This descriptive phenomenology study was conducted on 20 pregnant women in a time-frame between the 10th to the 20th of May, 2020. The mandatory quarantine period (20th of March to the 3rd of April) had come to an end by the time the study was about to begin. The participating women were already pregnant when the first signs of the epidemic (19th of February) appeared in the country. Table 1 shows the specifics of the participating samples. In one of the interviews, one of the pregnant women stated: “I can seriously say that my anxiety and fear has doubled and includes anything and everything that could come to a person’s mind.” We directed her to a psychiatrist due to the possibility of mental illness. We acquired four themes including disruption of the tranquility and regular routines of daily life, new challenges caused by the epidemic, resilience and strength in facing the crisis, and adaptation with new conditions (Table 2).
Theme 1. Disruption of the tranquility and regular routines of daily life
This theme consists of five sub-themes in the areas of psychological responses related to stress, fear, anxiety, depression, loneliness, and lack of support from related organizations. We found five Sub-themes in the area of behavioral responses, including practical obsession, adhering to the quarantine and adhering to the sanitarian protocols, changing lifestyle, and following the news.
1.1. Intense Stress
The pregnant women were under intense stress for the first few weeks after the official confirmation of the epidemic in the country. This stress rose as the infection and mortality rates increased.
“In the beginning I wouldn’t even let my husband go to work. I was afraid of shopping or anything else that required contact with other people.”
“I was highly stressed and did not leave the house for a month. The only place I visited was my father’s house in Mashhad, because I was assured that they too were in self-quarantine.”
“I was not so stressed in the beginning but became so as the mortality rates increased.”
1.2. Fear of Infection
The pregnant women were highly afraid of becoming infected in the time of their pregnancy and childbirth. Since the health of a fetus and its mother is inseparable, this fear was mostly for the safety and health of the former. The women were afraid of busy places such as hospitals, of miscarriage due to the corona-virus, and of their children or companions becoming infected in the hospitals.
“It’s because no matter how careful you are, you’ll still be in close contact with the nurses and the midwives… especially the infant.”
“I was in my 5th month in March when I saw a clip of infected womens who had successfully given birth and were being treated. I was constantly stressed by not know what would happen to my unborn baby if I were to get sick. Would I have to abort? Would my child become sick too?”
“I would even cry whenever I’d hear that a newborn was infected. I didn’t want this to happen to me.”
“I am in the 38th week and I am worried about the hospital. I heard that the virus has involved all the hospitals. I am worried that my baby, my companion, or I would get the infection.”
The pregnant women were aware of the effects of stress in times of pregnancy. They had heard that a pregnant woman is more vulnerable towards COVID-19 compared to others. In some of the cases, pregnancy itself was high risk for the women, and this would worry them. Another source of distress for women was that, since the start of the pandemic, hospitals no longer allowed entry to companions and family members. The pregnant women also experienced other worries (as experienced by non-pregnant individuals), such as their husbands or older and sickly family members becoming infected. In some ways, the worry for the husbands becoming infected was because of the close nature of husband/wife relationship, and in reality a worry for the woman herself to get infected as a result. Some were also thinking about the possibility of the infection to pass to the infant through breastfeeding.
“What can we do with so stress these days? With these stresses, how we can be healthy women and give birth to a healthy child.”
“Is it true that pregnant women are more vulnerable to this infection? Are they immune system deficient?”
“I take care of myself but my husband go out. What can I do if he gets the virus and transmits it to me?”
“Right now my anxiety about corona is due to me having to be alone during childbirth. I wish that it would not continue.”
“This is my first pregnancy after trying for ten years. Maybe this why I am so worried.”
“I’m more concerned for my husband and my parents than myself. I was in home-quarantine but my husband had to leave every day for work. His job has him be in contact with many people.
“My husband would wear a mask whenever he left the house, but he didn’t care as much as I did, and that would add to my worries.”
1.4. Sense of Loneliness and Lack of Support
The pregnant women felt that they were not being sufficiently supported during this epidemic. They complained of the closing of the clinics, the push to make women avoid visiting health centers, and the lack of health-package allocation to pregnant women.
“The thing that I was unhappy with the most was that no organization provided support to pregnant women. I expected the Health Ministry to be more caring to high-risk individuals such as pregnant women, but they didn’t even give us masks.”
