Nineteen patients indicated a willingness to participate and 12 completed an interview. All participants were between 3 weeks to 12 months postpartum by the time of the interview. Table 1 shows participant characteristics.

Table 1 Participant Demographics

Six main themes emerged from our analysis of participants’ descriptions of their experience being pregnant and postpartum during COVID-19: 1) Childbearing-related challenges to everyday life; 2) Increased worry, uncertainty and fear; 3) Pervasive sense of loss; 4) Challenges accessing care; 5) Strategies for coping with pandemic stress; 6) Reflections and advice to other pregnant people and health care practitioners.

  1. 1)

    Childbearing-related challenges to everyday life

Participants described challenges to employment, finances, access to food and transportation. While many of these challenges may be common pandemic experiences, some were unique to pregnancy, and deeply affected the participants.

Employment

Several of our participants worked in a health care setting and were working while pregnant during the pandemic. One participant described feelings of guilt for working in an at-risk environment, “Emotionally, I was drained and I was devastated because I needed to work, but I also needed to feel like I am not exposing my unborn baby, myself, and the little one at home.” [P2] Another participant described her feelings of fear while working in the hospital during the early stages of the pandemic, “I remember being quite pregnant, like around 33, 34 weeks pregnant, and we’re in the hospital and no one really knowing kind of how dangerous it was or what to do.” [P5] One participant contracted COVID-19 while working and another was potentially exposed while working. The participant who tested positive while pregnant noted even though her symptoms were mild, the perceived stigma and fear of returning to work “took a toll on me more mentally than physically.” [P2]

Even those not working in health care felt pressure to stop working as one participant explained, “And I started to get a lot of I guess pressure from not necessarily family, but friends of my husband and other people asking like why am I still working when COVID is everywhere.” [P10]

While the majority of participants had savings to rely on, some were deeply impacted financially due to employment cuts. As this participant describes, the financial strain took its toll on her relationship, which in turn could affect the baby: “with me not working and [husband] on part time hours, we definitely got hit really hard financially…when you have this kind of financial stress, everything is more stressful. It hurts your relationship. It makes the house more tense then that’s not good for the baby.” [P9]

At one point, another participant had to rely on a food bank and expressed concerns about nutrition for her and baby, “that was a hard one for me, because everything was tin – they don’t give you always veggies and stuff.” [P8]

Access to food

Some participants created new routines to access food and delegated their partner as the sole person to go out to buy groceries, because of their perceived risk being pregnant or exposing their newborn baby. As one participant explained, “At the beginning it felt kind of scary…I didn’t want to take the baby to the grocery at all at first, so at the beginning my husband was doing all the grocery shopping.” [P1]

Transportation

Traveling on public transit also caused increased stress due to the perceived risk of exposure while pregnant. One participant shared, “I felt really stressed out… I was having panic attacks on the subway.” [P12] Another postpartum participant decided to avoid taking the bus all together out of fear for her exposure, “You can’t take a bus because the busses are still packed. There’s no distancing on that. I have to take the baby, I’d rather not.” [P8]

  1. 2)

    Increased Worry, Uncertainty and Fear

Participants described a range of emotional responses to COVID-19. Most commonly these included worry, uncertainty and fear.

Worry

Participants described worrying during the pandemic’s early stages as they tried to decrease potential exposure to the virus: “my partner…was still working full time and he didn’t have the option of taking the time off…we were concerned that if he caught it, he would bring it back to me and then subsequently me and the baby.” [P9] They also worried about what the birthing and visitor processes would be like and this caused increased anxiety, “I was very stressed about that in my pregnancy, very, and very upset at the thought of being alone.” [P4]

For some of the participants, medical testing was delayed and/or cancelled leading to anxiety waiting for results or worry about the baby. As one participant explained, “My genetics testing took longer long because there wasn’t any open.” [P3] Another participant described her worry during the postnatal period when her baby missed his hearing test, wondering if he would be OK, “all of these things were cancelled…is my baby going to be OK?” [P8]

Uncertainty

The feeling of uncertainty was commonly expressed due in large part to the lack of knowledge about the effects of the virus on their health or their baby’s health. One participant reported, “initially when the pandemic started, it was obviously pretty scary, because I didn’t know much about the effects that COVID could have on pregnant women, on their babies.” [P2] Another participant also voiced her concerns about the potential risks to baby, “I remember, with the COVID stuff, feeling stressed in March, thinking could this be risky to the baby, or if I got sick would I go into pre-term labour or, you know, that kind of stuff.” [P5].

