Childbirth Experiences in Hospital during

COVID-19 Pandemic

A Study Presented to
The Faculty of College of Nursing and Health Sciences
Samar State University
Catbalogan City, Samar

In Partial Fulfillment

Of the Requirement for the Degree

Bachelor of Science in Nursing

Babon, Mikee Rose

Catalan, Coleen

Dayap, Judiel

Geres, Margarette

Macaraeg, Ma. Flinky

Pomentil, Lorelie Charresse

SY: 2020-2021
 TABLE OF CONTENTS

Page

TABLE OF CONTENTS ……………………………………………………………………. i

CHAPTER

I INTRODUCTION

Background of the study ………………………………………………….. 1

Statement of the Problem ………………………………………………….. 2

Theoretical Framework ……………………………………………………. 3

Conceptual Framework ……………………………………………………. 5

Scope and Delimitation ……………………………………………………. 5

Definition of Terms …………………………………………………………5

II REVIEW OF RELATED LITERATURE

Related Literature ……………………………………………………………7

Related Studies ……………………………………………………………....12

III METHODOLOGY

Research Design ……………………………………………………………. 16

Instrumentation ………………………………………………………………16

Validation of the Instrument.….……………………………………………...16

Sampling Procedure…………………………………………………………..17

Data Gathering Procedure ……………………………………………………17

Data Analysis ………………………………………………………………...17

Ethical Consideration ………………………………………………………...18

i
IV PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

Difficulty in Hospital Access……………………………………………………21

Psychological Challenges Caused by the Pandemic………………………………….25

Difference in Childbirth Experiences Before and During the Pandemic……...28

Coping Mechanisms Utilized to Manage Difficulties………………...............31

Recommendations from the Participants …………………………………….34

V SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

Summary of Findings …………………………………………………………38

Conclusions …………………………………………………………………...39

Recommendations …………………………………………………………….40

REFERENCES………………………………………………………………………....41

APPENDIX …………………………………………………………………………….43

i
 CHAPTER 1

Introduction

Background of the study

Childbirth is a lived experience to women whose truth and reality is deeply

embedded in the lives of those that have experienced it. It is a crucial event in a

woman’s life. Childbirth experiences are the women’s personal feelings and

interpretations of birth processes. Birth experiences to some women have meant hard

work, exciting lovely event and to others it is a stressful, exhausting and unpredictable

experience. The woman’s emotional and cognitive experience of birth is recognized as

having a significant impact on her postpartum physical and psychological state and on

her first interactions with the infant. Childbirth experiences can have immediate as well

as long-term positive or negative effects on life, well-being and health (Nilver, Begley and

Berg 2017). A negative birth experience increases the risk of negative health outcomes,

such as postpartum depression and future fear of giving birth, that can lead to a request

for caesarean birth in future pregnancies, and have an impact on future reproduction. A

positive experience can be remembered as an empowering life event connected to

personal growth and self-knowledge affecting the transition to motherhood. The positive

memories of being in control over the situational happenings and the decisions on care

coupled with the healthcare providers’ support are said to enhance self-confidence with

feelings of accomplishment and better adjustment to motherhood.

The current global situation with COVID-19 pandemic

has led to extensive and deep-rooted changes in the number and nature of health

services. The healthcare system had been severely affected as it stands as the most

frontline in combating the crisis. As health institutions show strain in responding to the

pandemic, concern is increasing that COVID-19 will disrupt health-service delivery,

including for maternal and newborn health services, particularly in resource-limited

countries (Prasad A. and Prasad M. 2020). Standard of practice on different hospital

units and wards have been modified to control the spread of the virus causing COVID-

1
19. These changes made in the healthcare setting affect health services and clients’

experiences in the hospital setting including childbirth experience among women.

Pregnancy is already known to trigger anxiety, depression, and some physical

health issues. Along with the uncertainty surrounding the hospital environment and the

pregnancy outcome, this made pregnancy and delivery during the early months of the

pandemic a particularly worrisome time for these women (Thomas, 2020). Casualties

from COVID-19 may not only be those who contracted the disease and developed

complications, women who are afraid to give birth at the hospital for fear of infection and

women with their unborn child who have been denied access to health services because

the system is overrun, they, too may become casualties of the pandemic. Urgent

investments must be done to re-start disrupted health systems and services to prevent

further worsening of the situations especially casualties among childbearing women and

newborns. This includes rigorous study on how the pandemic made changes in women’s

experiences in childbirth (Mortazavi, Mehrabadi & KiaeeTabar, 2021).

This study focused on eliciting the experiences of women who gave birth at

hospital during the period of March to March 2021, particularly on how the changes

made in the hospital setting affected their personal experience in giving birth during a

pandemic.

Statement of the Problem

This study aims to describe women’s childbirth experiences in the hospital

during the COVID-19 pandemic with the end view of using the results in conjunction

with existing and future data from other sources to help control pandemic-related

factors that influence maternal and infant health.

1. What are the childbirth experiences of women in the hospital during the

pandemic?

2. What are the differences in their experience before and during the pandemic?

3. What are the coping mechanisms of the mothers?

2
 4. What are the participants’ recommendations?

Theoretical Framework

Phenomenology is the study of

essences
through their appearances (Lauer,
1958). It
studies phenomena–things as they
appear in a
person’s experience or ways persons
experience
things–thus, there are meanings in
experience.
These meanings are the essences of
human
experience. The conscious experience
is lived by
the person referred to as the subjective
or the first
person point of view (Smith, 200
Phenomenology is the study of
essences
3
through their appearances (Lauer,
1958). It
studies phenomena–things as they
appear in a
person’s experience or ways persons
experience
things–thus, there are meanings in
experience.
These meanings are the essences of
human
experience. The conscious experience
is lived by
the person referred to as the subjective
or the first
person point of view (Smith, 200
Phenomenology is the study of
essences
through their appearances (Lauer,
1958). It
studies phenomena–things as they
appear in a
4
person’s experience or ways persons
experience
things–thus, there are meanings in
experience.
These meanings are the essences of
human
experience. The conscious experience
is lived by
the person referred to as the subjective
or the first
person point of view (Smith, 200
Phenomenology is the study of
essences
through their appearances (Lauer,
1958). It
studies phenomena–things as they
appear in a
person’s experience or ways persons
experience
things–thus, there are meanings in
experience.
5
These meanings are the essences of
human
experience. The conscious experience
is lived by
the person referred to as the subjective
or the first
person point of view (Smith, 200
Phenomenology is the study of
essences
through their appearances (Lauer,
1958). It
studies phenomena–things as they
appear in a
person’s experience or ways persons
experience
things–thus, there are meanings in
experience.
These meanings are the essences of
human
experience. The conscious experience
is lived by
6
the person referred to as the subjective
or the first
person point of view (Smith, 200
Phenomenology is the study of
essences
through their appearances (Lauer,
1958). It
studies phenomena–things as they
appear in a
person’s experience or ways persons
experience
things–thus, there are meanings in
experience.
These meanings are the essences of
human
experience. The conscious experience
is lived by
the person referred to as the subjective
or the first
person point of view (Smith, 20
Phenomenology is the study of essences through their appearances. IT

7
 The researchers will use Husserlian Phenomenology. The main focus is

the study of phenomena as they appear through consciousness. Husserl purported

that minds and objects both occur within experience, thus eliminating mind-body

dualism. He viewed consciousness as a co-constituted dialogue between a person

and the world. Moreover, access to the structures of consciousness is not as a

matter of induction or generalization, but as a result of direct grasping of a

phenomenon. This grasping was seen as an intentional process, actively guided by

human intention, not mechanistic causation. Husserl viewed intentionality and

essences as key to our understanding of this phenomenology and intentionality as a

process where the mind is directed toward objects of study. Conscious awareness

was the starting point in building one's knowledge of reality. By intentionally directing

one's focus, Husserl proposed one could develop a description of particular realities.

This process is one of coming face to face with the ultimate structures of

consciousness. These structures were described as essences that made the object

identifiable as a particular type of object or experience, unique from others. Through

this methodology, disclosure of a realm of being which presented itself with absolute

certainty, arising from experience, seemed possible. Husserl saw this method as a

way of reaching true meaning through penetrating deeper and deeper into reality.

(Abalos, Chamillard, Diaz and Pasquale 2016).

Husserlian phenomenology studies phenomena; things as they appear in

a person’s experience or ways a person experience things- thus, there are

meanings in experience. Through this phenomenology, researchers will describe

the women’s experiences and give meaning to these experiences. These

meanings are the essences of human experience.

Entering into the phenomenon

Women who gave birth
before the pandemic and
during the pandemic in
the months of March 2020 8
to March 2021 at
hospitals in Catbalogan
City.
 1. Childbirth experiences of women in the
hospital during the pandemic.

2. Differences in their childbirth experience

before and during the pandemic.

3. Coping mechanisms of the mothers.

4. Participants’ recommendations

End results will be used in

conjunction with existing and
future data to control
pandemic-related factors
that influence maternal and
infant health.

