In all, 827 women’s responses were included in this study. Most women (87.8%) chose to respond to the Norwegian version of the survey, while 12.2% responded in English. The mean age was 29.8, (SD 4.7), and 45% of the women were primiparous and 55% multiparous. Forty-two of 45 available birthing units in Norway were represented. Eighty-six per cent of the respondents gave birth in a hospital, 8.7% in an alongside midwifery unit, 0.8% in a freestanding midwifery unit, 1.1% had a planned homebirth and 0.7 gave birth before they arrived at the planned place of birth. The proportion of vaginal births was 73.2%, operative vaginal births 9.8%, and caesarean Sect. 11.7%.
The qualitative analysis resulted in four themes: 1) Waiting period filled with stress and worries; 2) Feeling lonely, isolated and disempowered without the partner; 3) Sharing experiences and becoming a family; and 4) Busy postnatal care without compassion.
Waiting period filled with stress and worries
Many women felt that being pregnant during a pandemic was a stressful waiting period characterised by increased vulnerability and worries concerning what lied ahead of them. The lack of information and not knowing what restrictions would apply at the hospital in terms of companionship, was described as stressful, burdensome and extremely tough. Not knowing what to do or where to get updated information was described as something that took a lot of energy during the pregnancy.
All the insecurity surrounding the birth and that my husband could not be with me afterwards was scary and annoying and drained my energy before the birth.
The women’s anxiety and worry about them or their partner getting COVID-19 during the pregnancy also caused them stress. They were afraid an infection could affect the unborn child and found it very difficult to think about the risk of giving birth alone, without their partner, in isolation. This led to them placing restrictions on how they and their partner could live their lives during the pregnancy through self-imposed quarantine. The women also worried about being infected by COVID-19 when staying in the hospital during labour and post-partum, and how such a situation could affect them and their baby.
It was difficult to be worried in advance about whether my husband might not be present during the childbirth if he caught a cold.
The women learned that the birthing units’ restrictions during the pandemic permitted the partner to accompany the woman when she had reached active labour, which contributed to anxiety and insecurity during the pregnancy in case they needed care during the latent phase of labour. Some women had sought care later than they had planned after going into labour because they were afraid they would be alone without their partner. This resulted in chaotic births with the women fully dilated on admission, and they feared they would give birth at home or before arrival without assistance. Some women who wanted a check-up during early labour described difficulties in getting permission to be admitted to the hospital because of the strict rules, which led to feelings of uncertainty and insecurity in the first phase of labour.
As a first-time mother during the coronavirus pandemic, there was a lot of extra stress and nervousness. It’s difficult to be at home and feel that you are unwanted in the hospital. I was 5–6 cm when I finally begged to come in for a check-up.
Feeling lonely, isolated and disempowered without the partner
The women described feeling alone during their pregnancy when their partner was not allowed to attend the antenatal care sessions. This made them sad and led to a feeling of being “on your own”. Some women, especially if there were complications, had received a great deal of information during antenatal check-ups, and felt unable to absorb everything by themselves. At times, they had also needed to make important decisions about their pregnancy and birth without their partner, which led to them feeling lonely and powerless.
I think it's absolutely terrible that my husband can’t be there with me for the ultrasounds during my pregnancy. We live in the same house and have no symptoms.
The feeling of loneliness and being “on your own” was reinforced by being alone at a time when they really needed someone. When they arrived at the hospital, their partner often had to wait either outside the entrance or in the car in the parking lot, until he/she was given permission to enter. The women described being met by guards at the entrance, and then having to find their way to the birthing unit on their own. Some women spent hours or days alone in the hospital before labour started due to complications or the need for an induction, which caused them to feel isolated, insecure and afraid. Having labour induced at a hospital meant that they had to spend the whole period until reaching active labour alone, rather than being at home with their partner during early labour if induction was not necessary. Some women described hours of unbearable pain from induced contractions, on their own without their partner to support them, which made them feel extremely lonely, helpless and angry.
My birth was induced due to rising blood pressure and low amniotic fluid. I was alone for a day and a half in an observation ward before I came to the delivery room and was allowed to be with my husband. It was very hectic in the ward and I felt very alone.
The women saw their partner as the one person they could “lean on”; who knew them and their needs and wishes. They strongly express needing his/her support and help to cope with labour, also prior to the active phase, and called for it when it was lacking. Very many women expressed that the thing they would have wanted to change was to have their partner present during all stages of labour and at the postnatal ward. They reported feeling unsafe and even scared when they were alone without their partner. In those situations when it was possible to have their partner present, the women emphasised this as the best part of their care, and some express gratefulness to the staff who sometimes overlooked the restrictions and individualised their situation.
