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[This corrects the article DOI: 10.1371/journal.pone.0244221.].

In the spring of 2020, the SARS-CoV-2 virus caused the Covid-19 pandemic, bringing with it drastic changes and challenges for health systems and medical staff. Among the affected were obstetricians and midwives, whose close physical contact with pregnant women, women who recently gave birth, and their children was indispensable. In the obstetric setting, births cannot be postponed, and maternity staff had to adapt to assure obstetric safety while balancing evidence-based standards with the new challenges posed by the pandemic. This scoping review gives a comprehensive overview of the effecs the Covid-19 pandemic had on maternity staff. We followed the evidence-based approach described by Arksey & O’Malley: we searched several databases for English and German articles published between January 2020 and January 2021 that discussed or touched upon the effects the pandemic had on maternity staff in OECD countries and China. We found that structural challenges caused by the crisis and its subjective effects on maternity staff fell into two main topic areas. Structural challenges (the first main topic) were divided into five subtopics: staff shortages and restructuring; personal protective equipment and tests; switching to virtual communication; handling women with a positive SARS-CoV-2 infection; and excluding accompanying persons. The pandemic also strongly affected the staff’s mental health (the second main topic.) Attempting to meet challenges posed by the pandemic while afraid of contamination, suffering overwork and exhaustion, and struggling to resolve ethical-moral dilemmas had severe negative subjective effects. Several studies indicated increased depression, anxiety, stress levels, and risk of post-traumatic stress symptoms, although the crisis also generated strong occupational solidarity. Care for pregnant, birthing, and breast-feeding women cannot be interrupted, even during a pandemic crisis that requires social distancing. Maternity staff sometimes had to abandon normal standards of obstetric care and were confronted with enormous challenges and structural adjustments that did not leave them unscathed: their mental health suffered considerably. Researchers should study maternity staff’s experiences during the pandemic to prepare recommendations that will protect staff during future epidemics.

ObjectivesTo explore healthcare professionals’ perspectives and practices regarding informed consent during childbirth, particularly in the context of increased public awareness and discourse surrounding obstetric violence (OV) in France.DesignA qualitative study based on semistructured interviews and non-participant observations.SettingFour maternity units in France, representing a diversity of institutional contexts.ParticipantsA purposive sample of 32 participants, including midwives and obstetricians, was recruited across the four sites.MethodsData were collected through 32 semistructured interviews and in situ observations in labour and delivery rooms. A thematic analysis was conducted using a phenomenological approach, supported by NVivo software.ResultsFour main themes emerged: (1) relational malaise in the caregiver–patient relationship, reinforced by public discourse on OV, further hindered shared decision-making and open communication. (2) Challenges between caring values and systemic constraints (eg, lack of time, staffing shortages and protocol-driven care) limited professionals’ ability to engage in meaningful informed consent discussions. (3) Safety paradigm in obstetrics: fetal well-being emerged as a central and non-negotiable argument to justify medical interventions during childbirth. (4) Informed consent as a source of tension, where professionals struggled to balance legal and ethical obligations with clinical urgency, often leading to coercive or merely formal consent processes.ConclusionsInformed consent during childbirth remains a critical and unresolved ethical challenge. This study highlights systemic, relational and emotional barriers that hinder shared decision-making and compromise the core ethical principles of autonomy, beneficence and justice. Addressing these issues requires structural changes, improved working conditions to support individualised care, better training in ethics and communication and greater recognition of the moral distress experienced by healthcare professionals.Registration numberRegistration number 22-219 from CEEI-IRB INSERM (Research Institutional Review Board INSERM, France) (IRB 00003888, IORG 0003254, FWA 00005831).

Recent closures of rural obstetric units and entire hospitals have exacerbated concerns about access to care for more than twenty-eight million women of reproductive age living in rural America. Yet the extent of recent obstetric unit closures has not yet been measured. Using national data, we found that 9 percent of rural counties experienced the loss of all hospital obstetric services in the period 2004-14. In addition, another 45 percent of rural US counties had no hospital obstetric services at all during the study period. That left more than half of all rural US counties without hospital obstetric services. counties with fewer obstetricians and family physicians per women of reproductive age and per capita, respectively; a higher percentage of non-Hispanic black women of reproductive age; and lower median household incomes and those in states with more restrictive Medicaid income eligibility thresholds for pregnant women had higher odds of lacking hospital obstetric services. The same types of counties were also more likely to experience the loss of obstetric services, which highlights the challenge of providing adequate geographic access to obstetric care in vulnerable and underserved rural communities.