“I couldn’t find any masks when I had to go to the hospital around the 8th of April. They didn’t care enough to provide us with any, but would remind us that we must not enter without a mask.”
“Most of the physicians closed down their clinics. They are still closed. I was forced to visit the doctors in the hospitals. I was in that unclean environment from 9:00 to 13:00. The hospital is supposed to care for pregnant women, but unfortunately, it is not. I expected the hospital beds to have disposable sheets, used only once for each individual. There’s not even enough room there to sit down. They wouldn’t let us in the hallways and said that we had to wait in the yard. The seats were all filled by people who had accompanied other patients, sometimes from out-of-town.”
1.5. Depression and Loneliness in Quarantine
Although quarantine had resulted in the decrease of stress and obsession in the women, it had also resulted in the experience of loneliness and depression.
“Being imprisoned in the house and not being able to visit my family and friends for a month made me feel depressed and agitated.”
“I didn’t leave the house at all. I was going crazy with depression. I was sick of the house because I was alone.”
“My lifestyle was moving towards increased loneliness. I mean, I was becoming a solitary person because I had not seen any other people for so long. My family do not live in this city. I was very lonely.”
1.6. Practical Obsessions
The women themselves felt that they had become more obsessive in thought. This obsession manifested itself practically in repeatedly disinfecting surfaces, washing hands, fruits and vegetables, and a heightened sensitivity towards their husbands adhering to the sanitation protocols.
“I overdid it in the beginning. It was as if something had possessed me, and forced me to disinfect the house several times every day. My hands were completely ruined.”
“I was constantly reminding my husband. Constantly asking him about whether or not he has washed his hands is annoying to the both of us.”
“Certainly, everything becomes an obsession. Even now, I wash every fruit I buy and package it in clean plastic bags, and then wash them again before eating.”
1.7. Change in Nutrition
The nutritional intake of the pregnant women changed based on suggestions that were common in the beginning of the epidemic. Some of these changes included: abstaining from consuming bulk foodstuff and food from the outside (restaurants etc.), and consuming more cooked food and specific fruits and vegetables.
“Lemon consumption increased. We used to buy yogurt from local shops, but now we only buy the large packages from companies. We eat more cooked food. We no longer buy pickles and cheese in bulk. I make my own pickles, and we only buy pasteurized cheese.
“There was a lot that I wanted to eat outside but I couldn’t because of the virus. I still haven’t at all.”
1.8. Adhering to Quarantine
The pregnant women adhered to the quarantine very well. They stated that doing so had reduced their stress and obsessive behavior. Although it is common for Iranians to travel and visit their families during Now’Ruz (New Years), the pregnant women stayed at home and did not go on holidays.
“There was no New Year’s meet-and-greet this time around. I haven’t let anybody come to our house for the past 3 months. We only keep in-contact via telephone.”
“Me, my husband, my parents and my brother were all in quarantine outside the city and away from everybody else. I did not have any Corona-related stress because I closely followed the quarantine rules. For 2-3 months, I wouldn’t even roll down my car windows whenever I was in the city.”
1.9. Adhering to Sanitarian Protocols
Sanitarian protocols quickly went viral on the television and social media and the women would follow and adhere to them in detail.
“My husband and I closely follow the rules and always wear masks and gloves, and carry disinfectants with us.”
“In the beginning I would bring my own sheets to cover the beds in the sonography and other clinics. Sometimes I would even use my chador (veil covering the entire body) and then wash it once home.
“I’ve put a container in a corner of the kitchen and I put everything that comes from the outside there first so they are not in contact with anything else. Then I start washing them.”
1.10. Following the News
Most of the pregnant women initially followed the news via virtual (social networks) and official (television) channels but later avoided doing so – especially in the case of social media networks – to reduce stress and anxiety. Most of the women expressed lack of faith in the truthfulness of statistics provided by the Ministry of Health.
“I was always waiting for news and constantly followed it whether on the TV or social media because they were important to me.”
“I decided to pay less attention to the news after a while because it caused me a lot of anxiety.”
