Overall, twenty-four participants were interviewed. The women included in the present analyses were 26 to 42 years old (M = 35.38, SD = 4.43) and were recruited from the aforementioned hospitals in the Region of Madrid. Additional maternal characteristics are shown in Table 1.
Table 1. Maternal Characteristics.
Characteristics
|
Frequency (n)
|
Percentage (%)
|
COVID-19 disease
|
|
|
No
|
19
|
79.16%
|
Yes
|
5
|
20.83%
|
Parity
|
|
|
None
|
20
|
83.3%
|
One
|
2
|
8.3%
|
Two or more
|
2
|
8.3%
|
Smoking before pregnancy
|
|
|
No
|
1
|
4.20%
|
Yes
|
23
|
95.80%
|
Smoking during pregnancy
|
|
|
No
|
24
|
100%
|
Yes
|
0
|
0%
|
Occupation
|
|
|
Active job
|
8
|
33.30%
|
Sedentary job
|
12
|
50%
|
Homemaker
|
4
|
16.70%
|
Previous miscarriage
|
|
|
None
|
15
|
62.50%
|
One
|
9
|
37.50%
|
The findings from the interviews are presented as three themes: time availability, home confinement and COVID-19. Quotes of the study participants are labelled in line with the personal identification number assigned to each interview (Example: PI-1). Figure 1 shows the conceptual map with the relationships of the themes after the analysis of the data. The period of restrictions generated by the pandemic has created a special situation not previously experienced by the population. Three themes emerged clearly connected with the supervised online exercise program. The study participants highlight two realities resulting from the restrictions: on one hand, the availability of more time in their day-to-day life and, on the other, the lack of mobility caused by home confinement. In addition, the experience of the potential threat posed by the presence of the virus and the possibility of infection have nuances that are related and require exploration. Below, we have described each theme and presented representative participant quotes.
3.1 Time availability
The study participants stated that the greater availability of time had beneficial effects on their experience throughout the gestational period, including improvement in their quality of life and accessibility to exercise.
“It has influenced me a lot; I practice much more exercise than before I was pregnant and confined. When I work, I can´t practice three hours of exercise a week, no way, in fact, my biceps are stronger now than before. So yes, I am grateful that I had more time for doing the physical exercise program. (PI-5).”
“In my experience, being confined has helped me to practice more exercise because it has also been an escape route. I was able to keep a weekly rhythm that I would not have had without confinement.I was also able to perform tasks that I could not do in my day-to-day, such as reading or watching movies” (PI-23)
The increased availability of time, is also related to two other aspects that manifested from the interviews: greater adherence to the physically active pregnancy program and an improvement in their eating habits (see below).
3.1.1 Adherence to the program
COVID-19 lockdown has been a real advantage in the lives of pregnant women when it comes to engaging in exercise, because participants felt they had more control over organizing their time and could attend all classes within the week. In addition, although the general preference appears to be face-to-face classes, women are receptive to exercising in a group online as well.
“If I had done it in person, it would have been much better, right? Well, maybe I couldn’t go to Leganés [face-to-face program location], in my case, it would have been complicated. I prefer to go to the place in case you have doubts about the positions.... well, it’s more personal. I prefer face-to-face classes, but during confinement the online program was very good because, otherwise, I would not have done anything, it was a real discovery and it helped me a lot”. (PI-3)
“Okay, it did have an influence because, from March until June they already lifted the “punishment”… Well, the truth is that I couldn’t leave the house, exercising personally was an incredible experience for me. It was a hard start to train but once I did, and also my husband did it with me too, it was good. It made me feel good, well, after all, within what we have, we have to adapt to this and, well, practicing exercise and also being able to chat to the moms who talked and told you things it was fantastic. Well, emotional and support levels it has been good “ (PI-1)
Women emphasized that the online exercise classes is a contributing element to achieve optimal physical and mental well-being.
“Yes, of course, I’m participating in the program and it’s nice and we’re all grateful, but I don´t know how we would be, among the confinement, the extra kilos… In my case, I have stenosis and doctors tell me I shouldn’t gain more than nine kilos during pregnancy, so it’s been fundamental because the program helps me control my weight.” (PI-2)
Lastly, the study participants mentioned that the virtual group allowed for connectivity, support, and sisterhood, establishing a socio-affective bond with the rest of the participants.
“I liked very much to see all the bellies moving and even though it is only an hour and we do not know each other but you listen to how others feel: I have gone through this, I have gone through this other, and the experiences that they also told in the group, I enjoyed it very much. (PI-10)
3.1.2 Improved diet
The study participants considered that this time availability has been a necessary resource to be able to eat a healthier and a more complete diet. Confinement has led to changing the type of food they were eating for healthier options, cooking more often and weekly meal planning.
“I think I cooked, more or less, the same. Maybe I cooked healthier because being here, so long, at home and having more time helps me to cook better and choose healthier and less processed foods. […] and, maybe, I have also cooked more quantity for more days and healthier by having more time." (PI-2)
Yes, I changed. I spent more time cooking because I was at home teleworking. We work in a company where they give us food, we have a canteen there to eat, so fortunately, due to COVID we have stopped eating food soaked in oil, so it has been very good for us. I have also not gained excessive weight during my pregnancy, so it has been cool, so… well. ... yes, I’ve changed. (PI-6)
Finally, a positive connection between attending the supervised online exercise program during pregnancy and an improvement in eating habits was apparent. Women suggested that participating in the class allowed for identification of prior control over their diet, and they felt encouraged to follow dietary guidelines to have a balanced and healthy diet.
