COVID-19 Pandemic and Birth Experience. The Monopoly of Caesarean Sections. A Critical Realist Review.

With over a million people infected, the global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been growing at an accelerating degree. The rising mortality rate warrants identification and protection of the vulnerable populations in society. Despite the increasing number of published studies on COVID-19 in pregnancy, there are insufficient good-quality data to draw unbiased conclusions with regard to the severity of the disease or specific complications of COVID-19 with reference to the mode of delivery, vertical/peripartum transmission, and complications in neonates, born by infected pregnant women. Data on maternal and perinatal outcomes of women infected with the SARS-CoV-2 are limited to a handful of case reports and series. The sample sizes are small and findings are diverse. Regarding the mode of delivery in women with suspected or confirmed COVID-19, many studies conclude that the rates of Caesarean Section (CS) are higher in these women, despite the guidelines for vaginal labour. The aim of this critical realist review (CRR) is to investigate this phenomenon as well as the role of midwives in birth experience of women with COVID-19.