Fear

Participants expressed fear about COVID-19’s contagious nature and potential harmful effects. One participant described fear causing panic when thinking about how quickly COVID-19 was spreading, “I expressed the fear so many times, you know, to see how far it has gone because one, I’m pregnant and I have a little kid at home, and I just hoped that it does not get worse…So it was scary, I’ll tell you that. It was not the best.” [P3]

  1. 3)

    Persistent and Pervasive Sense of loss

Participants reported a profound sense of loss due to COVID-19. Their experience of pregnancy and postpartum was not aligned with their hopes and dreams. One participant described, “It’s a loss that you cannot really talk to people that you feel you lost because you lost enjoying the pregnancy. You, in a nutshell, lose yourself. You know, in this whole scare, you know, trying to sanitize and do everything, you forget and you do not really experience your pregnancy yourself.” [P3]

They lost both tangible and emotional family support and expressed challenges to bonding with their baby.

Expectations vs reality

Participants described that they had looked forward to spending time with others after the baby was born. One participant explained, “it seems like everything that you plan and everything that they tell you to do … You know, joining Mom and baby classes, and ask for help, and have people come over and all those things, it was just like OK, how do you deal when you suddenly can’t do any of those things?” [P1]

Many described a feeling of loss at not being able to celebrate their babies. One woman described feeling robbed as the celebrations for the baby both before and after birth did not occur as she had hoped, “yeah, definitely felt robbed of that. My mom had planned on having a party for everybody, the baby, which of course couldn’t happen and, yeah, those kind of things were kind of disappointing.” [P4]

Bonding with baby

Participants expressed challenges bonding with the baby due to fears and anxieties generated from the pandemic as well as sadness that baby bonding with family would be delayed. “We had a name for [older son], but this baby, we didn’t have a name until like two weeks after it was born and we didn’t even engage ourselves with baby names and talking about names… so we were kind of scared to even make the plans…I would have wanted to do shopping for the new baby. That didn’t happen. I cried all the way to (the hospital).” [P3]

Family support

Participants reflected on how the public health mandated separation from family resulted in missing out on much-needed support for them and the baby. One participant tried to use technology to bridge the gap, however she still felt disconnected, “we talked on the phone … [but] it cannot be compared with the physical presence of your family members when you’re eating together, laughing and sharing thoughts … It felt distant.” [P3]

Participants described breaking pandemic public health directives to access the emotional and physical family support that they needed: “at around two months I had to leave the city and go stay with my parents … it was definitely a feeling of unfairness, this isn’t fair. I wanted to have family, I wanted help.” [P9]

Another loss frequently expressed by the participants was the partner missing out on prenatal visits and imaging visits, “I think for him it was just kind of sad not to be super part of the experience it was just kind of sad for him not to get to see the ultrasounds and stuff.” [P11]

  1. 4)

    Challenges to Care

Participants described their access to care during pregnancy and postpartum care was compromised by the pandemic, especially breastfeeding support.

Access

While some participants described enjoying aspects of virtual care, its inadequacies were a common theme. As this participant expressed, “Probably the most bothersome about this entire situation was I didn’t feel like I was getting the medical care that I needed or that the baby needed…you kind of feel like you’re being pushed aside a little bit.” [P9] As she explains, “I never had a six week postpartum appointment … I have not had a doctor look at me since I left the hospital … you’re on a virtual call and you can’t really explain things, you’re taking pictures that aren’t clear, it’s really, it’s not helpful.” [P9] Patients reported less access to IUD insertions and pelvic floor physiotherapy during pregnancy and postpartum as well.