Obstetrician-Gynecologist (OB-GYNs) mothers, serving dual roles as healthcare providers and patients, present an interesting demographic for studying this dynamic, particularly in China where empirical data on this subject is limited. The study aimed to determine whether OB-GYNs experience better pregnancy outcomes compared to non-physician women, hypothesizing that their medical background could lead to different health behaviors and outcomes. This was a retrospective matched cohort study conducted at the Women’s Hospital, Zhejiang University School of Medicine. It included 100 OB-GYNs who gave birth between January 2012 and April 2022 and a matched control group of 200 non-medical background women. Outcomes measured were Cesarean section rates, emergency cesarean section, operative vaginal delivery, birth weight, Apgar score, and various pregnancy and childbirth complications. Statistical analysis was performed using descriptive statistics, generalized estimating equation model and Fisher’s exact tests. Cesarean section rates were similar between OB-GYNs (32%) and non-physicians (36.5%). OB-GYNs had similar incidences of pregnancy complications compared with non-physicians except postpartum hemorrhage (0% in OB-GYNs vs. 5.5% in non-physicians, P  = 0.018). The findings indicate that OB-GYNs do not differ significantly from non-physician women in terms of Cesarean section rates and incidences of pregnancy complications except postpartum hemorrhage.

Fetal growth restriction is a risk factor for intrauterine fetal death. Currently, definitions of fetal growth restriction in stillborns are heterogeneous. To develop a consensus definition for fetal growth restriction retrospectively diagnosed at fetal autopsy in intrauterine fetal death. A modified online Delphi survey in an international panel of experts in perinatal pathology, with feedback at group level and exclusion of nonresponders. The survey scoped all possible variables with an open question. Variables suggested by 2 or more experts were scored on a 5-point Likert scale. In subsequent rounds, inclusion of variables and thresholds were determined with a 70% level of agreement. In the final rounds, participants selected the consensus algorithm. Fifty-two experts participated in the first round; 88% (46 of 52) completed all rounds. The consensus definition included antenatal clinical diagnosis of fetal growth restriction OR a birth weight lower than third percentile OR at least 5 of 10 contributory variables (risk factors in the clinical antenatal history: birth weight lower than 10th percentile, body weight at time of autopsy lower than 10th percentile, brain weight lower than 10th percentile, foot length lower than 10th percentile, liver weight lower than 10th percentile, placental weight lower than 10th percentile, brain weight to liver weight ratio higher than 4, placental weight to birth weight ratio higher than 90th percentile, histologic or gross features of placental insufficiency/malperfusion). There was no consensus on some aspects, including how to correct for interval between fetal death and delivery. A consensus-based definition of fetal growth restriction in fetal death was determined with utility to improve management and outcomes of subsequent pregnancies.

The Japanese government suspended its proactive recommendation for routine HPV vaccination for nine years, from June 2013 to May 2022, due to concerns about unconfirmed reports of adverse events. This study represents the fifth in our ongoing series of surveys assessing Japanese obstetricians’ and gynecologists’ attitudes toward HPV vaccination, and the first survey conducted since the recommendation was reinstated. In January 2024, we distributed a questionnaire to 632 obstetricians and gynecologists affiliated with Osaka University Hospital. The survey evaluated their attitudes toward HPV vaccination for both daughters and sons. A total of 348 specialists (55.1%) responded. After the government resumed its proactive recommendation, approximately 90% of their daughters had received or planned to receive the HPV vaccine. Among daughters eligible for catch-up vaccination, 71.4% had been vaccinated. Over 70% of respondents agreed that boys should also routinely receive HPV vaccination. Among those with sons aged 12 to 16 at the time of approval for boys, 12.5% had vaccinated them. Most respondents ensured HPV vaccination for their daughters, and some for their sons. Encouraging physicians from other specialties to do the same may help promote widespread HPV vaccine uptake in Japan.

Ranee Thakar, president of the Royal College of Obstetricians and Gynaecologists, speaks to Emma Wilkinson about her concerns for a maternity workforce on the edge