Figure 1. Conceptual Framework of the Study

Conceptual Framework

The diagram represented by Figure 1 is the conceptual framework of the study. The

diagram starts with entering into the phenomena; the input which contains the experiences

of the women in childbirth in the hospital during the pandemic, differences in their experience

9
before and during the pandemic, coping mechanisms of the mother and their

recommendations and then the end results that will be used in conjunction with future

studies for the advancement of health services during a pandemic.

Scope and Delimitation

The study explored women’s experiences in childbirth at hospitals in the midst of

chaos brought by the COVID-19 pandemic. Specifically, what are the experiences of women

who delivered in the hospital during the pandemic, comparison of their experiences in

childbirth before and during the pandemic, what were their coping mechanisms and the

recommendations based on the findings of the study including the specific concerns the

women want to address regarding her whole experience in giving birth during the pandemic.

The participants of the study are discharged clients of hospitals in Catbalogan City

who gave birth in maternal units during the pandemic, assuming these women have

previously given birth in hospitals before the pandemic. Inclusion criteria were set for the

purpose of delimitation. The participants should have given birth from the months of March

2020 until March 2021, delivery method is normal spontaneous vaginal delivery (NSVD),

physically and mentally able to answer the interview, and consented to participate in this

study.

Definition of Terms

The following terms are defined both conceptually and operationally.

Childbirth experience. Refers to individual woman’s life event that incorporates interrelated

subjective psychological and physiological processes, influenced by social, environmental,

organizational and policy contexts (Larkin 2007). In this study, this refers to how the woman

perceive the events of her childbirth in the hospital in the midst of changes brought by the

pandemic.

Childbirth. Also parturition, process of bringing forth a child from the uterus, or womb

(Beck 2010). In this study, this refers to labor and birth.

10
Mothers. A female parent; a woman in relation to her child or children (merriam-webster). In

this study this refers to women who had been pregnant and delivered before and after

community quarantine due to the pandemic.

COVID-19. The disease caused by the new coronavirus; COVID-19 is marked by symptoms

that can include fever, dry cough, and shortness of breath (WHO 2019). In this study, this

refers to the infection that spread worldwide that caused the pandemic

Pandemic. An epidemic that spreads worldwide, often because the disease is new and there is

little to no immunity (WHO 2010). In this study, this refers to the present crisis the country is

facing which causes significant changes in the healthcare setting.

Conceptual Model: The lived

experience of male sex workers: A
qualitative study utilizing
Husserlian phenomenology with
Colaizzi’s method of data analysis
Conceptual Model: The lived
experience of male sex workers: A
qualitative study utilizing
Husserlian phenomenology with
Colaizzi’s method of data analysis
Conceptual Model: The lived
experience of male sex workers: A
qualitative study utilizing
11
Husserlian phenomenology with
Colaizzi’s method of data analys

Chapter II

REVIEW OF RELATED LITERATURE

This chapter presents the related literature and related studies after the thorough and

in-depth search done by the researchers. Related literature and studies will serve as the

basis of the analysis of results of the current study.

Related Literature

The new coronavirus (COVID-19) have become the biggest concern in the

healthcare system around the world for the past year. The pandemic of the severe acute

respiratory syndrome coronavirus (SARS-CoV-2) has forced a rapid and dramatic change to

12
when, where, and how prenatal care and obstetric services are delivered in order to reduce

the risk of viral transmission. Limited clinical data and the unknown nature of the virus’

impact and transmission routes have forced constant changes to traditional care delivery

(Bradley et al., 2020). With much being unknown, little to no accurate information was

shared to the people. This resulted to parents and prospective parents being confused as

they try to understand the situation and figure out what is best for their families. This leads to

the people relying solely on healthcare professionals and services.

Pregnant women have similar clinical manifestations of COVID-19 to those non-

pregnant individuals, but those with congenital or acquired heart disease are at highest risk,

and it is also important to consider the potential impact of pre‐existing hyperglycemia,

hypertension, and preeclampsia on the outcome of COVID‐19 in pregnant women (Wane,

2020). Symptoms of COVID-19 are commonly found in different illnesses, these symptoms

even overlap with those that are found in normal pregnancy thus extensive assessment even

in afebrile women is necessary.

Early and close contact between the mother and neonate has many well-established

benefits including increased success with breastfeeding, facilitation of mother-infant bonding,

and promotion of family-centered care. Given the available evidence on this topic, mother-

infant dyads where the mother has suspected or confirmed SARS-CoV-2 infection should

ideally room-in according to usual facility policy. Although data is still emerging and long-

term effects are not yet fully understood, data suggests that there is no difference in risk of

SARS-CoV-2 infection to the neonate whether a neonate is cared for in a separate room or

remains in the mother’s room. Healthcare providers should respect maternal autonomy in

the medical decision-making process. This issue should be raised during prenatal care and

continue through the intrapartum period. Any determination of whether to keep individuals

with known or suspected SARS-CoV-2 infection and their infants together or separate after

birth should include a process of shared decision-making with the patient, their family, and

the clinical team (American College of Obstetricians and Gynecologists, 2020). Concerns

13
have also been raised whether breast-feeding should be encouraged in COVID-19 positive

and suspected positive women. Current evidences show that the virus causing COVID-19

infection is not transmitted via breast milk. The benefits of breastfeeding outweigh possible

risks during the COVID-19 pandemic and may even protect the infant and mother, therefore,

breastfeeding should be encouraged. Mothers who are too ill to breastfeed are supported to

express their milk and infant is fed by a healthy individual.

Early in the crisis, importance of close and frequent communication with patients and

with staff members is found to be vital. As the healthcare setting was dealing with two

epidemics: COVID-19 and the resulting fear, communication needed to be simultaneously

educational, logistic, strategic, and supportive. Both the pandemic and the resulting fear

among patients and staffs represented significant, new challenges. The obligation to provide

safe and effective patient care, while responding to the understandable fears of both staff

and patients, informed our responses in communication, testing, and scheduling work hours

and patient visits. Accelerated remote access for staff was an early response to the crisis.

Meetings were conducted virtually among health professionals to ensure statistics for

COVID-19 patients were reported, including the total number of patients admitted to

facilities, as well as any COVID-positive obstetrical admissions, whether they were

antepartum, or patients admitted for delivery. These virtual sessions were used to develop

strategies for a standardized system-wide approach to the clinical management of COVID-

positive pregnant patients. With the continuously evolving nature of the pandemic, guidelines

required frequent revision, sometimes daily. The availability of appropriate personal

protection equipment, viral polymerase chain reaction (PCR) testing, and testing of

asymptomatic patients presenting for delivery were examples of constantly evolving

practices making the need for rapid communication and dissemination of new information

essential (Rochelson et al., 2020).

Intensive Care Units (ICUs) were overwhelmed with the rapid increase of COVID-19

positive patients; critically ill pregnant women were transferred to other ICUs in hospitals

where the appropriate services were available with less resource tension.

14
 Social distancing was reinforced for staff and patients at all sites and in order to

reduce potential exposures to staff and patients, changes were made to the guidelines for

frequency of prenatal visits, ultrasound examinations, and antepartum testing. These

guidelines were individualized for patients based upon their history and co-morbidities, as

well as institutional practices. Although available services and access to providers may have

varied at each site, conformity to revised guidelines was emphasized. At two tertiary care

facilities, the prenatal diagnostic centers were located in the hospital. In response to the

need for hospital space for COVID-19 patients, these centers were relocated to ambulatory

sites. Although this required a significant amount of logistic support and manpower, it

allowed the vacated spaces to be converted to surge units for COVID-19 patients. Pregnant

patients fearful of entering hospitals could now receive the care they required in a setting

that felt less threatening to them, outside of the hospital (Rochelson, Nimaroff, Combs and

Schwartz 2020).

Early establishment of protocols for COVID-19 screening, isolation, testing, and use

of PPE in the obstetrical triage unit were done in hospitals to reduce exposures for patients

and triage staff. Once there was evidence of community transmission, screening focused on

symptoms of respiratory disease and fever. As information suggested a high prevalence of

asymptomatic carriers, universal testing for all women presenting to hospitals for delivery

were conducted. The awareness of significant false-positive rate led to continue the policy to

wear mask at all times, even in patients who were tested PCR negative.

The main concern with patient care has been providing a safe environment for

patients and staff with appropriate use of Personal Protective Equipment (PPE). There has

been some controversy as to whether or not the second stage of labor represented an

aerosolizing event. This concept was highlighted in a letter to the CDC from ACOG, SMFM,

and other societies, advocating the use of full PPE in the second stage of labor. To reduce

this potential risk, at North protocols for COVID-19 screening, isolation, testing, and use of

PPE in the obstetrical triage unit well hospitals, all staff present during labor and delivery

wore full PPEs, including N95 masks. Once COVID-19 testing was universal, the use of full

15
PPE could be more selective, based on symptoms, fever, and COVID-19 PCR results. The

issue of visitors during labor and delivery has been controversial. Decision making regarding

allowing the presence of visitors was initially individualized based on institutional concerns

and capacity.