Access to breast feeding support was negatively impacted due to the pandemic’s restrictions. As one participant reported, “We don’t have breastfeeding classes to go to and you don’t have in person… I was going to have a lactation consultant come to my home … I did it, virtually, once or twice and it was awkward and hard. I wanted someone right there with me. It’s just such a personal thing and they need to be right there to see so closely with the baby.” [P5]

Other participants had planned to attend a hospital breastfeeding class or in-home breast feeding support following delivery with either a lactation consultant or a midwife, however these too were cancelled due to pandemic restrictions. This left several of the first time parents with many questions regarding breastfeeding with very few opportunities for support.

Quality

Some participants felt the quality of postpartum care was also compromised: “I did feel like my nursing care was – I don’t know if it was different because of the pandemic, or if it was just like workload, but I did feel like it wasn’t as ideal as I would have hoped, postpartum.” [P5]

Further, some participants felt that COVID-19 related topics overshadowed their health care visits, became the focus during their postpartum visits and thus the quality of care was impacted. One participant said, “you have all these questions, but it got so shadowed over by COVID.” [P6]

  1. 5)

    Strategies for Coping with Pandemic Stress

Participants developed different coping strategies to manage pandemic stress. Some described how they relied on or avoided information, while others participated in both adaptive and maladaptive behaviors.

Approach to pandemic information

Some participants described themselves as information seekers. As one participant reported, “So paying more attention to the news, it was kind of like a distracter … I think that I’d rather know as much as I can.” [P9]

Conversely, most participants reported they avoided information overload to protect their mental health. As one participant described, information in the media was causing her heightened anxiety and she found she was better off not knowing, “I’ve been trying to avoid looking at the numbers as of late … Looking back I wish I hadn’t known. I think it would’ve been better for me to be kind of ignorant about it, because like it just gave me more anxiety than I was already feeling.” [P12]

Adaptive behaviors

Participants described adaptive behaviors to help them cope, which included seeking support, exercise, self-care and finding a way to balance the risks and benefits of visiting with friends and family.

Seeking support

Participants described seeking support as helpful. One participant found that by speaking to her doctor she was reassured, “Definitely talking to my doctor about it … and then just sort of the reassurance that she was able to provide me.” [P2] Another participant found an online community that was supportive, “I’m in the one mom group … everybody’s going through stuff at the same time … it is definitely a place where I talk to other people just about how they’re dealing with things.” [P1]

Exercise

Many participants reported positive benefits on their mood and general well-being when they exercised. Some were able to find creative ways to stay active while maintaining social distancing protocols. Their strategies included online personal training, walking outside, using home gym equipment or meeting others at a park for an activity while maintaining social distancing protocols.

Self-care

It was common for participants to describe how important taking time to focus on themselves was for their mental health. As this participant explains, “I just turned mental health into my job … just really for once taking time for myself. A lot of self-talk too.” [P2] Another participant found listing what she is appreciative for as helpful, “every day I try to list what I’m grateful for. I get a lot of joy just out of the baby, like why have a baby if you’re not going to find her endlessly fascinating.” [P7]

Balancing exposure risks for the benefit of their mental health

Some participants decided to expand their bubble despite the risk of infection to themselves or their parents in order to surround themselves with the support they needed. One participant explained, “we decided it was more important to have people around, like COVID was a lower risk I guess than my mental health at that point.” [P10] One participant explained if she had not taken these actions, her mental health would have suffered, “We decided that the risk for my mental health was greater than the risk of them catching COVID from me, so I ended up going to stay with them [family] … If I didn’t have the ability to go and stay with them, I think that that would have been really detrimental.” [P9]

Maladaptive behaviors

Some participants developed maladaptive behaviors during the pandemic, including decreased exercise, obsessively following strict hygienic practices and overeating.

