The present descriptive-interpretive phenomenological study was conducted on 12 birth attendants. Table 1 shows the demographic characteristics of the participants. The real-time experiences of birth attendants taking care of pregnant women suspected/infected with Covid-19 in the delivery department are summarized in Table 2 under the four themes: 'Lost Peace,' 'Spirituality,' 'Pride,' and 'Looking Forward to a Better Future.
Theme 1- Lost peace
This theme consists of four sub-themes, including: "social isolation", "family separation", "psychological tensions" and "occupational challenges".
Subtheme 1-1 Social Isolation
The birth attendants who were obliged to take care of pregnant mothers suspected/infected with Covid-19 during the pandemic period, felt lonely and isolated due to limiting and avoiding communication with others, and the pressure they suffered as a result of this isolation, made them regret not meeting their relatives and family members:
"I confined myself to the hospital and home. I couldn't even visit my family for a long time. I felt lonely." (Midwife/35 years of work experiences)
Several participants talked about their sense of isolation while being cautious:
"Our lifestyle was changed with this isolation. Since we didn't want to expose others to danger, we gradually became an isolated person. Because for a long time, we didn't see anyone other than our classmates and maternity staff. I couldn’t visit my family and I felt very lonely." (Residents of Obstetrics and Gynecology/ 3 years of work experiences)
"I don't feel very comfortable about visiting my parents or the family members. I'm afraid to make them sick or I get infected by them and then go to my house. I think all the people are somehow isolated, especially the medical staff who are on the front line, who have a lot of responsibilities and suffer from more isolation." (Midwife/12 years of work experiences)
Subtheme 1-2 Family Separation
Being careful about health and working in the hospital environment causes more isolation and withdrawal from social relationships in the family, and being far from their closest family members, i.e. spouses and children:
"The situation at home was very difficult for me. I was going crazy. I was even afraid to hug my child and I missed him." (Midwife/14 years of work experiences)
A lot of participants were concerned about infecting their family members. They talked being far from family members. One of the participating midwives noted to fear infecting her partner and that she kept away from him and didn’t visit her husband for almost 11 weeks:
“I think I was right about getting distancing from my husband. I had to do this to protect him. Because if there was a possibility of his infection, it would only be because of me, and the thought that this would cause me to lose him was too much for me. So, all I could do was keep working and stay away from him so I could protect him." (4 years of work experiences)
Subtheme 1-3 Psychological Tensions
Being in contaminated medical environments and labor departments that housed infected or suspected pregnant women has been associated with experiencing a lot of stress and obsession in the medical staff and the birth attendants. On the one hand, the birth attendants were afraid of being infected with the virus, and on the other hand, they were worried about the health of the mother and infant. Since the health of the mother is not the same as the infant’s health, a large part of this fear and obsession has been for the safety and health of pregnancy and childbirth.
"No matter how careful we are, it is still not enough, because in addition to the stress and obsessions that the birth phenomenon itself brings to us, the emergence of such unknown conditions makes the work more difficult than before, because we are in contact with mothers and infants, and sometimes we may transmit the virus to them, or as a result of the fear of transmitting the virus, we may not provide them with the care they should." (Midwife/1.5 years of work experiences)
The birth attendants are worried about their performance regarding the care of mothers and infants who are suspected or infected with Covid-19, or whether the recommendations and instructions given to them were helpful or not:
"When we had a delivery, no matter how successful it was, its treatment was still a challenge for us, we were constantly stressed and did not know what would happen to the newborn infant, if he/she is effected, whether is breastfeeding suitable, or about the contact between mother and infant." (Midwife/15 years of work experiences)
Some other birth attendants expressed their concern about the increased sensitivity of their work during the pandemic and their greater responsibility:
"There are more responsibilities and work pressure in caring for mothers infected by Covid-19. In this condition we have more responsibilities to make sure what we are doing right and they're 100% okay." (Residents of Obstetrics and Gynecology/ 3 years of work experiences)
One of the psychological tensions faced by the birth attendants has been the involvement of mothers and infants in the covid-19 virus and being worry about their deterioration:
"When the test result of a newborn was reported positive, it made me crying. I didn't want this to happen to any baby." (Midwife/1 years of work experiences)
"we are always concerned that pregnant mothers do not get infected during labor. It would be very bad if they get infected in the hospital. We won’t forgive ourselves if we make them get infected." (Midwife/29 years of work experiences)
The birth attendants became obsessed with the health of the mother and the baby, and this obsession showed itself in practice with the continuous monitoring of the mother during labor, and uncertainty about the health of the fetus:
"At first, I was overdoing it. Something forced me to visit the mother a thousand times, to constantly check the infant’s heartbeat. When completing the report, I thought about the problems about the heartbeat and I was afraid of not understanding it." (Midwife/1.5 years of work experiences)
"I kept reminding the mother about not taking off the oxygen mask, so that the oxygen level be enough. I knew that this kind of reminding was annoying for both of us." (Residents of Obstetrics and Gynecology/ 2 years of work experiences)
"Because the sensitivity of this group is higher than all other patients, it is normal to be obsessed with them in this situation." (Obstetrician/ 10 years of work experiences)
Subtheme 1-4 Occupational Challenges
Midwives were aware of the challenges that the pandemic had created in their work environment. They knew that pregnant women and infants were more vulnerable to covid-19 than other people. Adapting to the new conditions, following the instructions that are constantly being updated and were accompanied by many defects, long-term placement without rest in personal protective clothing, all of them are issues that make working in this department difficult and challenging for them.
