Problem or issue
What is already known
What this paper adds
WHO Director – General’s Opening Remarks at the Media Briefing on COVID-19-11 March 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.
- Poon L.C.
- Yang H.
- Kapur A.
- Melamed N.
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- Kihara A.B.
- Ayres-de-Campos D.
- Ferrazzi E.M.
- et al.
- Ornaghi S.
- Callegari C.
- Milazzo R.
- La Milia L.
- Brunetti F.
- Lubrano C.
- Tasca C.
- Livio S.
- Savasi V.M.
- Cetin I.
- et al.
2.1 Research design
2.2 Research setting
2.3 Sampling strategy, participants and recruitment
2.4 Data collection
2.5 Data analysis
2.6 Authors’ background
2.7 Ethical considerations
|Participant||Age||Country of birth||Educational level||Occupational status||Parity|
|W1||33||Peru||High school||Not working||Multiparous|
|W13||30||Dominican Republic||High school||Working||Multiparous|
|Themes and sub-themes||N. of participants||N. of supporting quotes|
|Theme 1: coping with unmet expectations||22||312|
|Chaos and uncertainty||20||68|
|Non-modifiable unmet expectations||22||148|
|Theme 2: adapting to the ‘new ordinary’||22||211|
|Threat of potential virus transmission||19||44|
|Communication of positive test||18||29|
|Living with Covid-19 disease||17||42|
|The ‘new ordinary’||20||62|
|Theme 3: ‘pandemic’ relashionships||22||539|
|Family separation and reunification||22||148|
|Maternity services and healthcare professionals||21||135|
|Theme 4: sharing a traumatic experience with long-lasting emotional impact||21||98|
|Tragic and traumatic experience followed by resignation||20||55|
|Long-lasting emotional impact||11||26|
|Recounting the experience||12||15|
3.1 Theme 1: coping with unmet expectations
It wasn’t like I expected it. […] when I found out I was pregnant I would’ve never imagined to give birth this way, alone and positive to coronavirus. (W7)
3.1.1 Chaos and uncertainty
When I tested positive everyone was still unsure of what would happen or how to approach the disease. Everyone’s uncertainty worried me a lot, especially the one of healthcare professionals. Potential vertical transmission and safety measures in case of COVID were still a doubt. (W21)
I was very scared and started to search for information but obviously the media weren’t helpful due to the overall alarmism. The news circulating were always uncertain and this uncertainty was terrifying. (W21)
It reassured me a little bit when they finally understood that in most cases COVID-19 positive women would not transmit the disease to the fetus. (W11)
It was a big question mark. The world collapsed on me and I was like oh my God what now? What will happen now? How this will progress? A big question mark.(W12)
3.1.2 Non-modifiable unmet expectations
I was expecting to get to the end of pregnancy, relax and sort out the last few bits for the baby’s arrival and I found myself locked at home instead. (W10)
Definitely the wrong time to be pregnant… a difficult time. (W6)
I went for an antenatal appointment and didn’t come back home anymore, plus I was COVID positive and got transferred to an unfamiliar place… let’s say it all happened in a blink of an eye. (W5)
Three days felt like a week […] time was dragging. (W4)
Those two weeks waiting to do the next test you are very stressed cause you think it may turn out to be positive again. (W18)
The ambulance arrived and transferred me, they didn’t let me take anything of mine, not even a suitcase […] and I was basically in my pajamas. (W15)
3.1.3 Reassuring factors
I was reassured by the fact that the checks, scans and fetal monitoring were good. My baby was okay. And my symptoms were mild, I’ve never had severe symptoms (W2)
I was reassured by the support of my parents, family and partner… even though there was no physical contact and we could not meet, I used to see them on videocall. (W6)
The professional competence of the people working in the [multidisciplinary hospital] team made me feel relieved. (W14)
I arrived [at the referral centre] and found very smiling hospital staff welcoming me […] despite they had a mask on I saw they were smiling through their eyes. They told me don’t worry now you are safe here […] I saw very professional people and I perceived they were ready […] I perceived the difference from the other hospital [non referral centre] straight away. (W14)
The fact that she was protected [by PPEs] made me feel relieved when she was close to me, also because with the progression of labour and time going by she got closer and closer. (W14)
I was reassured by the fact we were all home together with no contact with the outside world. (W16)
You go at the emergency department and if you dont have it [the virus] you risk to be infected, if you have it you risk to infect other people. (W14)
I asked to give birth at home […] I was afraid of the hospital because I had never been admitted to hospital before, I had to give birth and there was an ongoing global emergency. (W12)