The unusual and significant demands of the COVID-19 pandemic required a rapid,

flexible response from our large health system. The ability to quickly and effectively meet

these challenges and to respond with major changes in short time intervals was promoted by

a multidisciplinary approach and frequent and effective communication. The already

established lines of communication among hospitals, shared guidelines, maternal transport

mechanisms, and the range of support of tertiary hospitals for regional community hospitals

facilitated rapid and organized response.

The challenges of the pandemic remain ongoing. Lessons learned in the course of

responding to this challenge will likely be valuable in the post-COVID-19 period and should

guide responses by obstetric services to future pandemics, or to other unexpected crises

(Rochelson et al. 2020).

Pregnancy and early parenthood are life‐changing periods characterized by intense

emotions and a high vulnerability to emotional problems. Overall, 10–20% of pregnant

women and women in the early postpartum period suffer from mental health problems. In the

first months of 2020, pregnant and breastfeeding women have also needed to face the

COVID‐19 pandemic, including the exceptional quarantine measures that have disturbed

private and professional life. In addition to the fear of infection, these measures might have

negatively impacted the emotional wellbeing of women. As depressive symptoms and

anxiety in the pre and peripartum period have been associated with adverse maternal,

neonatal, and infant outcomes, the psychological impact of COVID‐19, and its associated

quarantine measures, on pregnant women and new mothers is cause for concern

(Ceulemans, Hompes and Fuolon 2020).

According to the study of Fort Wayne (2020), the pandemic imposes higher risk of

mental health issues to pregnant women given the many compounding factors, including the

16
fear of becoming infected, transmitting the infection to her infant if infected, social isolation,

financial difficulties, potential reduction in household help, insecurity, and the inability to

access support systems. All these add to already existing stress of a pregnant woman which

may affect the pregnancy and delivery. Particular attention should be paid to these aspects

of maternal care.

Pregnant patients are assumed to be making health care decisions influenced by fear

that they will contract COVID-19 within a healthcare setting. Risk to personal health or their

newborn’s health, fear that support people will be unable to attend deliver, risk of contracting

COVID-19 during a prenatal or obstetric appointment, fear that support people will become

sick with COVID-19, and concerns regarding financial or job security are among the

numerous concerns of pregnant women during the pandemic (Bradley et al., 2020). These

concerns are not unfounded; the pandemic essentially affected every aspect of people’s

lives.

Pawlak (2020) says there are many strategies that to reduce feelings of anxiety,

stress and helplessness during “pandemic pregnancy”. This includes, being careful where to

look for information about COVID-19 and pregnancy because some sources are better than

others. Women should talk with their obstetrician, midwife, or other prenatal healthcare

provider about the pregnancy and childbirth concerns. Healthcare provider will be able to

give up-to-date information about pandemic precautions for pregnant women and any ways

that childbirth experience will be impacted at delivery location. They will collaborate with

client to develop a safe, individualized plan for prenatal care and birthing experience. They

can also help to reassure client about the precautions that the hospital or clinic is taking.

Women should focus on the things she can control rather than those which she cannot. Take

steps to maintain positive mood and healthy behaviors and continue to engage in pandemic

precautions, such as mask-wearing, hand-washing, and social distancing. Keep up with

social connections; plan video calls with loved ones, help to plan a virtual baby shower, and

get ready to blow up social media with photos of your new pride and joy once he or she

arrives. Take things day-by-day, whenever possible. Each day brings new developments

17
regarding the coronavirus, local case numbers fluctuate frequently, and updates on

guidelines to limit transmission often change as we learn more about this virus. Trying to

predict too far ahead may not be helpful and may actually be a waste of precious energy.

Use proven stress-reduction tools such as deep breathing exercises, mindfulness practices,

positive self-care and gratitude-building if feeling sad or anxious. Be sure to tell doctor if

struggling emotionally – they can refer client to a mental health care provider (Williamson

2020).

Related Studies

Mitigation efforts to control the spread of COVID-19 have been implemented in all

healthcare settings. Although these efforts are important, ob-gyns and other health care

professionals should be aware of the unintended effect they may have, including limiting

access to routine prenatal care. Ob-gyns and other obstetric care professionals should

continue to provide medically necessary prenatal care, referrals, and consultations, although

modifications to health care delivery approaches may be necessary. Ob-gyns and other

prenatal care professionals also should consider creating a plan to address the possibility of

a decreased health care workforce, potential shortage of personal protective equipment, and

limited isolation rooms, and should maximize the use of telehealth across as many aspects

of prenatal care as possible (ACOG, 2020).

Universal S-ARS-CoV-2 testing with nasopharyngeal swabs and a quantitative

polymerase-chain-reaction test to detect SARS-CoV-2 infection was implemented in all

pregnant patients presenting for delivery in two New York Hospitals. This is due to the

preliminary findings from these two hospitals that 88% of COVID-19 positive obstetric

patients had no symptoms on labor presentation. This led for some facilities to treat all

patients as presumed positive until tested, and altering many patients’ delivery plans,

including support persons in the room and choice of facility. The universal testing approach

provide potential benefits which includes the ability to use Covid-19 status to determine

18
hospital isolation practices and bed assignments, inform neonatal care, and guide the use of

personal protective equipment. Access to such clinical data provides an important

opportunity to protect mothers, babies, and health care teams during these challenging times

(Sutton et al., 2020).

Center of Disease Control and Prevention (CDC) includes pregnant women in it

“increased risk” category for COVID-19 illness. This is because of the growing evidence that

symptomatic pregnant women infected with SARS-CoV-2 are at increased risk of more

severe illness compared with non-pregnant peers. It has also been found that symptomatic

pregnant women are at significant risk of ICU admissions, mechanical ventilation, and death

when compared with symptomatic non-pregnant women. Client education should focus on

counseling pregnant women about the potential risk of COVID-19 and prevention measures

to avoid contracting the SARS-CoV-2 infection should be given emphasis to clients and their

family. Pregnant individuals are encouraged to take all available precautions to avoid

exposure to COVID-19 and optimize health (ACOG, 2020).

A study conducted by Patabendige et al. (2020) shows an increase in the prevalence

of antenatal depression among non-COVID-19-infected women. The COVID‐19 pandemic

has resulted in an increase in prevalence of perinatal anxiety and depression among Sri

Lankan pregnant women with no proven/known COVID‐19 infection. Special support is

needed for pregnant mothers during infectious epidemics.

A study in prenatal anxiety and obstetric decisions among pregnant women in Wuhan

and Chongqing, China during the COVID‐19 outbreak shows differences of women’s attitude

towards COVID-19. Factors that influenced anxiety included household income, subjective

symptom and attitudes. Overall, obstetric decisions also revealed city‐based differences;

these decisions mainly concerned hospital preference, time of prenatal care or delivery,

mode of delivery and infant feeding. The outbreak aggravated prenatal anxiety and the

associated factors could be targets for psychological care. In parallel, key obstetric decision‐

making changed, emphasizing the need for pertinent professional advice. Special support is

19
essential for pregnant mothers during epidemics. The COVID‐19 outbreak increased

pregnant women's anxiety and affected their decision‐making (Liu, Chen, Wang, Sun, Zhang

& Shi 2020).

A study in psychological impact of COVID‐19 quarantine measures in northeastern

Italy on mothers in the immediate postpartum period found that pregnant women giving birth

during the COVID‐19 pandemic represent a high‐risk, vulnerable population that needs to be

carefully followed to minimize postpartum mental dysfunction. Medical and mental

healthcare interventions should be carried out immediately to prevent deterioration of

maternal psychological health, which is made more severe by social containment than

reported for previous natural disasters (Zanardo, Manghina, Giliberti & Vettore 2020).

Mental health status of pregnant and breastfeeding women during the COVID‐19

pandemic had been studied in Belgium. Results show that an increased likelihood of

depressive symptoms and anxiety among pregnant women and women in the early

postpartum period during the COVID‐19 lockdown, thereby corroborating previous findings.

Obstetricians and policymakers should be aware that COVID‐19, along with its isolation

measures, may put a higher burden on the emotional wellbeing of pregnant women and

women in the early postpartum period. Routine depression and anxiety screening should be

considered in obstetrical settings in the wake of the current pandemic to ensure optimal

perinatal and infant mental health (Ceulemans et al., 2020).

Number of pregnant women planned for home-birth prior to the pandemic, this

dramatically increased since COVID-19 caused major changes in various healthcare settings

(Bradley et al., 2020), this shows that pregnant women feels safer and has opted to give

birth at home than in the hospital and other healthcare facilities during this pandemic. While

there are women who still decided to give birth in the hospital, a large percentage of them

opted not to have a no partner attendant physically present at delivery; this is for lesser

chance of contracting the disease by reducing the exposure to more people during labor and

delivery.

