Obstetric views on reduced preterm birth rates early in the COVID-19 pandemic

A significant decrease in preterm births occurred during the first few months of the COVID-19 lockdown across the U.S. and in other high-income countries, particularly among medically induced births, or artificially initiated births. This unexpected phenomenon raised speculation that the reduction was influenced by changes in obstetric care or hospital policy shaped by the pandemic. Reductions in spontaneous preterm births also occurred and may have been related to reductions in stress, fewer infectious exposures, and less daily exertions due to the ability for some to work at home in early months of quarantine. There is currently no clear explanation for the short-term reduction in preterm births, but it is clear that obstetric practices were altered during the early pandemic, which may have impacted birth outcomes. To gain more insight into potential shifts in clinical perspectives and reproductive care practices during the pandemic that may have influenced preterm births, fifteen semi-structured interviews of prenatal caregivers working during lockdown in the U.S. were conducted in 2023-2024 and analyzed in this qualitative study. Many clinicians hypothesized that the decrease of in-person prenatal visits led clinicians to miss critical indicators for preterm inductions that could have reduced the rate of preterm births. However, clinicians offered an alternative, but not mutually exclusive, hypothesis suggesting that clinical practices were overmedicalizing pregnancy pre-pandemic. These perspectives on the impacts of reduced prenatal care warrant further discussion on risk tolerances around pregnancy, the current structure of U.S. obstetric healthcare, and effects on birth outcomes.