The current study's sample consisted of 12 pregnant women who had health records in six selected health centers in Babol. They were regularly receiving their prenatal care in these centers before COVID-19 crises. Three theme categories were extracted from analysis of the pregnant women's experiences in COVID-19 crises (panel): unpleasant feelings during pregnancy, adjusted lifestyle, and safe pregnancy care.
Theme categories and clusters
1. Unpleasant feelings during pregnancy
A. Worry and fear
B. Become obsessed
C. Decreased tolerance threshold
D. Feeling of sickness
E. Be discouraged
2. Adjusted lifestyle
A. Negative interpersonal communication
B. Positive interpersonal communication
C. Pay attention to hygiene
D. Changing the diet plan
E. Restrictions on social activities
F. Management of concerns
3. Safe pregnancy care
A. Restrictions on prenatal care
B. Virtual care
C. Adjusted pregnancy care
Theme category 1:Unpleasant feelings during pregnancy
The participants' statements show that concomitant pregnancy with COVID-19 epidemic led to experiencing of unpleasant feelings during pregnancy.
Theme cluster 1-1: Worry and fear
The pregnant women shared their experiences that presence of the disease in society has led to worry and fear in various aspects of life, especially in relation to pregnancy, fetus, and childbirth. They expressed this concern and fear in different terms; worry about catching COVID-19 and transmission it to the fetus, worry about the susceptibility of pregnant women, worry about the fetal miscarriages and death, fears of congenital and genetic abnormalities in the fetus, fears of damage to fetal intelligence, and lack of companionship during childbirth and after that..
"My biggest worry was that, for example, if I get infected, my baby will get it too, it has a negative effect on my baby, and I may even lose my baby." (P7)
"I'm always worried that my baby will be born with low birth weight and she needs special care, or I'm afraid my baby will have abnormalities or congenital disorders on genetic, bone, and heart. "(P2)
"I'm worried about catching the virus because others were emphasizing that pregnant women get sick very quickly."(P6)
"The biggest worry is childbirth, what should I do? What should I do with a small child? Neither my mother nor anyone can come to me; I am alone during childbirth and after that. My problems will increase." (P5)
Theme cluster 1-2: Become obsessed
High transferability and stability of virus on surfaces of objects, and also the different syndromes of COVID-19 infection have lead the pregnant women experienced the obsessive thinking. The obsessive thinking was about pay attention to hygiene, symptoms of the disease, and fetal health.
"I think I became obsessed; I always wash my hands. For example, I wash my hands, the moment I touch the phone, I wash my hands again."(P3)
"All the time, I was counting my baby's movements at home or for example, if I had a little cough, fever or a headache, I'm worried I might get infected." (P6)
Theme cluster 1-3: Decreased tolerance threshold
Staying at home, quarantine, and restrictions on the social activities during COVID-19 crisis led to decreased tolerance threshold in pregnant women. They highlighted that get anger quickly and become aggressive with their husbands.
"I think that sitting at home is a disease, I don't have the patience, when my husband comes, he is tired too, but I expect a lot from him. I'm not bored of reading a book; I'm not bored at all." (P6)
"Staying at home made me nervous, I'm not bored. I used to help my daughter with homework, but not now." (P8)
Theme cluster 1-4: Feeling of sickness
The pregnant women reported decreased sleep and appetite, a sense of introversion, and in general, the feeling of being sick.
"At first my appetite was good, but in the last month I have no appetite. My sleep is very low; I can't sleep at night." (P6)
"It was a very bad time, I just cried, I felt sick. I feel that I can't live in calm, the change has been huge." (P1)
Theme cluster 1-5: Be discouraged
The pregnant women stated that did not enjoy their pregnancy and did not have a pleasant pregnancy which discouraged them from living.
"I think that life is cold and soulless, we always have to pay attention to hygiene, we can't go out and communicate with anyone, I like to go out." (P6)
"I got pregnant after ten years, I wish I could get pregnant later and I didn't have these worries." (P12)
Theme category 2: Adjusted lifestyle
The second category of themes extracted is "adjusted lifestyle", which included six clusters.
Theme cluster 2-1: Negative interpersonal communication
All the pregnant women pointed to make "negative interpersonal communication" during COVID-19 epidemic. This cluster was emerged in response to the health warnings at social distances to prevent the disease.
