“I had so many life-changing decisions I had to make without support”: a qualitative analysis of women’s pregnant and postpartum experiences during the COVID-19 pandemic

Abstract

Background The COVID-19 pandemic has posed profound challenges for pregnant patients and their families. Studies conducted early in the pandemic found that pregnant individuals reported increased mental health concerns in response to pandemic-related stress. Many obstetric practices changed their healthcare delivery models, further impacting the experiences of pregnant patients. We conducted a survey study to explore the ways in which COVID-19 impacted the lives of pregnant and newly postpartum people. Methods A mixed-methods survey was distributed to all patients ≥18 years old who were pregnant between January 1st, 2020 – April 28, 2021 in a large Midwest health system. Open-ended survey responses were analyzed for common themes using standard qualitative methodology. Results Among the 1182 survey respondents, 647 women provided an open-ended response. Of these, 77% were in the postpartum period. The majority of respondents identified as white, were partnered or married, and owned their own home. Respondents reported feeling greater uncertainty, social isolation, as though they had limited social and practical support, and negative mental health effects as a result of the pandemic. Many cited sudden or arbitrary changes to their medical care as a contributing factor. Though in the minority, some respondents also reported benefits from the changes to daily life, including perceived improvements to medical care, better work-life balance, and opportunities for new perspectives. Conclusions This large qualitative dataset provides insight into how healthcare policy and lifestyle changes impacted pregnant and postpartum people. Respondents expressed similar levels of uncertainty and mental health concerns compared to other cohorts but less overall positivity. Our findings suggest greater attention be given to the impact of pandemic-related stress on pregnant and postpartum women. As the pandemic continues, these data identify areas where investment in additional support may have the greatest impact.

Influence of the COVID‐19 pandemic on prenatal and postpartum patient experiences and well‐being

“…This may be a product of the health system's ability to successfully pivot to alternative modes of care with minimal disruptions to patient care, based on their prior experience implementing similar programs 17 . Even with the change to virtual visits, analysis of open‐ended responses found that some respondents viewed the flexibility offered by virtual appointments as a benefit 13 …”

Risk Management-Obstetrics and Gynecology Perspective

“…As it relates to new problems, the pandemic punctuated the health disparities that exist based on income and race. 10 From a patient perspective, the following were amplified, access issues, underlying health disparities, and access or lack thereof to vaccines. From an industry perspective, workforce shortages, supply chain barriers, and provider fears were noted.…”

“…Furthermore, pregnancy was classified as a comorbidity for SARS-CoV-2 disease, which increased the risk of maternal and fetal death by 70% and increased the risk of perinatal complications, and heightened patient and provider anxiety. 10 These stressors have impacted the patient risk for adverse events making the health care risk management perspective imperative for physicians.…”

“…Also, there were cancellations of routine testing and elective procedures, fear of intrauterine SARS-CoV-2 transmission, and controversy regarding coronavirus disease vaccination during pregnancy to name a few. Furthermore, pregnancy was classified as a comorbidity for SARS-CoV-2 disease, which increased the risk of maternal and fetal death by 70% and increased the risk of perinatal complications, and heightened patient and provider anxiety 10. These stressors have impacted the patient risk for adverse events making the health care risk management perspective imperative for physicians.…”

“…Notably, since family members were restricted from hospitals during that time, it remains to be seen whether the absence of those patient champions resulted in an increase in adverse events and medical malpractice claims. As it relates to new problems, the pandemic punctuated the health disparities that exist based on income and race 10. From a patient perspective, the following were amplified, access issues, underlying health disparities, and access or lack thereof to vaccines.…”