Summary of themes from qualitative data and representative quotes (Mar. 20 to May 31, 2020; British Columbia, Canada)
| Theme/category | Representative quote |
|---|---|
| Responses to the COVID-19 pandemic | |
| Psychological responses | |
| Anxiety and grief | “It’s had a major impact mentally and physically ... I had my anxiety in check, it was well managed. Now I feel anxious every day. I’ve felt panic. I’m teary and emotional.”(Participant 28, Mar. 29) “It is something I think about and get frustrated about … why does it have to happen during my pregnancy?” (Participant 6, Apr. 1) “I have been sad most days, as this was not how we planned for the pregnancy to go. After 5½ years of trying to get pregnant, we really wanted to celebrate this baby; this will now change our plans.” (Participant 38, Apr. 6) “It had a huge impact 2 months ago, when it began. Mid-March when everything was ramping up and the world was changing. That was also when we had our detailed ultrasound and the small pleural effusion was noted. I just completely ran out of any ability to cope. I think I had a panic attack. I couldn’t stop worrying, crying. And of course then I worried about my mental state having an effect on the baby. I’m happy to say I’ve been doing a lot better since the end of March. It feels like we adapted to this new reality. We’re healthy and safe. The pleural effusion is gone; baby is healthy and safe. I feel much more calm and steady now.” (Participant 71, May 11) “It has impacted my mental health. I’m a bit better this month, but I was really stressed out in March and parts of April while I was in the first trimester. I’m not coping with the uncertainty well, and I’m upset because these are my last few months of being in a childless couple and I’m not getting to savour our freedom as much as I’d like.” (Participant 80, May 13) “Definitely increased anxiety in a lot of areas I never would have had anxiety prepandemic (hospital setting, will my spouse be allowed in, what will my quality of care look like in hospital, will they be rushing me out before I’m ready) — all thoughts of unknown and worry around these factors increasing anxiety.” (Participant 92, May 23) “It [pandemic] has definitely impacted me and my experience with pregnancy. It has taken away many of the experiences I was looking forward to, removed the majority of human–human interaction from my life and placed a whole lot of uncertainty on a time already filled with so many physical and mental changes. Only time will tell if or how it impacts my baby. I can only hope this doesn’t continue throughout baby’s first year of life.” (Participant 89, May 28) |
| Responses to pandemic-imposed prenatal care, birth restrictions and protective measures | |
| Loss of support and connections | “My partner is no longer allowed to attend our OB [obstetrician] appointments due to COVID, and his emotional support has been very important to me during those appointments, because I have a phobia of doctors and often forget what the doctor says, or I forget to ask the questions I need to ask. Not having him there to see the ultrasounds or hear the heartbeat interferes with his ability to attach, and our shared experience of attachment with our baby.” (Participant 13, Mar. 27) “My boys were looking forward to the ultrasound, but I wasn’t allowed any extra people due to precautions. I cried during the ultrasound.” (Participant 53, Apr. 24) |
| Loss of control and autonomy | “The uncertainty of restrictions at the hospital makes me feel a loss of control and has significantly impacted my anxiety (i.e., will the doula we paid for be allowed, how will we safely leave the hospital to minimize exposure, how clean will the staff and room be, will there be adequate staffing, will me and baby be in danger, will I have less choice or control due to these restrictions?)” (Participant 13, Mar. 27) “Fear of the unknown [and] lack of control and freedom contribute to the return of moderate anxiety and depression, feelings of being mentally trapped. I feel [like] I’m grieving, losing some freedom.” (Participant 28, Mar. 29) “I feel slightly worried and a bit angry over choices that have been taken away from me, such as having a support person present during my prenatal and ultrasound appointments.” (Participant 30, Apr. 9) “I [am] also nervous about everyone being in masks and goggles while I’m delivering; not very personal.” (Participant 35, Apr. 10) |
| Experiences related to the pandemic | |
| Uncertainty about birth plans and setting | “I am scared how the virus will impact our plan for a hospital birth and what risks are going to be associated with a hospital birth.” (Participant 7, Mar. 29) “I wanted to possibly have a home birth before this pandemic, but now I am fully planned on delivering at home. I worry that I may have to go to hospital with baby even if I deliver at home … What if I tear, bleeding doesn’t stop etc. I don’t want to bring baby into a hospital.” (Participant 28, Mar. 29) |
| Added burden to existing health and social disparities | “We also don’t have a vehicle and have been told to avoid public transit and car shares; so for my biweekly OB appointments, I’m needing to walk an hour each way, which is exposing me to others I pass on the sidewalk or bridge (which worries me), and it is also hard on my body at this stage in [the] pregnancy.” (Participant 13, Mar. 27) |