I already knew the hospital because I gave birth to my first daughter and I had my antenatal appointments there, therefore I knew the staff. It’s a very small hospital. This reassured me because it felt like a familiar setting. (W11)
When I was admitted I thought okay I am here, they are safely taking care of me, so it’s okay. (W3)
I didn’t want to stay on the ward, I wanted to go away. After giving birth I didn’t want to stay there anymore with masks and gloves (W14)
3.2 Theme 2: reacting to the ‘new ordinary’
I went out only for antenatal checks. I stayed at home for the rest of the time. (W1)
I was calm cause we have a small garden and my daughter could go out and have fun […] it was like a holiday at the beginning. (W16)
Yeah we felt a bit anxious cause we couldn’t go out. When my husband came back from work, he used to shower straight away. We were also afraid of going grocery shopping cause it was inevitable to have contact with other people there. So I used to wash all the grocery shopping with alcohol. (W4)
3.2.2 Threat of potential virus transmission
Thinking about what would follow [if testing COVID-19 positive], what could happen to the baby and the subsequent consequences was difficult. The separation from my partner would have made us feel even more isolated than what we already were. Not having a treatment available [for the virus]… entering something uncertain and unknown… (W15)
I wasn’t worried anyway cause we live in a small town where there have probably been 10 COVID cases with 2 hospitalisations in total. I wasn’t afraid [of catching the virus], we all felt a bit untouchable. (W16)
3.2.3 Communication of positive test
I was expecting it due to the family situation. (W10)
Yes it’s been a little bit of a cold shower… I immediately realised I would have had to self-isolate, I was worried for breastfeeding, I was worried. (W22)
3.2.4 Living with Covid-19 disease
My main worry was if the baby was positive too. I entered an abyss from which I came out after a long time. (W14)
Chatting with the midwife… I have been in hospital for 40 days and you establish a strong relationship… some of them told me they went away from their own place and they lived with each others [midwives] due to the fear of infecting someone at home […]. When they shared these things, I was even more afraid of me being the person infecting them. (W5)
My main fear was the baby and caring for her with this problem [having COVID-19]… the fear of not being able to breastfeed or holding her. I was also sad that my husband couldn’t be with me on labour ward so. I got discouraged. (W4)
At the beginning I imagined myself crying from morning to evening during the hospital stay. I actually reacted well instead. (W10)
3.2.5 The ‘new ordinary’
And then in the end I said well, it is what it is, let’s move on and I resigned myself to it. Let’s look to the future. I concentrated on the baby who was due to arrive and that was it. (W11)
I sympathised with the midwives’ struggling seeing me not being able to receive visits. Staying at the hospital for a month… you get used to it. I persuaded myself that it was the right thing cause I was [COVID-19] positive. (W2)
3.3 Theme 3: ‘pandemic’ relationships
3.3.1 Family separation and reunification
I was sorry cause my partner has not seen the baby anymore during pregnancy after the anomaly scan. It’s a missing piece, you can’t fully share these moments without being together. (W10)
I regret the fact that my husband couldn’t be present at birth. He’s a very important figure and he would’ve been of support. And I would have liked to share this moment with him really. (W11And then there was all the sadness of going back home and not being able to see him [partner], he couldn’t touch the baby and all those things. (W22)
Goodness yes, yes, I remember the separation really well. It’s been like an abandonment and I was also sorry for him. (W6)
I arrived at the emergency department and I had to say goodbye to my husband and go in on my own […] so I went in and he stayed outside in the car park [woman cries]. He saw her [baby] only on video. (W17)
It was very hard cause when I was breastfeeding I was always afraid of holding her for a little longer for a cuddle despite the mask, gloves and washing hands… I wanted to avoid the contagion (W16)
Touching her [baby] with gloves without feeling the skin, not being able to kiss her or do anything else… it’s like you can’t feel her […] that’s horrible. (W22)
They told me my baby was slightly [COVID-19] positive so they took him away from me. They took him away from me for two days and admitted him to the neonatal intensive care unit. I’ve been two days without my baby and it felt like a further abandonment. (W6)
Then another mum arrived in the room with me […] it was a bit hard cause when she arrived I didn’t have my baby back with me yet so seeing another mum with her child was not great […]. I told the midwives ‘I am here without my baby and you bring here another mum with her baby’. It was psychologically strenuous. (W6)