20
 While the idea of going to the hospital might feel anxiety-inducing right now, experts

maintain that it's still the safest place to give birth, and your chances of being infected with

COVID-19 in the maternity ward are small (Jena 2020).

Chapter III:

Methodology

This chapter presents the methods used in this study. This chapter consists of

Research Design, Instrumentation, Validation of the instrument, Sampling procedure, Data

gathering procedure, Data analysis and Ethical consideration.

Research Design

21
 This study is qualitative in nature, descriptive phenomenological in design which aims to

explore and describe how childbirth experiences changed in the hospital during the

pandemic. The researcher aims to describe the change, limitations, and effect it caused to

expecting mothers in giving birth during the pandemic. This study aims to explore knowledge

and share the experiences of the mothers who gave birth during the pandemic.

Instrumentation

The researchers used a semi-structured questions specifically designed for the study

to explore and describe lived experiences of the participants who have given birth during the

pandemic. Participants will be interviewed following safety protocols.

Validation of the instrument

Validation of instrument was done by face validity. Face validity refers to the scope

which a test appears to measure what it is intended to measure. A test were most people

would agree that the test items appear to measure what the test is intended to measure

would have strong face validity Johnson (2013). This was done through submitting semi-

structured questions to experts, those professors with qualitative experience. Researchers

will avoid using esoteric jargon in research interview questions and instead adopt layman’s

language when possible to better deliver the questions to participants. The instrument has

balanced considerations for accurate interpretation of data.

Sampling procedure

Purposive sampling will be used by the researchers in selecting participants of the

study with the goal of data saturation. Inclusion criteria includes mothers who experience

giving birth in hospitals prior the pandemic and during the pandemic particularly those who

gave birth in the months of March 2020 through March 2021. This sampling is done for the

purpose of differentiating experiences in childbirth before and during health setting

modifications brought by the pandemic. Researchers will select participants who are willing

22
to participate in the study and will obtain information through an interview. Snowball

sampling applied as a non-probability sampling technique in which researchers begins from

a small population of known participants and expands the sample by asking those initial

participants to recruit others that should participate in the study. The sample starts small but

“snowball” into a larger sample through the course of the research (Ashley Crossman, May 6

2019).

Data gathering procedure

The researches would provide documents that are needed before data gathering;

consent forms, health certificates and approval from the school that the researchers are

eligible to obtain data from the participants. The researchers will obtain informed consent

from the target participants, explaining the purpose of the study and ensuring that their

responses are kept confidential and for academic purposes only. Before proceeding to the

interview the researchers will first make sure that the participants understood the nature of

the study and voluntarily participate in this study. Face-to-face interview was conducted

through following the strict health protocols such as social distancing, wearing face mask

and face shield. Participants was made aware of the health protocols before and during the

interview ensuring the safety of both side.

Data Analysis

Colaizzi (1978) phenomenological data analysis model emphasize conceptual

patterns and describes the process the researchers prepared. Researches will use a

descriptive phenomenological approach to understand the lived experience of pregnant

women in COVID-19 pandemic. Colaizzi’s seven-step content analysis method will be

used to analyze the research data.

23
 At the end of each interview, conversations will be transferred into a word file. In

the first stage, the files will be read several times to understand women’s feelings and

experiences. Researchers will try to suspend previous thoughts, feelings, or ideas

(bracketing) about the phenomenon under study. In the second stage, important

phrases in the text of the interviews will be identified. In the third step, the concepts will

be extracted. In the fourth, concepts will be categorized into classes based on the

similarity of the concepts. In the fifth stage, the results will be combined to describe the

phenomenon under study in terms of categories that are more general. In the sixth

stage, researchers will present a comprehensive description of the structure of the

phenomenon under study. In the final stage, the structure will be validated by comparing

it to the experiences of the participants (Mortazavi and Ghardashi 2020).

Ethical consideration

The researchers followed ethical considerations and must acquire ethical clearance

from IRERC first before pursuing data collection. The interview questions that are to be

asked are non-offensive and non-discriminatory to the participants. The researchers obtains

narration of participants experience and must assure participants regarding the

confidentiality of data collected. Interview consent form will be provided for participants to

sign their approval. Participants can withdraw anytime aroud the study even without valid

reason. During the interview, the researchers and participants will practice safety protocols

such as wearing surgical mask and face shield and practice social distancing.

CHAPTER IV

Presentation, Analysis and Interpretation of Data

This phenomenological study presents the childbirth experiences of women during

the COVID-19 pandemic. Phenomenology provides an opportunity for individuals to share

their life experiences in order to illuminate the previously misunderstood, unknown, or

discounted (Zeeck, 2012). A variety of experiences are provided to help the reader

24
understand the research participants. Quotations allow the participants to speak for

themselves, providing multiple perspectives.

This chapter presents the key findings obtained from ten in-depth interviews

beginning with a brief description of the interviewees. The results of the study inform

understanding of childbirth experiences in a pandemic in four ways by showing the (a)

experiences of women who delivered in the hospital during the pandemic, (b) significant

differences in childbirth experience before and during the pandemic, (c) coping mechanisms

of the mothers and (d) recommendations based on the findings of the study. The major

findings will be discussed in this chapter.

This study included ten multipara women who experienced giving birth before and

during the pandemic. All of which are living with their partners, six are married and four are

unmarried. The respondents’ age ranged from 19 to 37 years old; one 19 year-old, one 21

year-old, one 22 year-old, one 25 year-old, three 26 year-old, one 31 year-old, one 33 year-

old and one 37 year-old. Out of the 10 women, four gave birth to their second child, three to

their third child and three gave birth to their sixth child during the pandemic. Eight of the

women gave birth before and during the pandemic on Samar Provincial Hospital (SPH), one

woman gave birth in Eastern Visayas Regional Medical Center (EVRMC) in her previous

pregnancy and delivered her last baby in SPH while the remaining one woman gave birth in

SPH before the pandemic and in Catbalogan Doctor’s Hospital during the pandemic. Data

are gathered from participants in Catbalogan City from different barangays. Following is a

brief description of each participant.

Participant 1 in Brgy. Socorro, she is 31 years old, married and has three children.

She gave birth to her third child during the pandemic in Samar Provincial Hospital (SPH) on

July 8, 2020. She was sent to SPH during her labor and gave birth the next day. After

delivery, she stayed admitted in the hospital for five more days as per doctor

recommendation due to hypertension.

25
 Participant 2 is 19 years old and lives in Brgy. Salug. She and her partner lives

together but are unmarried. On July 16, 2020, she gave birth to her second child during the

pandemic in SPH who is unfortunately now her only child. Jenn lost her firstborn due to an

accident.

Participant 3 is 33 years old and is from Brgy. Pupua. She is married and have six

children, her sixth child was born this pandemic in SPH on July 7, 2020.

Participant 4 from Brgy. 6 is 26 years old. She is married and lives with her husband

and their two children. She gave birth to her firstborn in Eastern Visayas Regional Medical

Center (EVRMC) in Tacloban City while her youngest was born during the pandemic in SPH

on October 22, 2020.

Participant 5 is 21 years old from Brgy. Socorro, she lives with her partner but are

unmarried. On Jan 30, 2021 in the midst of pandemic she gave birth to her third child in

SPH.

Participant 6 is a 22 year-old from Barangay 6. She lives with her partner but are

unmarried, they have two children with the youngest being born during the pandemic in SPH

on March 23, 2020. She had been admitted to the hospital 5 days’ prior her due date for

delivery, this is due to her doctor’s recommendation because of probable complications that

may result from her history of hypotension and urinary tract infection (UTI).

Participant 7 from Brgy. Socorro is 26 years old and gave birth to her second child in

Catbalogan Doctor’s Hospital on October 1, 2020. Her firstborn was born in SPH. She is

married and lives with her husband and their children.

Participant 8 lives in Brgy. 6 and is 37 years old. She is married and live with her

husband and their six children. She gave birth to their sixth child on Sept 14, 2020 in SPH.

26
 Participant 9 is a 25 years old from Brgy. 6. She lives together with her partner but

are unmarried and three children. During this pandemic on October 19, 2020 she gave birth

to her third child.

Participant 10 is a 26 years old is from Brgy. 13, she is married with six children. She

gave birth to her youngest on November 9, 2020 in SPH.

After interviewing the participants and analyzing the data, five major themes emerged

that expand and enrich the understanding of the lived experience of the women. The first

theme was difficulty in hospital access. The second theme was psychological challenges

caused by the pandemic. The third theme was the differences in childbirth experience before

and during pandemic. The fourth theme emerging was a variety of coping strategies that

women employed to manage difficulties encountered. The fifth theme are the participants’

recommendations.

Difficulty in Hospital Access

The COVID-19 pandemic caused great changes in the hospital setting altering the

health care system. In the first theme, participants expressed difficulty in hospital access.

