adopting Shared Decision-Making around ISS and Breastfeeding. Conclusions: Our results support the need for physical and psychosocial care to reduce crisis-related burnout for clinicians to encourage the continued provision of ISS and breastfeeding education, particularly while navigating capacity constraints. Our findings also suggest that clinicians perceived that parents may require additional support to enhance potentially limited ISS and breastfeeding education. These findings may be used to inform approaches to parental and clinician maternity care support in future public health crises.