“My stress increased gradually and I was constantly worried of losing someone which really depressed my mood. It got much better once I abstained from social media for a while, but usually a single piece of bad news was enough for me to feel down for the rest of the day. I mostly followed the news via television, even though I knew the statistics provided is false. But at least they didn’t exaggerate things morbidly like they do on social media.
“I saw on the internet and satellite TV that the pandemic has reached Iran. Watching videos of people falling on the ground caused me great fear. I experienced a lot of stress and decided to abstain from social media for a while. It made me feel better.”
Theme 2. New challenges caused by the epidemic
The epidemic caused a lot of problems for the pregnant women such as the push to prevent people from visiting health centers, the closing-down of some clinics, the week-long New Year’s holidays, and the shortage of health products.
2.1. Problems in Acquiring Health Products and Lack of Facilities
In the beginnings of the epidemic, there was a noticeable shortage of health products such as hygiene gels and masks in the hospitals, health centers, and pharmacies.
“Initially I could not find any masks at all. I think the Health Ministry should have provided a package including these items just like it does with the drugs it provides pregnant women.”
2.2. Disruptions in Receiving Health-Care
Women mentioned some disruptions in receiving health-care in the beginnings of the epidemic such as cancellation of pregnancy-related appointments, the closing-down of some specialist private offices, the wait-times for visits in hospitals, and the crowds of visitors in sonography and other types of clinics.
“The fear, stress and the warnings by the health ministry have made me no longer visit my doctor or other health centers. I’ve been having cramps for two weeks and it’s getting worse. I’m afraid of giving birth pre-maturely.
“The clinic overseeing me is very busy and they don’t follow the protocols. They won’t give appointments by the telephone either. It always bothers me and my back gets hurt”
2.3. Cancellation Childbirth Preparatory Classes
Childbirth preparatory classes have become common in recent years. Usually, after attending the classes, the women could select their own midwives. The cancellations of the childbirth preparatory classes initially worried the pregnant women who looked forward to them.
“All the preparatory classes by the hospitals got cancelled and there were talk of us having to wait until after the New-Year’s holidays for things to go back to normal. We waited but things did not change.”
“With the closure of the classes, we do not learn anything; so, at the time of labor in the hospital, midwives would say that you do not know anything.”
Theme 3. Resilience and strength in facing the crisis
3.1. Creation of a WhatsApp Social Media Group
Pregnant women’s responses to the creation of the whatsApp online group were generally positive and welcoming. This group comprised of pregnant women, midwives from health centers, and some faculty members.
“There was a counseling group and you could ask questions, which is ideal and great. In my opinion, it should continue even after Corona. I read the content and trust it since it’s written by experienced midwives. I feel comfortable knowing that the information is from a verified source. Also, you can always ask questions from the midwives or other women like yourself.”
“I’ve only been a member for a 2-3 days but it has still been useful to me in this short time. I’m very grateful that you answer our questions and it’s great to know that the person answering them is an experienced.”
3.2. Holding Virtual childbirth-Preparatory Classes
Women found the idea of online preparatory classes useful and were keen to participate in them.
“The most important event that occurred in the time of the Corona were the virtual classes. They greatly increased my understanding and gave me hope, since I was already looking for information. I did the exercises slowly and carefully. You could even save the videos so you don’t forget the small details.
“I definitely think it was necessary and I really appreciated it. Thank God the Corona couldn’t take this away from us.”
“Virtual classes are easier and they won’t waste your time, but of course the quality is better in-person. Still, it’s better for the pregnant women who cannot sit for long.”
- Adaptation with new conditions
4.1. Reduction in Stress
The findings show that the level of stress has decreased as time passed. Some of the women spoke of reductions in their stress levels and obsessive behavior.
“I don’t worry much about getting infected because I follow the guidelines.”
“My obsessions have subsided significantly, because I spend most of the time at home. First off, I follow the sanitation guidelines, and next I’ll continue living a stress-free life with the help of God.”
4.2. Regulations in the Levels of Adherence the Sanitarian Protocols
Due to the reduced stress, most of the women have revised their obsessive adherence to the sanitarian protocols.
“I relaxed a bit after Eid-e-Fitr. I had previously quarantined myself, but now I leave the house, albeit by following the protocols. I even allow some guests to visit us, but I always give them disinfectants to clean their hands first-thing.
“I no longer have the same fear, though the cleanliness habits have remained.”