Several subthemes emerged relating to this difficulty. These included difficulty in pre-natal

check-up, transportation to the hospital and financial challenges.

Pre-natal care is important for both the mother and the baby’s health. When a mother

does not get prenatal care, the baby is three times more likely to have a low birth weight.

When a doctor checks up the mother regularly, they can spot problems early and treat them

so that they can have the healthiest pregnancy possible. The community quarantine and

local lockdowns hindered pregnant women’s need to accomplish pre-natal check-ups. A

recommended schedule for a healthy pregnancy is one pre-natal visit a month in the first

four to 28 weeks, one pre-natal visit every two weeks in week 28-36 and one pre-natal visit

every week in weeks 36-40. Of the ten women-participants, two had their pre-natal care in

Barangay Clinic while eight had their pre-natal care in hospitals on which seven visited

27
Samar Provincial Hospital (SPH) and one visited Catbalogan Doctor’s Hospital for pre-natal

care. Due to increased hospital restrictions, women experienced limited hospital access to

accomplish their pre-natal check-ups. None of the participants have completed a

recommended number of pre-natal visitations. The two women who had pre-natal care in

Brgy. Clinic only visited three times for a check-up in the whole period of pregnancy. One

woman who visited Catbalogan Doctor’s Hospital only went twice for pre-natal care. Out of

the seven women who visited SPH, one visited only once, three visited twice, one visited

three times and two visited for four times. All interviewees described that going to the

hospital during the pandemic is “complicated”, they call it. One participant mirrored the

sentiment of many others regarding hospital accessibility when she stated, “Every visit to the

hospital requires travel pass or quarantine pass and health certificate from the barangay…

and getting these was often not easy”. One who was supposed to have her pre-natal care in

SPH shared why she was not able to complete her visits:

“In my first visit in SPH they already informed us that we will have specific schedules

for pre-natal care because only five mothers were allowed for pre-natal every day for

the purpose of social distancing. But in the midst of the pandemic, SPH was lock

downed because most of its staff contracted the virus, schedules were altered and

from there I lost track of the days of my suppose visits and just decided to not have

them anymore.”

This result is consistent with the findings of Rosenbaum (2020) that many patients

are not going to health-care providers or to hospitals, even when there is a need, due to

SARS-CoV-2. Public policies have been focused mainly on treating infected patients by

COVID-19 and on restrictive measures to protect people from being infected. In this

scenario, elective and preventive care has been deferred or eliminated. The clinical impact

of this trend is not clear, but concerns arise especially for patients in need of treatment and

follow-up such as pregnant women. By limiting the provision of essential care, patients will

experience a near miss situation, or even a lethal event, not related to COVID-19. The

28
provision of prenatal care could be one of the conditions compromised by the above

scenarios with the potential of resulting in adverse outcomes (Osana, Vidarte and Ludmir,

2020).

Another factor that affected the accessibility of hospitals is transportation. During

community quarantine and lockdown, public transport has been limited especially to

pregnant women. Since none of the participants owned a private vehicle, they had difficulty

finding a way of transportation to the hospital. Of the ten women, three were admitted to the

hospital days before their delivery thus having their labor while on admission, seven of the

women-participants had gone to the hospital during their labor and gave birth at the same

day. The participant from Brgy. Papua was able to ride a free transportation in a bus on her

way to the hospital, she stated:

“The local government was offering that time a free transportation with a bus, luckily I

was able to ride on it on my way to the hospital, otherwise we would have had

difficulty finding another form of transportation.”

Two women from Brgy. Socorro were able to ride in a rescue vehicle provided by the

barangay, one of them shared:

“On that day I really felt I was about to give birth and we immediately had to go to the

hospital. We were very problematic because there was no public transport vehicle,

so I asked a relative to go to the Brgy. Hall for the rescue vehicle and thankfully they

responded quickly and I rode on it to the hospital.”

The four remaining women expressed difficulty in finding a public vehicle such as the

three-seater tricycle on their way to the hospital. The respondent from Brgy, Salug clearly

described her struggle to find a vehicle that will send her to the hospital:

“My contractions were already very strong that time and I remember my mother-in-

law and I walking for a lengthy period from our home to St. Bartholomew Church

29
 because we could not find any vehicle. I could not walk any further because the

contractions were getting stronger and more painful. I waited for a few more minutes

before my mother-in-law found a tricycle that will send us to the hospital.”

In terms of financial responsibilities, nine women-participants that gave birth in

Samar Provincial Hospital during the pandemic stated that they had not paid any amount for

childbirth in the hospital while the woman who gave birth in Catbalogan Doctor’s Hospital

had an amount to pay but was lessened because of her PhilHealth. The most common

reason for financial problem for the women was increased expenses in transportation. The

lockdown had brought a huge price-hike in transportation fare, this is mostly another reason

why they had not completed their pre-natal check-ups. Out of the ten women, eight stated

that they had more expenses giving birth now during a pandemic compared to giving birth

before the pandemic, one woman said:

“There is much more expenses now, because even though hospital expenses remain

the same as before, no payment in childbirth and for the doctor, all basic necessities

now have increased prices, especially those for the baby.”

Addition to these expenses are laboratory tests and ultrasound and prescribed

medications that are not available in the hospital and has to be purchased by the participants

in private clinics. According to Calvello, Skog, Tenner and Wallis (2015), there three well-

known factors or delays increase the risk for adverse maternal outcome: delay in seeking

care; delay in reaching health-care services; and delay in receiving adequate care at the

health facility. Financial problems and access to transportation due to restriction measures

and lockdown to avoid virus spread was a main cause of delay in receiving adequate care at

the facility by pregnant women (Osana et al., 2020). This result of the study confirms that

financial and access to transportation problems delay adequate care needed by childbearing

women.

Psychological Challenges Caused by the Pandemic

30
 Pregnant women are very sensitive to emotional stress and the pandemic have

brought a series of stressors. The second theme emerging was psychological challenges

caused by the pandemic. Subthemes relating to this were fear of getting a swab test and

concern of safe delivery amidst COVID-19 infection. Stress is known for its impact on

pregnancy. Participants often mention that increased stress are due to restrictions and

protocols that were established for safety during this pandemic. This resulted to limited

activities that involved going outside and social gatherings and prevented most of the

participants to do things that were even necessary for them, these lead the participants to

stress even more.

All of the interviewees shared of their worries of having a swab test upon hospital

admission. As shared by one woman:

“I was told by some that I would be tested using a swab before I get admitted to the

hospital for my delivery, thankfully this wasn’t true and I never had a swab test. I

feared to have a swab testing because I often hear from other people that it can hurt

badly sometimes.”

Each of the women expressed how it terrified them that they will have a swab test

prior to admission. This fear is from the knowledge from other people that swab tests are

painful and they also worried that they might end up getting a false positive result.

Psychological experiences during childbirth in the hospital vary in each participant. A

surprising data gathered showed that most of the participants are not worried about

contracting the COVID-19 virus while on hospital for labor and birth. Out of the ten

participants only three women stated that they feared contracting the COVID-19 virus. They

described how the fear in contracting COVID-19 virus affected them. One woman described:

“While I was pregnant and was at home, I watch the daily news and I felt really

anxious seeing that the number of cases for COVID-19 was continuously and rapidly

increasing. Every time I hear in the news that more and more people results positive

31
 with corona and more people are dying, I can’t help but think that I might contract the

virus and get positive too when I go to the hospital for my delivery!”

A second woman added:

“I was uncomfortable while at the hospital, not only with the other patients but even

with the nurses and doctors because you’ll never know who and who’s not carrying

the virus right? I kept thinking I might get the virus in the hospital from anybody and

spread it to my family and even pass it to my incoming baby.”

Although three women were excessively worried about contracting the COVID-19

virus in the hospital, the majority of women did not have fears and were not bothered of the

corona virus. “I’m not really concerned about the pandemic and I’m not afraid of getting the

virus”, said one woman after being asked if she worried about contracting the virus. All these

seven women spoke about not thinking much about the virus and the pandemic while they

were already at labor and delivery. One participant recapitulated:

“I am hypertensive, and while I was on my labor my blood pressure almost reached

the ceiling. I was very anxious whether I will be able to deliver my baby safely or not

or will I suffer complications... I really didn’t have the energy to think about COVID

and wasn’t even bothered about it before going to the hospital.”

The other participants had the same statements saying they were already very

conscious about delivering their baby safely and did not think about the virus anymore. Their

focus was mainly on having a safe delivery and to not have any complications as evidenced

in the comment “Whatever happens, my outmost concern was to give birth to my child and to

not have any further problems.”

The study finds that during labor, women’s concern was mainly focused on their safe

delivery and was less concerned about contracting the virus. This result refutes the study of

Fort Wayne (2020) that the pandemic imposes higher risk of mental health issues to

32
pregnant women given the many compounding factors, including the fear of becoming

infected, transmitting the infection to her infant if infected, social isolation, financial

difficulties, potential reduction in household help, insecurity, and the inability to access

support systems. He further added that all these add to already existing stress of a pregnant

woman which may affect the pregnancy and delivery.