Exercise

Some participants decreased the amount they exercised due to fear of leaving the home and risking exposure to the virus, “No, I wasn’t [exercising] because – oh my goodness, in my house? Where else? I didn’t want to go out.” [P3]

Hygiene practices

Participants described how their hygiene practices had changed due to the pandemic, with some becoming excessive. One participant shared her obsession with cleaning, “Wipe down the stroller and wash my hands, take off all his clothes. I don’t understand why I do that part, but I take off all his clothes, change him into a different set of clothes. … it makes me feel obsessed … Every minute you’re cleaning, because you just don’t know.” [P8]

Overeating

Stress eating was mentioned by some participants as a coping mechanism, “it’s one of the only things you can do at home, but it actually makes me feel worse … I’m just sitting at home and eating brownies, it definitely makes me feel worse.” [P1] See Table 2 for additional quotes supporting themes 1–5.

  1. 6)

    Advice

Table 2 Themes, subthemes and representative quotes derived from thematic analyses of participant interviews

Advice for other patients

The participants had several pieces of advice for other pregnant and postpartum individuals during a stressful period such as a pandemic. This advice included advocating for oneself and avoiding isolation.

Advocating for oneself

Participants stressed the importance of advocating for oneself in order to ensure adequate care, “I think that everyone’s doing a really good job with doing the best care they can, but I think it’s important to ask questions and seek out information about pregnancy or postpartum things, if you need it. I think that’s normal anyway, but I think, with the pandemic, it just makes it so much more necessary.” [P5]

Avoiding isolation

Participants focused on the importance of reducing isolation, “keep socializing as much as possible, bundle up and be outdoors as much as possible. Keep talking to people – friends, family, whoever. I mean those are strategies that worked for me, but I mean maternity leave can be a very isolating – I found it isolating without a pandemic at the same time. So even more so this time, I feel like we just have to rely on each other.” [P10]

Despite pandemic restrictions, participants emphasized the importance of reaching out for help, whether from family, friends, or health professionals: “having people that you can talk to, whether it’s a partner or family member, friend, a mental health professional … you don’t want to be holding those emotions inside of you, you want to find a release.” [P2]

Recommendations for health care providers (HCPs)

Participants had recommendations for health care providers in order to help them improve care during a pandemic including: Providing clear and up to date information and increasing post-partum support.

Provide clear and up to date information

With the ever-changing recommendations and suggested precautions during a pandemic, participants felt there should be clear communication and up to date information coming from their HCPs. Specifically, they suggested clear messaging regarding hospital policies and what care would look like during their hospital stay, “it would be great if they had a better idea of what your stay is going to look like, so you’re a bit more mentally prepared for what’s to come.” [P10] One participant put it plainly, “there was a lot of confusion … try to be as clear to the patients as you can.” [P5] Moreover, participants wanted the health care team to have consistent messaging regarding in person versus virtual visit timing.

Increase postpartum support

Following discharge from hospital several participants voiced a need for more postpartum support. The suggestions as to what type of supports ranged from increased mental health support, increased breastfeeding support, more frequent maternal check ins to address any baby concerns as well as mom’s physical and psychological changes during the postpartum period. See Table 3 for additional quotes regarding advice.

Table 3 Participant’s advice for pregnant women and healthcare providers during COVID-19

Silver linings

Although the COVID-19 pandemic was a challenging time for our participants, several were able to find positives during the pandemic. Due to social distancing requirements, many participants had partners who were required to work at home. This enabled the partner to provide support and companionship as one participant explained, “His presence provided company and support … it was almost like a blessing in disguise.” [P2] Others appreciated the postpartum support from their husbands who were working from home, “having him being able to do more of the cooking and helping me get a nap every day.” [P1]

Other participants mentioned pregnancy and having a newborn provided a welcome distraction from the pandemic, “.. in some ways I think having a baby makes this whole situation easier. ..she really gives structure to my day. Like I have to get up in the morning, I have to do certain things for her. I just sort of focus on her and she’s changing all the time so it doesn’t feel like life has just stopped. So I think just finding the joy that you can in enjoying your baby and Face Timing a lot with family and friends. [P1]

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