"Well, that was upsetting. I am the only child in the family. I couldn't see my dad and mom. Yeah, it was really sad that I couldn't hug my dad and mom." (P1)
"Our life was hard. We were in quarantine. I can't stay in quarantine for long. Well, If I don't communicate, I get depressed." (P8)
Theme cluster 2-2: Positive interpersonal communication
The experiences of some pregnant women in the critical period of COVID-19 showed that quarantine and being at home can also have "positive interpersonal communication". For example, the first and second participants talked about positive experiences in interacting with her spouse:
"My relationship with my husband has improved. We didn't have time at all before Corona. We just saw each other at dinner. I was out and my husband was at work. Now, we talk and laugh more. We did joint work. We got much closer and more connected." (P1)
"Because my husband was in the house, my mind was free, we spend more time together, another thing is that we appreciate each other more." (P2)
Theme cluster 2-3: Pay attention to hygiene
All pregnant women repeatedly stated that they did hygienic items such as frequent hand washing and disinfection of things during this period.
"My husband and I used to disinfect the whole house with alcohol and like this such as mobile phone, pen, TV remote…. If we touched anything, we must have disinfected our hands at that moment. We disinfected everything bought first, we didn't have to put it directly in the refrigerator." (P6).
"When we bought bread, we must have warmed it up, or disinfected the surfaces, the doors, we wore masks and gloves." (P9)
Theme cluster 2-4: Changing the diet plan
Almost all participants have experienced changes in their diet plan to strengthen the immune system and prevent the occurrence of COVID-19 disease. Here are some examples:
"For example, I ate certain foods or things that strengthened my immune system, such as orange juice, vitamin C pills." (P7)
"Eating herbal tea such as cinnamon tea, ginger tea… I mix everything I have for example, cinnamon, thyme, jujube ..." (P9)
"We try to eat fewer foods with a cold nature, I was cooking foods with a hot nature, spicier, and in general, I ate herbal teas, hot nature drinks such as thyme, and so on." (P5)
Theme cluster 2-5: Restrictions on social activities
This cluster was formed according to the pregnant women's statements about not going to public places to prevent the epidemic.
"Then I say we had our own special plans, we planned for our Nowruz holiday, we planned for Charshanbe souri ceremony, I am a happy person and I loved these things very much, I got away from these good things in my life. I'd like to go out, for example, I like to go to a coffee shop with my friends, but everything has been removed from my life. "(P6)
"We do not have much fun anymore. Long quarantine is annoying to me. In corona epidemic, I didn't even go out to shop. I bought online my newborn's clothes and other needed things." (P10)
Theme cluster 2-6: Management of concerns
The latest cluster in the adjusted lifestyle theme category is "management of concerns". This cluster refers to a set of experienced practices that women apply to control and reduce their worry and anxiety. Almost all pregnant women, based on their interests and beliefs, decided to do something to alleviate the worries created during COVID-19 critical period.
"I tried to reduce my worry by reading Quran or praying. By communicating with God, by heart contacting with God, I keep calm. I was thinking about the positive aspects. I was trying to use news sources that I think are very credible, such as our own newscasts or TV shows for pregnant women."(P2)
"I turn on the incense stick, I lit a candle, I try not to think about corona, I was trying to do those." (P6)
Theme category 3: Safe pregnancy care
The pregnant women, while paying attention to the importance of pregnancy care, were forced to limit, delay, or modify some cares in order to be safe.
Theme cluster 3-1: Restrictions on prenatal care
The pregnant women stated that they limited or delayed many of their pregnancy care, because they were worried about getting Covid-19. These care were such as ultrasound of the fetal, the routine pregnancy visits, and fetal health screening,
"During corona crisis, I did not go the health center or my doctor office. In my opinion, if I went, I would get this infection. My pregnancy care was not performed on time. I delayed the fetal health test and had to have an amniocentesis. If I had done this test on time, I wouldn't be done amniocentesis now, this is a very difficult test." (P6)
"I delayed my pregnancy care and did not do the tests. I only was going for the essential care." (P10)
Theme cluster 3-2: Virtual care
According to the quotes of pregnant women, virtual care was one strategy for receiving pregnancy care during corona crisis. Healthcare providers have created a group in the virtual space such as WhatsApp or Telegram to provide care for the pregnant women. In this virtual group, the questions, problems, and concerns of pregnant women were answered. Of course, along with this virtual program, telephone counseling was also providing.
"Midwives have formed a WhatsApp group for pregnancy care. We sent the test and ultrasound sheets in WhatsApp. Midwives see them and answer."(P2)
"If I had a problem or question, I would contact my midwife by phone and I was guided. For example, about my constipation, I got a phone call and my problem was solved." (P11)
Theme cluster 3-3: Adjusted pregnancy care
This cluster was extracted is another strategy for the pregnant women who to miss out the face-to-face prenatal care or be deprived of some of the health-promoting group programs during COVID- 19 crisis.
"I couldn't go to the doctor; I was measuring my blood pressure and weight at home." (P12)
"I can't go to the pregnancy classes; I prefer to read a book to get information." (P7)
"Exercise during pregnancy that is good for my mood as well as making my childbirth easier; I did these exercises at home." (P2).