While the findings support Han Selye’s resistance stage of the General Adaptation

Syndrome (GAS). GAS describes the pattern of responses that the body goes through after

being prompted by a stressor (Burgess 2017). It proceeds in three stages: the alarm

reaction stage, a distress signal is to a part of the brain which prepares a person to respond

to the stressor (fight or flight response); the stage of resistance where the body tries to

counteract the physiological changes that happened during the alarm reaction stage; the

exhaustion stage, the body has depleted its energy resources by continually trying but failing

to recover from the initial alarm reaction stage. During the stage of resistance when the

person tries to adapt to the stressor, resistance to other kinds or weaker stressors decreases

at the same time (Gutenberg 2012). When the women were in the resistance stage under

the stress of delivery, their focus of resistance was to fight the physiological changes,

specifically the pain from delivering their baby. Other kinds of stressor such as the COVID-

19 virus became a lesser concern since the focus of resistance was towards the greater

stressor at the time. This support that during the resistance stage in the General Adaptation

Syndrome, the body and the mind’s focus of resistance is on the greater stressor.

Difference in Childbirth Experiences Before and During the Pandemic

All interviewees are multipara women varying in their number of children. The third

theme emerging were the differences in childbirth experience before and during the

pandemic. Three subthemes emerged: improved healthcare services in the hospital, better

33
support and assistance received from healthcare workers and being fine with of having only

one watcher during admission.

When asked about the comparison of their experience in childbirth before and during

the pandemic in terms of health care services, four women expressed that the healthcare

services before the pandemic was better and six women expressed that it has improved

during the pandemic. A major cause of frustration from the women who perceived their

experience in childbirth to be better before the pandemic stems from the strictness of health

protocols. Participants noted the impact of the pandemic on their childbirth experience. One

woman expressed her frustration:

“Delivering a child from your body is already hard, beyond words to describe. And

pushing your baby out while wearing a face mask, face shield and having a plastic

barrier between you and the nurse made everything harder and more challenging. I

felt very hot and it was difficult to breath”

A second participant added:

“My experience in childbirth before the pandemic was better because there was no

perceived risk in [contracting] any virus. Before, I did not feel uncomfortable around

nurses and other healthcare workers and patients. During my hospital stay [this

pandemic], I felt like I should try avoiding everyone in the hospital.”

The stress of the four interviewees in healthcare services during this pandemic

mainly occurs from struggle to comply with health protocols, difficulty in hospital access thus

limiting services acquired and the perceived threat in contracting COVID-19 virus.

Although four interviewees expressed that the pandemic worsen their childbirth

experience, statement from six participants showed that they experienced the opposite.

These six participants agreed that the hospital services in Samar Provincial Hospital (SPH)

had generally improved in quality. Their experiences are generalized by the statement of one

participant:

34
 “SPH have greatly improved in their hospital services compared to few years ago in

my previous child delivery before this pandemic. Facilities have improved and

patients are better attended now by hospital staff.”

These six interviewees agreed that even though the pandemic is going on and

hospital setting have been modified, hospital staff are still able to render quality care despite

busyness around the hospital and despite the implemented protocols.

Participants were also asked to compare the experience they had in terms of support

and assistance they received from health care providers and allies before and during the

pandemic. Of the ten interviewees, six agreed that support and assistance from hospital staff

are better now, two stated that before was better and two agreed that care from

doctors/nurses before and during the pandemic are essentially the same. The six women

reported that they received good support and guidance from nurses. Their experience is

summed up in the statement of one participant:

“Hospital staff before particularly nurses were not very accommodating and

empathetic, in my experience now in giving birth this pandemic, the nurses who

cared for me assisted and guided me well and attended my needs.”

Two participants reported that their experiences in relation to support and assistance

from healthcare workers are better before the pandemic. One explained that the nurse who

attended her was not very supportive and lacks empathy while the other complained that the

nurse did not attend to her needs in a timely manner. The two remaining women stated that

the guidance and support they received was both essentially good and the same before and

during the pandemic.

All of the participants shared the same experience in the availability of support and

visitations from significant others (SO) and loved ones. One strict rule implemented by

hospitals during the pandemic is only one watcher per admitted patient is allowed (unless

health care provider recommend having two). All interviewees acknowledged and complied

35
to this protocol and shared that they only had one family member with them during their

hospital stay. When asked whether it was uncomfortable to only have one watcher during

the time, most participants claimed that they had no troubles and was fine having only one

with them. Participants were asked to compare their experience of having more than one

watcher allowed to visit them before the pandemic and their experience now that only one

was allowed. The following is a commonly held response:

“It was nice before to have more than one companion to the hospital like having both

my partner and my mother around but it was also fine to only have one during the

pandemic. I already assumed that that would be the case and it was announced

beforehand. The good thing was that the hospital allowed to exchange watchers so

I’ll have my sister in the morning and then my partner comes at night.”

Viral transmission is dependent on human behavior. Slowing the transmission of

COVID‐19 has required people globally to undertake significant and profound behavioral

changes almost overnight – and continue to comply with these changes. How to reduce viral

transmission is therefore as much a question of social psychology as it is of virology and

epidemiology, and requires the careful deployment of all we know about the factors that

influence collective solidarity and lasting behavior change (Smith and Gibson 2020). All of

the participants complied with the protocols implemented by the facility and was fine with

having only one family member as watcher while at the hospital. These actions and behavior

of compliance supports Action Identification Theory by Robin Vallacher and Daniel Wegner.

This theory specifies the principles by which people adopt a single act identity for their

behavior and outlines the conditions under which people maintain this act identity or adopt a

new one. These principles explain how people's thoughts of what they are doing relate to

what they do. In a sense, the principles suggest an "operating system" for a human being –

a program linking thought to action. The principles suggest simply that people do what they

think of doing, that when they can think of doing something more, they do that – but that

when they can't do what they were thinking of doing, they think of doing less (Vallacher and

36
Wegner 2012). When the participants think that they have to follow the protocols, these

thoughts relate and manifest in their behavior through compliance. And when the women

accepted the rule of having only one watcher, they became fine with this and complied even

though at previous experiences in childbirth, it was better for them to have more than one

family member present. This confirms the suggestion of the theory that when they can’t do

what they were thinking of doing, they think of doing less.

Coping Mechanisms Utilized to Manage Difficulties

The women were overloaded with the combining stress of pregnancy and altered

environmental processes due to health protocols. The fourth theme emerging recognizes the

coping strategies utilized to manage difficulties experienced. Two major subthemes

emerged: problem-focused strategies and emotion focused strategies. All women developed

coping mechanisms in an attempt to combat the effects of stress. (Zeek, 2012). The purpose

of problem-focused coping strategies is for individuals to actively seek solutions or set

priorities while emotion-focused coping strategies target calming or regulating emotions

stimulated by a stressor.

Data showed that participants utilized both of these strategies. Problem-focused

strategies included always staying at home during their pregnancy, keeping a stock of foods

and other home necessities, being “extra” careful and sanitizing personal belongings and

while at the hospital maintains social distancing from both hospital staff and other patients.

Emotion-focused strategies included accepting the situation, not complaining about

restrictions and protocols, seeking support from SO and family and maintaining a positive

outlook despite the pandemic. When asked what specifically their coping mechanisms are,

seven participants responded with a problem-focused strategy. “I just looked at the things

that are in my control and tried everything I can to ease my situation,” one woman reported.

Majority of the participants seemed to have coped with the situation simply by avoiding the

stressors by staying at home. One woman mirrored the sentiments of others:

37
 “Staying [at home] because it only seemed like the safe place, the virus was all over

Catbalogan. And aside from that, going outside and seeing how things were not

normal causes unnecessary stress.”

To lessen the need of going outside, participants reported that they keep a stock of

food and other home necessities limited only to what they can afford. Upon purchasing

things such as groceries from stores, sanitization was an important part of the routine when

arriving at home. One common problem-focused strategy utilized by the women in the

hospital was maintaining distance from other people inside the facility. This is an important

protocol that they had to follow and at the same time offers relief that this lessens the

possibility of contracting the virus.

Three participants shared an emotion-focused strategy when asked about their

coping mechanisms. One interviewee narrated how she coped with the situation by being in

control of her reactions:

“Months in the community quarantine, I have just simply accepted the current

situation and I knew that [my delivery] with my baby this time is not going to be the

same. So whatever I had to do, I complied and did not complain. Surprisingly it

wasn’t that hard and I felt that it made everything easier for me and my baby.”

A second interviewee posited:

“Positive thinking. I keep thinking that everything will be okay after I give birth and

that I will not get the COVID virus in the hospital. That’s all I did because what else

can I do for myself?”