"In the first days, we didn't know what to do with all that stress. How could we do our job properly in such a stressful situation? The patient load was high. In addition to the maternity ward, we also had to cover pregnant mothers hospitalized in other departments. Our workload and stress were more than ever. With such a situation, how could we help a healthy and safe childbirth?" (Obstetrician/ 10 years of work experiences)
"Putting on and taking off the overall clothes was really exhausting. We also had to observe infection control. The order of putting them on and taking them off was very important in order to minimize the risk of transmission and contamination. But with all those clothes, our activity was limited. It was very difficult to work with all those masks, shields and thick clothes. We were sweating and couldn't do our work properly." (Midwife/15 years of work experiences)
The lack of basic preparation and the lack of familiarity of the actors with the correct processes of caring for mothers and infants with corona virus is one of their most important challenges:
"When I entered the respiratory isolation ward as a midwife in covid-19 section, it was difficult for me to work, because we were not taught anything, the lack of practice and repetition caused forgetting the processes that they explained to us, I just knew that I should not work without personal protection equipment." (Midwife/1.5 years of work experiences)
The personnel who worked in large and referral hospitals have faced many problems in accepting pregnant mothers. In addition to being forced to accept corona virus mothers, they should also accept healthy mothers in this sense, and managing these two groups together is often considered a serious challenge:
"Because most hospitals prevented the admission of infected pregnant mothers, only this hospital and another one were referrals for Covid-19. We had to accept infected mothers under any circumstances. The environment was really unsafe and contaminated, and respiratory triage was not performing properly. Unfortunately, the situation was like this. In addition to infected mothers, other pregnant mothers were also referred to here for any reason. There was not even enough space for them to sit. A lot of them had to wait behind the door. There was only one isolated room for hospitalization, and if the mother was suspected and infected, she had to be hospitalized in a normal room. This would put both the midwives, and even other mothers and other infants into danger." (Residents of Obstetrics and Gynecology/ 2 years of work experiences)
Carrying out the duties of the maternity staff, along with witnessing the cases of mothers and infants suffering from covid-19, especially the severe course of the disease, has made the working environment more difficult for them:
"It was very difficult and painful to witness the corona virus mothers dying, to see them getting sick in front of your eyes and you did everything you could and couldn't save her. The virus activity was unknown to us. Some of them had clinical symptoms unrelated to Corona, but over time the patient's condition worsened. We did everything we could, but we lost a lot of people. It was one of the worst memories of my work experience. Losing Mother and infant are always hard, but losing them like this is the hardest." (Obstetrician/ 10 years of work experiences)
Theme 2- Spirituality
Most of the participants mentioned the spiritual dimensions of working as a factor in giving birth in pandemic conditions. This theme consists of two sub-themes "in the field of divine test" and "demanding from God".