The midwife allowed my partner to stay the night until before 8 in the morning since the child was born in the middle of the night. He had to leave before the change of shifts, as this was not really allowed at the hospital.
The women’s feelings of loneliness and isolation are even more prominent in their accounts of their stay at the postnatal ward. The fact that their partner could not be with them throughout the stay and that they were often not allowed to leave the room at all, gave rise to difficult emotions. It could also cause them to feel imprisoned when being left alone in a small, hot room. The women reported feeling “on their own” and questioned whether that kind of care was even safe. The respondents emphasised how much they missed practical and emotional support from their partners after the birth. They believed that their partner being allowed to stay with them and the baby in the postnatal ward would have been both good for them and very helpful for the staff. The women felt that the postnatal ward had been understaffed and pointed out that their partner could have helped out and relieved the midwives and nurses with practical tasks such as fetching food and drinks.
The birth was quick and, as expected, really terrible. But the midwife was good, and I felt relatively safe. The post-partum days were very lonely, and I longed for my husband. It was difficult to get help (get food, talk about the baby, get a smile from someone). I felt that the staff were avoiding me and no one asked how I was doing.
Sharing experiences and becoming a family
The women emphasised wanting to be together as a family during the whole maternity episode; through pregnancy, birth and the post-partum period. They perceived it as a very special period with precious moments for the couple and the family. The women wanted to take the first steps of parenthood together with their partner and spend time with the newborn baby as a family. They described sadness if they lost the possibility of experiencing the joy and excitement of the first few hours and days as a unit and of creating shared memories for the future. Some women continued to express grief, sorrow and loss months after the birth if they had not been able to share the first few hours or days together.
It was quite tragic that the father was not allowed to attend the birth which was an elective C-section. This makes the birth experience difficult to think back on. We never got to experience meeting the twins together, just one of us at a time.
To be together as a family also meant deciding for themselves who they were going to share the experience of the new baby with and when. For example, some women thought it was a shame that older siblings could not come to meet the baby straight away to share the moment together as a family, instead having to wait until the mother and baby arrived home. Some women described how this important family moment had been taken away from them, and they felt miserable about this loss.
I was induced and gave birth two days later. Went home after six days. For me as a mum and my family, it was absolutely awful. Not being able to share the joy, the scary experience, the ups and downs with my husband and children. It IS still a crisis. The fact that we could not share this together is really painful. It hurts so much that we could not be together when we needed it the most.
The strong wish for a family focus is very evident in the data; many women highlight the best part of their maternity care as when they were given an opportunity to spend time with their partner and the newborn together, and they express gratefulness about situations when this was facilitated – despite the restrictions.
Busy postnatal care without compassion
Many women reported feeling safe and well cared for by competent staff during the birth, despite their partner only being able to be present during the active stage of labour. This is in stark contrast to their experiences of postnatal care.
The labour ward was very good, but the experience of the postnatal care overshadows most of it. I felt overlooked and not taken care of.
The women frequently pointed out that the postnatal ward was seriously understaffed, they felt that the midwives and nurses had very little time for them and that their needs had not been fulfilled. Since they were often not allowed to leave their room, and their partners were not allowed to stay, the women had to ask the staff for help with everything they needed. For some, this led to them feeling that they were a bother. For others, who were not able to get out of bed on their own after, for example, a caesarean section or to carry the crying baby themselves, it resulted in feelings of helplessness and sorrow. Many women felt overlooked and not seen as a person and called for more compassion in postpartum care.
Being abandoned and left to fend for myself with a newborn baby has been a very traumatic experience for me. My partner was not allowed to attend the postpartum ward due to corona, and the staff was even more overworked than usual. No one had time to help me with breastfeeding. I was clearly told that there were others who needed the staff more than me when I asked for help. I just felt like I was bothering the staff.
The women felt that the midwives and nurses had signalled that they were overloaded with tasks, and this made the atmosphere in the ward busy and tense. The staff was often characterised as doing the best they could in a very difficult time, but also as being brusque and not always polite, failing to demonstrate an understanding of the new mothers’ situation. This was especially evident in connection with breastfeeding consultations, which were sometimes described as cold and insensitive. Many women felt that they had been given very little help with breastfeeding, and that the one or two consultations they received were quick, abrupt and insensitive. Furthermore, there was a feeling of being overruled by the staff on decisions concerning the mother and the baby, for instance when it came to breastfeeding versus bottle-feeding or using a pacifier.
Some of the staff at the postnatal hotel created unnecessary stress and negative thoughts by being patronising and stressed out.
A few multiparous women had, in contrast to the above, enjoyed not having visitors in the postnatal ward. They felt that they had enjoyed a couple of days off, without any pressure to receive visitors, on legitimate grounds.