Participants in this study recognized the need to develop coping strategies in order to

diminish the effects of stress. Two types of coping strategies were utilized: problem focused

and emotion-focused. Problem-focused strategies attempted to find solutions, while emotion-

focused strategies tried to balance the emotions activated by a stressor. Problem-focused

38
strategies included: always staying at home during the pregnancy, keeping a stock of foods

and other home necessities, sanitization and maintaining social distancing in the hospital.

Emotion-focused strategies involved: acceptance of the situation, complying instead of

complaining, seeking support from SO and family and maintaining a positive outlook despite

the pandemic This result confirms Lazarus and Folkman’s Transactional Theory of Stress

and Coping (1984). This theory presents stress as a product of a transaction between a

person and his or her complex environment and includes primary, secondary, and

reappraisal components. Primary appraisal involves determining whether the stressor

poses a threat. Secondary appraisal involves the individual’s evaluation of the resources or

coping strategies at his or her disposal for addressing any perceived threats. The process

of reappraisal is ongoing and involves continually reappraising both the nature of the

stressor and the resources available for responding to the stressor. The appraisal literature

explains the response or coping process in terms of problem-focused coping or emotion-

focused coping also referred to as active and passive coping styles (Stangor & Walinga

2014). When faced with a challenge, an individual primarily appraises the challenge as either

threatening or non-threatening, and secondarily in terms of whether he or she has the

resources to respond to or cope with the challenge effectively. It is theorized and empirically

demonstrated that a person’s secondary appraisal then determines coping strategies. If the

individual does not believe he or she has the capacity to respond to the challenge or feels a

lack of control, he or she is most likely to turn to an emotion-focused coping response such

as wishful thinking, distancing, or emphasizing the positive. If the person has the resources

to manage the challenge, he or she will usually develop a problem-focused coping response

such as analysis (Stangor & Walinga 2014).

As the data presented, out of the ten interviewees, seven women managed the

challenge and developed a problem-focused response while three women resorted to

emotion-focused coping response such as wishful thinking and emphasizing the positive.

This supports that those who find the resources to manage the challenge develop a

39
problem-focused strategy and analyze the situation while those who lack of control and

believe she does not have the capacity to respond to the challenge as evidenced by the

statement, “I just kept thinking positive because what else can I do for myself?” turn to

emotion-focused strategy.

Recommendations from the Participants

Women’s childbirth experiences during this pandemic largely differs and is unique

from previous experiences of child delivery. The fifth theme emerge are recommendation

from the participants. Four subthemes emerged: do not get pregnant during a pandemic,

expectations of health protocols, suggestions for improvement in health services and

recommendation to pregnant women at the present time.

Prior to giving their recommendations, participants were asked regarding their

insights in the experience of giving birth during the pandemic. All participants have one

single response, “Do not get pregnant yet while we are at the pandemic.” Most of the

participants just simply stated this while two women agreed, reasoning out, “It’s difficult with

all the strict protocols. If I have known, I would have waited after the pandemic until I get

another baby.” Expectations before hospital admission were also pointed out. Seven women

expressed that they already had looked forward to the health protocols in the hospital, such

as wearing face mask and face shield while giving birth and having a plastic barrier between

the healthcare worker assisting the delivery. The three remaining participants expressed

how they did not expect all the said protocols resulting to them being surprised and finding

the situation uncomfortable:

“I really did not expect to be wearing both face mask and shield while delivering my

baby. It was very hard to breath and they will not [allow me] to lower my mask so I

can breathe better.”

From this, interviewees were asked to make recommendations based on their own

experiences and participants’ suggestions are almost distinct from one another. One said,

40
“The hospital (SPH) lack medicine supply that are needed after birth, we had to purchase it

outside and spend money.” This participant suggested that SPH should have a complete

supply of medicines that are immediately needed after giving birth. She further explained:

“I only had one watcher with me but because the medicine was not available at the

hospital, he (her SO), has to leave to buy outside the facility.”

Another interviewee had an almost the same experience when she shared:

“After I gave birth to my baby, I learned that they did not have a supply of BCG

vaccine at that time so my baby had not been immediately vaccinated after birth and

we had to get the vaccine in a Bgry. clinic a few days later.”

Bacillus Calmette–Guérin (BCG) vaccine is recommended to be administered in

healthy babies as soon after birth as possible. But due to lack of supply, this participant’s

child had not been vaccinated. She suggested that this may not happen again, not only

because of the inconvenience but she also thought about the effects of delayed vaccine

administration to her baby.

One woman exclaimed, “It’s very hot especially in the ward, they lack proper

ventilation.” Another participant supported this, making the same suggestion of having

additional ventilation such as electric fans in the ward to lessen the heat. This

recommendation from the participants supports Florence Nightingale’s Environmental theory

wherein Nightingale believes that those who repeatedly breathed his or her air would

become sick and that it was necessary to have fresh air to eliminate any foul odors from the

surrounding. She stated it was important that room temperate was not too cold or too hot to

promote better healing (Hegge, 2013). Complains about proper ventilation are common in

public hospitals especially before the pandemic, but when other participants were asked

regarding this, they explained that ventilation became a lesser problem during the pandemic

because social distancing had to be implemented. There are fewer patients in every ward

which means you can find a spot with electric fans and lesser people means lower heat in

41
the surrounding. Regardless, two participants still suggested for an increased ventilation in

ward.

Cleanliness was also an important concern the participants wanted to address. A

clean environment is vital for healing and good health. Unfortunately, hospitals often lack in

maintaining this important criterion for health and this is a common complaint from patients

or clients. As one woman reported:

“I was brought to the Emergency room when I arrived in the hospital and I noticed

how dirty it was in there. It was uncomfortable, with flies everywhere”

Second woman added, “I would suggest for an improved cleanliness especially in the

ward and CR.” A clean environment is very important for both the patient’s recovery and

comfort. For mothers who had just recently given birth, this is vital to avoid infection more

importantly when they use the comfort room in the ward. And a clean environment would

also be very beneficial to the newborn as their immune system is not yet fully functional.

Iatrogenic infection is pervasive and poses health risk to both the mother and her child. This

can be avoided with an improved cleanliness in the hospital as proposed by Florence

Nightingale. In her Environmental Theory, Florence Nightingale identified cleanliness or

sanitation as the fourth environmental factor affecting health. According to Nightingale’s

theory, the body could repair itself with a nurturing environment (Gonzalo, 2021).

One woman who did not receive satisfying care and support from a healthcare ally

recommended that hospital staff should be more caring and offer support to patients. She

claimed, “The nurse who was attending me and my baby and was not very gentle and she

wasn’t always available when we asked for assistance.” With all these recommendations

made by the majority of the interviewees, there are three who did not give any

recommendations since according to them they had a positive experience in the hospital

during their labor and delivery and received satisfactory care.

42
 Participants were asked for recommendations they want to address towards other

women during this pandemic. All of the participants do not recommend for women to get

pregnant during this time. Their reasons reflect one statement of a woman, “it’s really

inconvenient and even risky” they advise other women to wait as much as possible until

everything’s better and almost back to normal. A survey conducted in May 2020 found that

of 2,000 women, 34% wanted to delay pregnancy or have fewer children because of the

pandemic (Boehrer, 2020).

They also expressed their advices for women who are at the current time

childbearing and will deliver their baby during the pandemic. Three participants emphasized

the importance of bringing a result for an ultrasound as well as other paper requirements

such as health certificate from the barangay because these are necessary for admission and

acceptance in the hospital. All of the interviewees pointed out that they would really advice

pregnant women at the present time to still give birth in the hospital even in the midst of the

pandemic.

According to her,

“The hospital is still the safest place to give birth. I feel secured knowing that there

are doctors and nurses, they know what to do and they have everything they need in

the hospital to help me deliver my baby safely.”

This result corresponds with Jena (2020), that the idea of going to the hospital might feel

anxiety-inducing right now, but experts maintain that it's still the safest place to give birth, and

your chances of being infected with COVID-19 in the maternity ward are small. This further

supports the recommendation of the Department of Health (DOH) who at the same time

assures it is safe to give birth in hospitals and other health facilities amid the Coronavirus

crisis (Johnson 2020). Some participants recommend for other pregnant women to be more

careful and take care of their selves by strictly following health protocols. They also

suggested that as much as they can, they should try to complete their pre-natal visitations.

43
 Chapter 5

Summary of Findings, Conclusions and Recommendations

This chapter presents the summary of findings, conclusions and recommendations of

the study.

Summary of Findings

Based on the findings of this study, the following were the salient findings of the

study:

1. Difficulty in hospital access was experienced by the women-participants due to strict

health protocols. All of the participants were not able to complete their pre-natal visit.

Transportation and financial responsibilities were also a huge challenge for them

which contributed to the difficulty in hospital access. In terms of financial

responsibilities, nine women did not pay for anything in the hospital (SPH), while one

participant who had her delivery in Catbalogan Doctor’s Hospital (CDH) paid an

amount that was lessened by her PhilHealth. Out of the ten interviewees, eight stated

that they had more expenses giving birth now during the pandemic and two

considered that their expenses before and during pandemic were the same.