I lived with her this thing of seeing her baby taken away and it’s an awful thing. (W19)
I went out without even saying goodbye to my son cause I though I would go back home, then they actually admitted me to hospital straight away and I took it badly, I burst into tears as I thought all of a sudden my other child would not see me anymore. (W10)
My son asked me ‘mummy I miss you a lot, when are you coming back?’ […] He told his grandma “you can’t change the bed sheets cause then mummy’s scent goes away and I can’t smell it anymore when I go in her bed’. (W9)
I remember it was a Friday, it was a beautiful Friday as all the four of us were [COVID-19] negative at home and I could hug them all, husband and child, without a mask on. That’s when our life as a family of four started. (W19)
I threw the mask, my partner threw the mask too and finally we were able to kiss this baby which was the thing we were waiting for the most. (W22)
3.3.2 Maternity services and healthcare professionals
Can’t fault them, information was good and they sent all the links to join the online antenatal classes. (W15)
I have been left from 10am to 11pm on a chair, with no water or anything else, with giant breasts full of milk, to then tell me I was positive and that they were going to transfer me to the referral hospital. (W8)
Unquestionable kindness and professional manner. We made it even on time to let my husband know so he brought me the hospital bag. They’ve been kind but it’s still been a shock. (W16)
On several occasions they told me ‘Stay away, stay away, keep the 1 meter distance, go to that corner in the lift […] When they came in the room to wake me up at 6am they used to open the door shouting ‘masks!’. It felt like being in a barrack […] It was very annoying. (W10)
They were so good and compassionate that the fact they were harnessed became less important. […] You could tell from their eyes that they were taking care of you. They were there no matter what. (W2)
She made me feel like she was my sister, she didn’t go away not even for a second. (W18)
The midwives and other staff were always very kind and optimistic and this reassured me. They didn’t come in very often, I think they had to wear all the protective equipment every time they wanted to come in my room and the preparation was probably very long. So I noticed that the visits were made only when necessary. (W21)
I was admitted in advanced labour and I honestly expected to be more pampered and supported given that I was there alone […]. The doctor was tired and was hot so he sat on a chair with his eyes closed. The midwife was busy writing. Apart when she visited me and asked routine questions, she didn’t really consider me and wasn’t present throughout […] I was alone. […] Then on the ward it’s been the opposite, they’ve all been extremely caring, from the first to the last midwife. (W10)
3.3.3 Relationships’ facilitators/barriers
|Use of technology||Virtual contact with loved ones when physical contact was not allowed||Screen-mediated relationship|
|I could show her [baby] to him [partner] only by video. (W17)|
|We have maintained the contact with videocalls and calls (W10)|
|Self-isolation and family separation||Opportunity to establish emotionally intense and life-saving relationships with the midwife||Obstacle to partner’s participation especially at birth|
|Postnatal period spent with close family + limited interference from others||Limiting postnatal support from social network|
|Feeling alone in taking care of the newborn, with no breaks from it|
|She made me feel like she was my sister, she didn’t go away not even for a second. (W19)|
|During the hospital stay unfortunately you feel alone cause the contact with healthcare professionals is limited. You are in a room, you can’t go out and you’ve got to stay between those four walls. (W15)|
|Not having visits, you don’t even have a time during which you take a break, go to the toilet and have a shower. This aspect has been quite heavy. (W10)|
|Testing positive to Covid-19||Increased acceptance of distancing rules and separation due to feeling responsible towards safeguarding others’ health (partner, child and professionals)||When used by others as discriminatory factor|
|Sense of guilty generated difficulties in establishing mother-newborn relationship|
|Despite all mine and other people’s protective equipment, I noticed them taking a step back yet again. And I also perceived this when I went back home from the hospital. (W11)|
|I still have a sense of guilty for my baby. Due to me being positive you were born in a horrible ward without shower, with a stinking mother and I couldn’t even put clothes on you. I felt discgusting. I had gloves and a mask on and he [baby] wasn’t even able to see my face, I feel so guilty. (W14)|