Subtheme 2-1 in the field of divine test
Midwives or gynecologists, whether during labor care, childbirth or postpartum, sometimes have to communicate with mothers despite the dangerous conditions, and in this condition test their patience and tolerance:
"When I entered the isolation room, I tried to keep calm. I shouldn't have let myself get nervous and stressed." (Midwife/14 years of work experiences)
"Being calm and increasing the tolerance are essential elements in therapeutic relationships. Working with mothers infected with corona virus showed that it is more important to have patience and tolerance in these conditions. Everyone needs to be strong for working in these conditions." (Midwife/20 years of work experiences)
"Personally, I am a very energetic person. I am not afraid of such events. Corona made me understand why God chose me as a midwife. I was chosen to be here and help mothers in this situation." (Midwife/4 years of work experiences)
"I am here for a reason. God has great goals and dreams for me. The emergence of this virus, my profession as a midwife, my specialty, all of these are tied together, what God has planned for me." (Midwife/29 years of work experiences)
Subtheme 2-2 Demanding from God
Almost all the personnel and participants of the present study mentioned their relationship with God. They understood the presence of God in all stages of their work and by more trust, they found the ability to deal with the conditions and provide the best services:
One of the midwives described the relationship with God very well:
"The profession of midwifery is a sign of God's power. We see this sign every day, and now we can't do anything without God’s help. We move forward in all the steps with the name and remembrance of God. We constantly ask God for help. First, we ask him to keep the mother and the baby healthy, and then to keep us, our colleagues, and our family healthy." (Midwife/12 years of work experiences)
Another midwife described God as a source of strength and guidance:
"The source of our strength is God. If we have been able to endure so far and have not collapsed, it is because of the strength we get from God. I always ask God to fix my work. It is not easy, the health of two people with a dangerous disease is dependent on us." (Midwife/20 years of work experiences)
"I only know that God is always here and helps us. I always ask God to help us achieve our goals." (Midwife/1.5 years of work experiences)
Some other birth attendants are grateful to God for having such an opportunity to help the women and mothers of their country in these difficult times:
"I consider this situation as an opportunity to be grateful to God. Even if our hospital had not become a corona treatment center, I would have volunteered to work in the corona wards. I am really thankful that God gave me such an opportunity." (Midwife/4 years of work experiences)
Theme 3- Pride
Since the beginning of the pandemic, the efforts, sacrifices and tireless work of health care workers have made them real heroes and the respect they have received from society has brought them feelings of pride and honor. This theme consists of two sub-themes "a result of a hero" and "a manifestation of self-sacrifice".
Subtheme 3-1 A result of a hero
The participants described the feeling of respect they received from the people and society more intensely than before. They appreciated such respect and saw it as a sign of recognition for their round-the-clock efforts.
"Midwives have always been respected by the people and in the society, because of the sanctity of this field. But when we put ourselves in danger and continued to work despite the corona virus, this sense of respect doubled. Everywhere you go, everyone thanks the medical staff, and the media and television also thank you very much." (Midwife/14 years of work experiences)
"For me, the fact that I can be in a position where mothers trust my words and believe in our power to protect themselves and their children is enough." (Obstetrician/ 10 years of work experiences)
Another participant, despite the challenging nature of working in a dangerous and unknown therapeutic environment, considers it an opportunity to get closer to pregnant mothers and points to the unquestioning obedience of mothers:
"The instructions that came to us were new and there were many challenges. But these mothers trusted in us and our work so much that they listened to everything you told them. Their cooperation with us during this period was very good. For example, when we explained about our clothes, separating the infant from them, how to breathe or anything else, they accepted from us and cooperated with us." (Midwife/15 years of work experiences)
Subtheme 3-2 A manifestation of self-sacrifice
Birth attendants working during the pandemic, despite the unprecedented risks and threats, stress and high workload, described feelings such as commitment and positivity, freedom from selfishness and supporting the mothers:
"The best part of the job for me, which of course was accompanied by many internal contradictions, was that I had the power to hold the hands of the mothers with corona virus when they were in pain or put my hands on their shoulders. Maybe on the one hand, the possibility of transmitting the virus to me increased, I was in danger, but at that moment I was only thinking about how much I could calm that mother." (Midwife/1.5 years of work experiences)
During the interview, the birth attendants positively evaluated their overall experience of care and by overcoming their personal challenges, they removed the feeling of selfishness:
"Our skills and competencies have allowed us to take care of corona patients. I know that the women of my country need this knowledge and skills. Therefore, it was not just me, my colleagues or my family. We were involved in a war and we must go beyond ourselves." (Midwife/29 years of work experiences)
"These mothers had no support but us. No hospital except university hospitals would accept them. The pain of childbirth was enough for them at that moment, adding the pain of rejection was too much for them. It was our duty to admit them here. And we would do everything we could for them." (Midwife/12 years of work experiences)
Theme 4- Looking forward to a better future
Birth attendants, while referring to the many hardships, high workload and job stress that they suffered during the Corona period, to their needs and expectations regarding "improvement of working environment conditions", "enhancement of career field" and "improvement of employment conditions".
