In a recent study published in the Midwifery Journal, researchers aimed to understand mothers' experiences of pregnancy during the COVID-19 pandemic.
Study: “Fear and anxiety is what I recall the best.": A phenomenological examination of mothers’ pregnancy experiences during COVID-19 in the United States. Image Credit: MMVieira/Shutterstock.com
During the coronavirus disease 2019 (COVID-19) pandemic, pregnancy experience was often affected by restrictions on routine physical healthcare and the expected availability of interactions with family, friends, and other support persons.
A recent study explored the qualitative experience of pregnancy in the United States during the pandemic. The study took place between November and December 2021, including 28 pregnant mothers.
Pregnancy may heighten the risk of depression or anxiety, especially after childbirth. Each of which occurs in a third of first-time mothers. Studies have highlighted both conditions' prevalence has increased since the pandemic's onset.
Public health guidelines mandated social distancing, and the overwhelming stress on healthcare systems resulted in the shift of many healthcare professionals and providers to urgent areas dealing with COVID-19 patients. This in turn led to the redistribution of healthcare services in elective regions, such as antenatal care.
Secondly, the need to curtail the spread of infection led to restrictions on the presence of non-medical personnel before, at, and after delivery, including in the labor suite.
Unable to have their partners, family, or friends accompany them to appointments, mothers often experienced increased stress, anxiety, and dissatisfaction with their care. An additional feeling of being isolated and lacking the social support that is important for a healthy pregnancy.
Such emotional risk factors could underlie the observed increase in the rates of depression, stress, and anxiety seen worldwide in pregnancy, as well as the rates of preterm labor, childbirth-related trauma, and reduced bonding between the mother and infant.
The study used a qualitative approach based on an inductive thematic design to explore the impact of the pandemic on American pregnancy experiences. Most mothers in the study were white, in full-time employment, with one or two children. The majority of them were aged 31 years or above.
All subjects were postpartum at the time of the interview.
What did the study show?
The researchers analyzed the data obtained from the 28 women in six phases, finding two cardinal themes and eight subthemes. The two chief themes were based on knowledge about COVID-19 and the impacts of COVID-19.
The first included knowledge about the vaccines against the disease and about the certainty of exposure in different situations. Conversely, the second included the type of support received, public health restrictions related to the pandemic, childcare, mental health, time spent at home, and isolation.
Many mothers said they did not know much about the vaccines, their potential impact on the pregnancy, or the effects of being exposed to COVID-19 during pregnancy. Knowing the virus was airborne made mothers fearful about becoming sick, and the resulting risk of fetal infection or adverse impact.
The risk of exposure of other family members to COVID-19, with the resulting risk that the expectant mother could contract the disease, also led to significant anxiety about becoming sick, having to be put on a ventilator, and of dying. Obviously, many felt that without COVID-19 being present, their pregnancy experience would have been much better.
Secondly, the mothers generally felt that they were not supported by people who would otherwise have been expected to provide such bolsters because of the pandemic and the restrictions in place. The restrictions were partly due to maternal fears of exposing newborn babies to COVID-19 and partly due to public health guidelines.
Several women did mention in favorable and appreciative terms the support they felt from their mothers and/or partners, as well as from groups that reached out to help them with meals and other essential items for the baby.
In some cases, medical staff provided emotional support by celebrating each pregnancy milestone, knowing that family and significant others could not be present.
The most challenging part for most mothers was the restrictions on visitors, both during antenatal and postnatal appointments. Attending important appointments without support, especially for a first-time mother or one with a history of pregnancy loss, led to high levels of stress and frustration with the hospital for adhering to extreme social distancing policies.
Importantly, some partners also struggled to adapt to the new baby as a result of the disconnect during the prenatal appointments.
One mother perceptively commented that while the no-visitor policy during pregnancy appointments and labor undoubtedly aimed to help women and their babies avoid infection, "it was a disservice to the whole health of pregnant women—mental and physical health—to not allow a support person to come." A few mothers were glad of the restrictions since they escaped pressure to attend social gatherings.
Conversely, mothers struggled with childcare during pregnancy, especially working mothers, who often found it difficult to find safe care for their other children while they attended prenatal appointments. Even those who still had childcare facilities experienced unpredictable outages due to the pandemic.
However, work-from-home policies also benefited some working mothers, who could continue at their jobs until just before labor began. Family time improved, and mothers could be more comfortable during pregnancy in terms of not having to be on their feet, face non-family members, or dress formally.
Poor access to mental health services was a ground for much dissatisfaction, especially among those who had been diagnosed with postpartum anxiety and/or depression during earlier pregnancies.
The loss of face-to-face meetings with others for birthing classes, baby showers, and just to describe pregnancy experiences in real-time led to feelings of isolation for many pregnant women.
What are the conclusions?
Despite compensatory measures that sought to reduce the adverse impact of public health restrictions on healthcare and social interactions, pregnancy experiences in the USA continued to revolve around the theme of poor or absent emotional support during childbirth and the early postpartum period during the pandemic period.
The restrictions also restricted the husbands and partners of the pregnant individuals, as they could not be present to see the growth and development of their babies during prenatal appointments.
A better understanding of the disruptions they faced in their fathering experiences due to the pandemic, and the need for better support, should be addressed in future research, as this will improve maternal and infant well-being as well.
Little was known about the disease during the study period. With much more information being available at present, it is important that women be equipped with adequate knowledge rather than suffering the fears arising from uncertainty.
The current study poorly captured the pregnancy experiences of women from other communities and other socioeconomic strata. Women from a diverse range of backgrounds have magnified risks for hypertension, obesity, diabetes, and pre-eclampsia, during pregnancy, which need to be examined in future studies.
However, the findings from the current study so corroborate existing studies from other countries, validating these global pregnancy experiences during COVID-19.
Our findings highlight the need to provide pregnant mothers comprehensive care, including mental health services, adequate access to social support, and providing clear information regarding COVID-19 vaccination and its impacts on pregnancy."