Adaptation of Coronavirus Disease (COVID-19) Protocols to a Parisian Maternity Unit during the 2020 Pandemic: A Managerial Perspective

Abstract

The coronavirus disease (COVID-19) pandemic overwhelmed health services in France during March 2020 and, to cope, service delivery was reduced in most disciplines. However, as this was impossible for Obstetrics, the COVID-19 infection had to be added to existing clinical care pathways at the children's hospital, Hôpital Necker-Enfants Malades. This was further complicated by an increasing number of pregnancies affected by infection, in addition to scientific uncertainty about the virus. Procedures based on scientific recommendations from French and international authorities were adapted to maternity care and regularly updated as the situation progressed. Weekly medical manager team meetings covered the evolving clinical situation, and an initial evaluation revealed that our procedures worked well. However, it was necessary to adapt the policy as the epidemic progressed rapidly. Shortly after March 16, traffic control bundling was implemented in anticipation of a dramatic increase in pregnant women affected by infection and to better protect the staff. By April 18, with the peak of the COVID-19 epidemic receding, protocols were again readjusted to meet new service delivery requirements. Although a full debrief is yet to occur, from an operational level perspective, staff response was more than satisfactory. While preventing another epidemic may be impossible, this experience will improve our resilience in the future.