Subtheme 4-1 Improvement of working environment conditions
Some of the birth attendants complained about the high workload and lack of personnel:
"At one time, the patient load was very high, especially during peak periods, there were many patients, our work shifts were long, but the number of staff in the shift did not change. The lack of staff was annoying at times like this. We needed more staff." (Midwife/15 years of work experiences)
The lack of proper knowledge of midwives or obstetricians in taking PCR samples to confirm the Covid-19 is considered a challenge for them and requires them to practice or get help from experts in this field:
"We had a lot of difficulty in taking PCR samples. We didn’t train for this. We didn't know if the sample we were taking was correct or not. We couldn't trust the results of our samples. We needed someone who knew how to get PCRs samples, so that we didn’t do it without training and in a stressful way.” (Midwife/12 years of work experiences)
According to some participants, one of the prerequisites for getting ready to provide services in pandemic conditions is access to clear instructions and updates on how to deal with patients, especially mothers infected with Covid-19, in order to protect them from confusion and ambiguity:
"At first, everyone said whatever they wanted. Treatments was performed based on the interests. The training unit posted the information in the group, and we would act based on that. They should have issued instructions or a protocol much earlier. This way, both mothers and infants were in danger." (Midwife/4 years of work experiences)
Team cooperation in the care and midwifery processes of pregnant women with covid-19 is one of the other requirements of the medical staff based in the maternity hospital:
" The issue of giving birth and taking care of children and newborns with corona should not be done by one person. I had a problem with doing all the work alone from the beginning to end. I understand that it was for preventing the contamination of others, but in this way, the number of deaths would increase. Everyone should cooperate, because we didn’t have enough information. For example, gynecologists on one hand, neonatologists and anesthesiologists on the other hand had to do their jobs. The issue of taking care of high-risk mothers is a matter of teamwork." (Midwife/15 years of work experiences)
"It's not possible to isolate a room and hospitalize the mother with Covid-19 and do all her works there. The facilities must be enough. The issue of air conditioning is very important. Our exhaust fans are mostly weak. Every time you had a Covid-19 mother, there were many shortages in the room. Once there was no Sonicaide, once there was no NST tape. Once there was a shortage of birthing kits. No matter what you did, no one would help us. We had to take them by yourself. This also caused the infection to spread. At first, they didn’t give the masks to us. They said it’s based on quota. For a long work shift, they gave a mask for 12 hours. There were many shortages and problems." (Midwife/20 years of work experiences)
Subtheme 4-2 Enhancement of career field
The participants pointed to their organizational and job needs from the government and other government organizations, and consider solving their problems and needs at the critical time, and receiving practical support as a type of appreciation.
"What I am most unsatisfied about is that no one supports the midwives. We expected the Ministry of Health and the University to at least support us here, but I remember that at the beginning they didn’t provide masks for us. Midwives don’t receive any support. Their position is always threatened. This situation showed how effective our existence can be, so it's time to show us our true position." (Midwife/15 years of work experiences)
"Some things may be very small and insignificant, but these things make us feel valued. For example, free parking, giving food packs during the work time, these kinds of things really help to make us feel better. We don’t need them, but doing these things for the staff makes them feel that their needs are respected and that they are valuable to the hospital, and this is very important. There is no need to always thank them with payment. Appreciation from authorities at the maternity hospital or the written encouragement is a great encouragement." (Midwife/1.5 years of work experiences)
Subtheme 4-3 Improvement of employment conditions
"It is not enough for us to get appreciation. It will even make us disappointed. They think this is enough for us. But we want safe working conditions and payments for our risks. They should pay attention to the needs of doctors and midwives. Our income should be fare. We risk our lives and our families’ lives." (Midwife/14 years of work experiences)
Some midwives defined the support plan they need in the stability of their job position:
"I spent the whole time at Corona Center Hospital. Hiring us is the least they can do for us. They should contract with us for a long time or hire us. There should be a quota for medical staff who are on the frontline in this situation." (Midwife/1.5 years of work experiences)