| Perceived or projected lack of support or limited support | “The vision of introducing our baby to our closest friends and family in person will now be by FaceTime, which is depressing. I worry how a lack of socialization will impact the baby over time.” (Participant 7, Mar. 29) “Allow more than one person during my delivery. I need both my husband and my mom, and I’m being forced to choose one. It’s horrible to put people in these positions.” (Participant 58, Apr. 24) “We can’t even plan how we are going to manage maternity or paternity leave, because my husband works out of province and flies, so he is in a higher risk category according to my doctor and we don’t know if he can keep working or will need to take time off so he can bond with baby. If his camp has an outbreak near my due date, he could be put on another 14-day self-isolation and miss the birth. He will be taking over a month of holidays, but if baby comes early it could be in a possible isolation window and I’ll have to do it without him … I am alone 50% of every month while husband works. We are in separate beds and bathrooms 25% of every month for 1 of his 2 weeks at home as a precaution due to his camp work and flights, and try to get back to normal the last 25% of each month … Especially my in-laws work in health care or have been continuing to meet with other for ‘distancing walks’ or ‘distant visits,’ which I don’t think entirely follow the safety recommendations, and I’m worried they won’t take the risk seriously enough and I will become a bad guy for protecting my newborn by keeping the baby away from those who I don’t think are keeping safe enough. I am already judged for being paranoid or taking it too seriously, but many pregnant friends or friends with little ones feel the same. I plan to put my little one’s safety first if needed, even at the expense of those other relationships, which sucks.” (Participant 89, May 28) |
| Concerns about early development | “I feel worried about how the stress is impacting my developing baby. If we were not in this current situation, my stress and anxiety levels would be much lower. I could manage my stress in normal ways like meeting up with friends or taking my children to go do something fun. Instead, it feels like constant stress with no break or end in sight.” (Participant 32, Apr. 11) |
| Struggles over managing multiple demands | “… has increased my anxiety. Concerned about working at my job … Concerned that I will contract the virus and there have been few studies identifying whether it is passed through vertical transmission, harm to fetus.” (Participant 15, Mar. 25) “It (the pandemic) has certainly caused stressed stemming from work–life balance. My workload is mounting as I have fewer hours in the day to work, trying to care for my child at home now. When I am working, I feel guilty I’m not focused on my child and when I’m not working, I feel stressed about falling more behind.” (Participant 18, Apr. 2) “Work is more challenging. PPE [personal protective equipment] makes nausea challenging … It’s [also] hard sitting with [the] pregnant people in my care through their anxieties.” (Participant 43, Apr. 17) |
| Perceived maternity care needs | |
| Positive experiences: a supportive system | “My health care provider has answered my questions about the hospital well and has found adaptive and creative ways to ensure I had the information I needed. At the midwifery–family doctor maternity care clinic I attend, they offer group classes for the end of the second trimester and beginning of the third trimester. When those were cancelled due to COVID-19, they created a condensed Zoom version that was really helpful. They also provided the typical hospital tour (which was now not allowed) by YouTube video. Both of these efforts helped to reduce uncertainty and provide knowledge and familiarity with the experience to come. It helped reduce some of my nervousness about labour.” (Participant 90, May 26) “My doctor has been amazing. She is new to me (since week 17) and has called me every few weeks to chat, even before the pandemic broke out in Canada. She has provided me with protocols and procedures so that I feel prepared should I contract COVID. She has provided me with update research of the realities of the impact that COVID-19 has on pregnant mothers and babies, and also given me various reliable social media pages to be following.” (Participant 46, Apr. 22) |
| Maintaining prenatal care visits | “I understand why in-person appointments aren’t possible now, but it is really hard to feel connected to health care providers over the phone. I think video calls work better.” (Participant 73, May 13) “My midwife appointments have been monthly, alternating between online and in person. I haven’t felt the need for additional check-ins; however, I’m sure some people would.” (Participant 86, May 19) “Keeping visits as normal as possible. More in person and less telehealth would be nice, but I understand it’s not reasonable at this point.” (Participant 94, May 25) |
| Offering the option of in-person visits | “The prenatal appointment schedule includes a lot less frequent visits, which worries me that things could get missed.” (Participant 20, Apr. 1) “My maternity doctor still sees me in person, which I really appreciate, and it’s been a big support for me.” (Participant 76, May 20) |
| Frequent and proactive check-ins to build rapport | “I think I am feeling a lack of connection to them. I had hoped to be building stronger relationships with them so I feel more comfortable with them during my delivery.” (Participant 78, May 12) “More check-ins would be nice. We have no appointments until 20 weeks after initial intake.” (Participant 74, May 13) “More regular check-ins via email or phone call. Providing available resources for those who aren’t aware of them.” (Participant 88, May 20) “More regular check-ins. I still have appointments with the midwife but no family doctor or any other health care provider to check in during those 1 to 1.5 months with no appointment. The health coverage I have for counselling is not great, so I have not been talking with a professional.” (Participant 82, May 26) |
| Mental health support | “They can emotionally support their patients.” (Participant 27, Apr. 2) “Setting up a counselling or psychology appointment.” (Participant 63, May 9) |
| Partner engagement | “They could let me take a video of my ultrasound so I can actually share it with my husband since he’s not allowed to join me at my ultrasound appointments and missed the last one. Hospital policy wouldn’t even let me FaceTime him live for a moment to show him the movement and heartbeat at 20 weeks. It really sucked not being able to share that with anyone, even though the tech was lovely and got some great pics.” (Participant 89, May 28) |