|Social distancing and use of PPEs||Protective measures||Limiting ‘physical’ relationships and contacts with newborn and healthcare professionals|
|Activation of alternative communication strategies (e.g. non-verbal language)||Limiting postnatal support from social network|
|Mask and gloves allowed to have contact (even if limited) with newborn||Feeling alone in taking care of the newborn|
|Postnatal period spent with close family + limited interference from others|
|You can’t even see the person who assists the birth of your baby. I can’t even remember her behind the mask, gown, hairnet, glasses and visor. I wouldn’t recognise her now, no. (W14)|
3.4 Theme 4: sharing a traumatic experience with long-lasting emotional impact
3.4.1 Tragic and traumatic experience followed by resignation
I’ve lived it all as a nightmare really. (W14)
Sometimes it looked like we were at war, there was lack of water, few essential aids, you asked things and they came after a while. They’ve not changed my sheets in hospital for a week. (W3)
It’s been very challenging fighting this pandemic war […] and who’s lived it in first person like me and my family knows it’s hard, it hurts. (W8)
It was what it was, but it ended well (W9)
It’s gone, thank goodness, for us it went well in the end (W4)
Thank God nothing bad happened (W1)
3.4.2 Long-lasting emotional impact
Yes these things stay with you and leave scars (W19)
Even now, if I look at the photos taken at the hospital I feel like crying and down […] I’ve lived this experience really badly, just seeing a photo on my phone hurts me a lot [cries]. (W14)
This pandemic made me feel the greatest fear of my life. It consumes you not being able to kiss your kids cause you’re afraid of killing them, not being able to hug your mum after she’s been at home with your dead father for two days. It kills you seeing your kid not sleeping at night with panic attacks because he’s afraid his dad is gonna die. This pandemic has killed me. (W8)
Yes I have already contacted a psychologist. I’m not afraid of asking for help, I’m afraid of going out from home. (W14)
Now that he [baby] is here I must try and live the happiest that I can possibly be, otherwise we will never be able to fully live anymore in this situation really. (W3)
I am thinking I need to have a second one [child] to experience what I haven’t with this first child. (W14)
The day they’ve discharged me I saw an awful lot of people out and I cried cause I thought ‘why are all these people out, don’t they know what happen if you get the virus?’. (W5)
3.4.3 Recounting the experience
Yes, I am not a very chatty person and I must say I am sharing this experience with everyone. It’s useful to talk about it cause it’s a trauma, we’ve lived some traumatic moments so it’s important to vent somehow. (W11)
I’m starting now to talk about it cause until the last few days it’s not been easy […]. It’s true it’s all gone now but it’s still difficult. (W15)
5. Strengths and limitations
6. Conclusions and implications for practice
- •support and follow-up women and families’ socio-psychological wellbeing, giving the opportunity to share and recount experiences, uncertainties and concerns throughout the childbearing event;
- •allow asymptomatic birth companions of COVID-19 positive women to stay with them throughout labour and birth with provision of appropriate PPEs;
- •draft comprehensive and shared transfer guidelines, with a focus on effective communication and support;
- •consider transfer to COVID-19 referral centers only for women with severe COVID-19 symptoms;
- •provide compassionate care at all times, especially during the critical test results’ waiting time with a focus on the individual's loneliness and isolation;
- •provide comprehensive communication of information, including maternity care pathways (e.g. in case of COVID-19 positive or negative test result), potential transfer to a referral centre and safety measures in place. Women should be given the opportunity to ask questions and share concerns/doubts;
- •implement alternative ways of communication and information provision such as virtual (or social-distanced and with use of PPEs if allowed by government rules) antenatal/postnatal classes and visits;
- •offer antenatal and postnatal home visiting from community midwives following a continuity of care model when possible;
- •support women in drafting a birth plan in order to decrease unmet expectations and increase awareness of different care pathways;
- •implement supporting measures to balance shortfalls caused by the birth companion not able to be physically present during labour, birth and in the postpartum period;
- •provision of professional, competent, emotional and compassionate support from caregivers, with healthcare professionals maintaining adequate contact with women and newborns using PPEs.
Conflict of interest
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