2. As regard to psychological challenges, all the participants worried of getting a SWAB

test upon hospital admission because of the assumption that this could be painful

and might get a false positive result. Seven of the participants were not concerned

44
 whether they will contract the COVID-19 virus in the hospital and was only focused

on safe delivery and three worried about contracting the virus. As regard to the

comparison of experiences in childbirth before and during the pandemic, four women

expressed that the healthcare services before the pandemic was better, four

expressed that during the pandemic was better while two stated that there are no

significant differences. In terms of support and assistance the, of the ten

interviewees, six agreed that support and assistance from hospital staff are better

now, two stated that before was better and two agreed that care from doctors/nurses

before and during the pandemic are essentially the same. In terms of availability of

support, all the participants acknowledged and complied with the rule of having only

one watcher and did not have problem with this.

3. As regards to coping mechanisms, seven of the participants used a problem-focused

strategy and three used an emotion-focused strategy of coping.

4. All of the participants have one insight with their experience, to not get pregnant

during the pandemic. In terms of expectations in health protocols in the hospital,

seven reported that they expected the rules and restrictions while three expressed

that they did not expect all the strict protocols in the hospital. As regards to specific

recommendations, two woman recommended that the hospital should have a supply

of medications and vaccines that are immediately needed after birth, two woman

requested for an increased proper ventilation, two address the issue of cleanliness

having to be maintained and one woman expressed that hospital staff should be

more caring and supportive to the patients. The three remaining participants did not

give any further recommendations. All of the participants do not recommend for other

women to get pregnant during this time of pandemic. Specific recommendations

participants want to address towards pregnant women at the present time include; to

still give birth in the hospital, bring ultrasound result and other paper requirements

such as health certificate from the barangay, be more careful and take care of their

45
 selves by strictly following health protocols and complete their pre-natal visitations as

much as possible.

Conclusions

On the basis of the salient findings, the following were the conclusions made in

this study:

1. Difficulties to gain hospital access due to strict health protocols and transportation

resulted to none of the participants completing the advised numbers of pre-natal.

Expenses was much higher for the participants now than before due to the

pandemic. Anxiety and fear were present among the participants due to the pain

expected for a swab test (although participants were not tested). During labor

participants were more focused on the delivery than their anxiety towards the virus.

2. Giving birth before was the most preferred experience of the participants. More than

half of the participants felt that the health care service was better now, and all of

them have abide having only one person to be allowed with them.

3. The majority of the participants used a problem-focused strategy than emotion-

focused strategy of coping which proves that most of the women has the capacity to

respond and have the resources to manage challenges.

4. The participants recommended not to get pregnant during the pandemic and most of

them expected strict rules of the hospital. The participants had reported that during

their stay at the hospital certain issues should be addressed such as the lack of

some medication, proper ventilation, and cleanliness. Participants also

recommended currently pregnant women to still give birth in the hospital and to bring

necessary documents if they go for a prenatal visit.

Recommendations

46
 Mitigation efforts to control the spread of COVID-19 are important, but

healthcare facilities and professionals should be aware of the unintended effect they

may have, including limiting access to routine prenatal care. Hospitals should

continue to provide medically necessary prenatal care, referrals, and consultations,

although modifications to health care delivery approaches may be necessary.

Healthcare and other prenatal care professionals also should consider creating a

plan to address the possibility of a decreased health care workforce. The healthcare

system and the local governments must provide transportation intended for pregnant

women during the pandemic to secure availability of vehicle in times of emergency.

Proper information dissemination from hospitals regarding health protocols

should be strictly implemented to avoid false information causing fear among

pregnant women. Samar Provincial Hospital and Catbalogan Doctor’s Hospital

should maintain the quality of their services that have been found to be improving.

Healthcare workers should help patients identify previously used effective coping

mechanism and guide patients through their own coping strategies.

Hospitals must ensure stock of available medications and vaccines

immediately needed after birth for patients’ safety and convenience. Samar

Provincial Hospital must improve their ventilation and improve cleanliness in the

facility. Amid pandemic, pregnant women are recommended to still give birth in the

hospital and other healthcare facilities such as health clinics and seek professional

help. Pregnant women must be fully aware of currently implemented protocols in

specific hospitals to receive continuous quality care.

REFERENCES

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AF. Bell, E., HJ. Re-Murray, J., F. Tani, V., S. Garthus-Niegel, T., S. Dekel, C., SH.
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APPENDIX

SEMI-STRUCTURED INTERVIEW QUESTIONS

A. What are the leading experiences of women?

1. What are the difficulties or challenges you've experienced during your pregnancy
& child birth during COVID19 pandemic?
- In terms of difficulty in hospital access.
- In financial responsibilities.
2. What psychological challenges have you experienced?

B. Comparison of the difference of experiences in childbirth before the pandemic and

during a pandemic.
1. In terms of heath care services (efficiency, effectivity, timely)
2. In the support and assistance of health care providers.
3. In terms of availability of support and visitations of significant others.

C. What were their coping mechanisms?

1. How did you overcome the challenges and difficulties during your pregnancy in a
pandemic?
- What specifically were your coping mechanisms?

C. Recommendations
1. What are your insights or lesson learned while being pregnant and having child
birth during pandemic?

49
 2. What were your expectations in terms of health protocols made by the healthcare
system?
3. What are your suggestions for improvement in health services provided to
pregnant women in the hospitals during COVID19 pandemic?
4. Will you recommend for women to get pregnant during this time of pandemic? Why
or why not?
5. What recommendations will you give to pregnant women at the present time?

Catbalogan City, Samar

Samar State University
College of Nursing and Health Sciences

January 29, 2021

Dear Participant,

We are a group of students from Samar State University from the College of Nursing
and Health Sciences. We are conducting a study about how the Covid-19 pandemic affected
women’s childbirth experiences in Samar Provincial Hospital, Catbalogan City. The objective
of this research project is to have a narrative result from studying childbirth experiences
during the pandemic. Through your wilful participation, we hope to know and understand the
unique experiences of new mothers who have gave birth this pandemic.

Enclosed with this letter are interview questions that inquire regarding your
experiences in childbirth in the hospital with all the restrictions and modifications done in the
hospital setting during this pandemic. We humbly ask for your participation by looking over
the questions and we will be very glad to retrieve it with your complete answers.

50
 It is optional whether or not to give your name as a participant of this study. Your
responses will not be identified with you personally and you can be assured that none of your
responses will influence your life.

Your participation is voluntary and there is no penalty if you choose to not participate.
But we, the researchers are full of hope for your participation in this study and you can be
sure that data garnered from your participation is of big help for changes and improvements
in our healthcare system.

For your questions and concerns, you may reach us at 09164315649 or through email
at lorchacristil@gmail.com. You may have questions about your rights as a research subject;
please feel free to reach or contact Samar State University.

Childbirth Experiences in Hospital during

COVID-19 Pandemic

Consent to take part in research

 I _______________________________ voluntarily agree to participate in this research

study.

 I understand that even if I agree to participate now, I can withdraw at any time or refuse to
answer any question without any consequences of any kind.

 I understand that I can withdraw permission to use data from my interview within two
weeks after the interview, in which case the material will be deleted.

 I have had the purpose and nature of the study explained to me in writing and I have had the
opportunity to ask questions about the study.

 I understand that participation involves honestly and fairly giving my responses to

interview questions.

 I understand that I will not benefit directly from participating in this research.

 I agree to my interview being audio-recorded.

51
 I understand that all information I provide for this study will be treated confidentially.

 I understand that in any report on the results of this research my identity will remain
anonymous. This will be done by changing my name and disguising any details of my
interview which may reveal my identity or the identity of people I speak about.

 I understand that disguised extracts from my interview may be quoted in dissertation,

conference presentation, published papers etc. from this study.

 I understand that if I inform the researcher that I or someone else is at risk of harm they
may have to report this to the relevant authorities - they will discuss this with me first but
may be required to report with or without my permission.

 I understand that signed consent forms and original audio recordings will be retained in the
researchers until the exam board confirms the student’s results of dissertation.

 I understand that a transcript of my interview in which all identifying information has been
removed will be retained for two years from the date of the exam board.

 I understand that under freedom of information legalization I am entitled to access the

information I have provided at any time while it is in storage as specified above.

 I understand that I am free to contact any of the people involved in the research to seek
further clarification and information.

Signature of research participant

________________________ ____________

Signature of participant Date

Signature of researcher

I believe the participant is giving informed consent to participate in this study

Researchers from College of Nursing and Health Sciences

Babon, Mikee Rose (BSN) ______________________

Catalan, Coleen (BSN) ______________________

Dayap, Judiel (BSN) ________________________

Geres, Margarette (BSN) ________________________

52
Macaraeg, Ma. Flinky (BSN) ________________________

Pomentil, Lorelie Charresse (BSN) ________________________

Signature of researcher

__________

Date

53