“Well, yes, I think so, because it seems that you stop exercising […], and you enter into a dynamic of… you don't exercise, and you are also eating badly. So I think yes, it helped, it helped a lot. Besides, it is also a psychological component […] as you are happier, you do everything with more motivation to continue eating well. " (PI-17)
"Yes, because you're exercising and in the end you encourage yourself to go on a better diet, everything goes together I think, because you start if you let yourself go, you don't exercise or diet or anything". (PI-7)
3.2 Home confinement
Participants described their pregnancy as ‘peaceful’ and they felt ‘stable’ at home during the confinement period. They felt that home confinement causes a substantial increase in the feeling of freedom from danger while the outside world is perceived as a threat to their pregnancy and postpartum health.
"Let's see, the truth is that I have not had it ... well, the typical pregnancy. I have not had stress or anxiety or anything, being at home was fine, I would even tell you that it was better for me. " (PI-13)
"If I stay two more months locked up at home, nothing happens." (PI-1)
The study participants state that they have experienced a sense of security and tranquillity within their homes, declaring in most cases that they did not have the need to go outside. In the same way, the exercise program has been used as a strategy to occupy the hours of the day and decrease sedentary behaviours.
"Yes, the truth is yes. I started the face-to-face with a great enthusiasm. I started the day after they told me. It has served a little to force you to stay active during the confinement. If I hadn't started the program, I would have probably spent the whole confinement lying on the sofa. Maybe climbing the walls, pulling my hair, and saying for goodness's sake, I want to get out of my house! But the truth is... that it has been very good for me.There came a time when you do more sessions because: what do I do? Well, I'm going to do another session, I don't have anything else to do.". (PI-1)
3.2.1 The situation generated by the coronavirus pandemic
COVID-19 generates uncertainty in this population as it is a situation not previously experienced. This fact mainly affects the feeling of safety when different variables come into play that cannot be fully controlled by women, such as the contagion of COVID-19 in their relatives, exposure to their baby and the possible lack of control over their own health during pregnancy, delivery and postpartum. However, virtual exercise classes had an indirect effect on the fear of contracting COVID-19 because women felt healthier because they are physically active. We further elaborate on these findings below.
3.2.1.1 Direct impact of COVID-19 on their relatives and the baby
Within the family group, pregnant women often stressed that the main cause of increased anxiety was caused by worrying about the severity of the virus if a family member were to be infected, fearing deaths among their close relatives. In addition, women who have had children before report feelings of concern and helplessness with the virus potentially infecting their child.
“I was worried with coronavirus, that my mother, my grandfather, my grandmother had it in my family and I had been in contact with all of them. Then I went into a total panic. " (PI-20)
"Yes, in all honesty, my father is currently in the hospital and he has tested positive for COVID. He is asymptomatic, but I am afraid that we might catch it. Furthermore, my father is a dependent person, and he has not left home, so we do not know how he has caught it". (PI-14)
Relating to the baby, the main concern is of a possible transmission of COVID-19 to their new-born. When the baby is inside the womb, they are perceived as a protective barrier between the baby and COVID-19. However, after labour, an inordinate fear arises when they lose that control over their child.
"Right now, I am a little more worried because I think I am going to test positive for COVID. I don´t know how it could affect the foetus although everyone has told me that there is no vertical effect, and nothing has to happen. Now, I’m ok. In fact, I have just measured oxygen saturation in my blood, and everything is perfect, so the baby should be perfect, and he moves around a lot, so that is a good sign. (PI-12)
3.2.1.2 Direct impact of COVID-19 on health emotional balance
The changes that may occur in hospital management due to the evolution of the pandemic have been another source of disruption to women's perceived safety during the pandemic and women also report feelings of impotence and forgetfulness during this period. Likewise, women report that facing motherhood within these circumstances, generates great confusion and uncertainty about their future, living a new reality where isolation and distance appears to be more encouraged than socialization.
"That I couldn´t go to the hospital, the need that if something happened, it was not a safe place, paradoxically enough" (PI-18)
“In the end, facing motherhood in this situation. All new changes in my life… I feel sorry for the situation. I would love my child to be born, to have a relationship with his family, and the new normality is very cold. I have been suffering from it for a long time and this new reality is terrifying". (PI-21)
3.3 Suggestions for improving the exercise program
Finally, the study participants understand the limitations of the tools available for exercise during home confinement, but add that some better recording and editing tools would increase the quality of the program. Although the general preference is to have face-to-face classes, the women find that the online program is a new reality. To improve future online exercise classes they emphasized that there should be flexible schedules, thorough explanations of exercises before starting the program, and continuous individualised feedback from qualified trainers.
3.4 Quantitative results
The mean of STAI questionnaire scores was 32.23 ± 9.31 with minimum and maximum values of 17-47. There were no differences in STAI scores compared to women who chose to not participate in the interviews, or when comparing women who tested positive for COVID-19 versus no infection.
The results show that low anxiety was identified in 42.7% and moderate anxiety in 58.3% of the participants. Among the pregnant women interviewed, no high levels of anxiety were recorded (Table 2).
Table 2. Descriptive data of scores of women interviewed for each subgroup of the STAI questionnaire.
|
n
|
M ± SD
|
Minimum - Maximun
|
Low anxiety
|
10 / 41.7%
|
22.33 ± 2.74
|
17 – 27
|
Moderate anxiety
|
14 / 58.3%
|
39.3 ± 4.37
|
33 - 47
|
High anxiety
|
0 / 0%
|
0
|
0
|