Abstract

Background

SARS-CoV-2 infections have spread worldwide, with a rapid increase in cases and deaths, becoming a pandemic¹1 Aimrane A, Laaradia MA, Sereno D, Perrin P, Draoui A, Bougadir B, et al. Insight into COVID-19’s epidemiology, pathology, and treatment. Heliyon. 2022; 8(1):e08799. Doi: https://doi.org/10.1016/j.heliyon.2022.e08799.
https://doi.org/10.1016/j.heliyon.2022.e... . It is a disease with respiratory manifestations, a clinical situation that varies from asymptomatic infections to severe cases, and may progress to death. About 80% of people recover without hospital treatment, but in severe cases it can affect other organs besides the respiratory system²2 Souza ASR, Amorim MMR, Melo ASO, Delgado AM, Florêncio ACMCC, Oliveira TV, et al. Aspectos gerais da pandemia de Covid-19. Rev Bras Saude Mater Infant. 2021; 21 Suppl 1:29-45. Doi: https://doi.org/10.1590/1806-9304202100S100003.
https://doi.org/10.1590/1806-9304202100S... ^,33 Munhoz RP, Pedroso JL, Nascimento FA, Almeida SM, Barsottini OGP, Cardoso FEC, et al. Neurological complications in patients with SARS-CoV-2 infection: a systematic review. Arq Neuropsiquiatr. 2020; 78(5):290-300. Doi: https://doi.org/10.1590/0004-282x20200051.
https://doi.org/10.1590/0004-282x2020005... .

The people at highest risk are the elderly and those with comorbidities, such as high blood pressure, heart and lung problems, diabetes, or cancer, including pregnant women and women who have recently given birth⁴4 Paz MMS, Almeida MO, Cabral NO, Assis TJCF, Mendes CKTT. Barriers imposed in the relationship between puerperal women and newborns in the COVID-19 pandemic scenario [Internet]. São Paulo: Preprints SciELO; 2020 [citado 18 Jul 2022]. Disponível em: https://preprints.scielo.org/index.php/scielo/preprint/view/965
https://preprints.scielo.org/index.php/s... ^,55 Organização Pan Americana da Saúde - OPAS. Folha informativa sobre Covid-19 [Internet]. Washington: OPAS; 2022 [citado 18 Jul 2022]. Disponível em: https://www.paho.org/bra/index.php?option=com_content&view=article&id=6101:covid19&Itemid=875
https://www.paho.org/bra/index.php?optio... . Protective measures, such as hand hygiene, covering the mouth when coughing or sneezing, wearing a mask, keeping physical distance, knowing the symptoms of Covid-19, monitoring, and especially vaccination, have been disseminated⁵5 Organização Pan Americana da Saúde - OPAS. Folha informativa sobre Covid-19 [Internet]. Washington: OPAS; 2022 [citado 18 Jul 2022]. Disponível em: https://www.paho.org/bra/index.php?option=com_content&view=article&id=6101:covid19&Itemid=875
https://www.paho.org/bra/index.php?optio... ^,66 World Health Organization - WHO. Rolling updates on coronavirus disease (COVID-19) [Internet]. Geneva: WHO; 2020 [citado 18 Jul 2022]. Disponível em: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen
https://www.who.int/emergencies/diseases... . Despite this, Brazil faces challenges in complying with the guidelines and in the effectiveness of the surveillance of the rules and regulations for the control and fight against the pandemic⁷7 Barroso BIL, Souza MBCA, Bregalda MM, Lancman S, Costa VBB. A saúde do trabalhador em tempos de COVID-19: reflexões sobre saúde, segurança e terapia ocupacional. Cad Bras Ter Ocup. 2020; 28(3):1093-1102. Doi: https://doi.org/10.4322/2526-8910.ctoARF2091.
https://doi.org/10.4322/2526-8910.ctoARF... .

Covid-19 affected people’s lives with changes in family routines, the closing of schools, and more time spent together between parents and children⁸8 Halvorsen E, Stamu-O’Brien C, Carniciu S, Jafferany M. Psychological effects of COVID-19 on parenting and maternal-fetal mental health. Dermatol Ther (Heidelb). 2020; 33(4):e13579. Doi: https://doi.org/10.1111/dth.13579.
https://doi.org/10.1111/dth.13579... . Social distancing measures, although necessary, may impose risks to women’s physical and psychological integrity, with an overload of domestic work and care activities for family members, including the less visible mental burden of emotional labor related to providing for the family’s needs. This unequal distribution on women⁹9 Pires RRC. Nota técnica nº 33 - Os efeitos sobre grupos sociais e territórios vulnerabilizados das medidas de enfrentamento à crise sanitária da Covid-19: propostas para o aperfeiçoamento da ação pública [Internet]. Brasília: IPEA; 2020 [citado 18 Jul 2022]. Disponível em: http://repositorio.ipea.gov.br/handle/11058/9839
http://repositorio.ipea.gov.br/handle/11... can affect their health and life satisfaction¹⁰10 Bar MA, Jarus T. The effect of engagement in everyday occupations, role overload and social support on health and life satisfaction among mothers. Int J Environ Res Public Health. 2015; 12(6):6045-6065. Doi: https://doi.org/10.3390/ijerph120606045.
https://doi.org/10.3390/ijerph120606045... . Motherhood brings about changes, creating occupational needs, not only related to caring for children, but also influenced by social expectations and responsibilities assigned to mothers¹¹11 Domínguez MM, Rivas-Quarneti N, Gonzalo NG. I gave birth to him and he gave me my life: study of occupational transition linked to motherhood of two women with mental disorders. Cad Bras Ter Ocup. 2018; 26(2):271-285. Doi: https://doi.org/10.4322/2526-8910.ctoAO1156.
https://doi.org/10.4322/2526-8910.ctoAO1... .

During the pandemic, women during pregnancy, childbirth, and the puerperium have unique needs that require health and safety guidelines regarding the risks of infection and the implications of physical distance for them, their child or children, and their family. Women are a vulnerable group at risk of psychological distress exacerbated by deprivation of social support, a high-risk external environment, lack of comprehensive information about isolation and safety during pregnancy, and increased risk of infection with Covid-19 at health care facilities and restrictions during delivery¹²12 Stofel NS, Christinelli D, Silva RCS, Salim NR, Beleza ACS, Bussadori JCC. Atenção perinatal na pandemia da COVID-19: análise de diretrizes e protocolos nacionais. Rev Bras Saude Mater Infant. 2021; 21 Supl 1:89-98. Doi: https://doi.org/1806-9304202100S100005..

This overall context of insecurity experienced, concomitant with the recognition of the difficulties and duties involved in the act of giving birth, becomes more impacting when faced with the transformations of pregnancy, permeated by doubts, fears, and emotional instability in relation to the exercise of motherhood¹³13 Brasil. Ministério da Saúde. Secretaria de Atenção em Saúde. Departamento de Ações Programáticas Estratégicas. Marco teórico e referencial: saúde sexual e saúde reprodutiva de adolescentes e jovens [Internet]. Brasília: Ministério da Saúde; 2007 [citado 18 Jul 2022]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/07_0471_M.pdf
https://bvsms.saude.gov.br/bvs/publicaco...

14 Ruggiero SEM, Fabbro MRC, Bussadori JCC. Saúde da mulher grávida. In: Fabbro MRC, Montrone AVG. Enfermagem em saúde da mulher. Rio de Janeiro: Senac; 2013. p. 223-377.^-1515 Zanatta E, Pereira CRR. Ela enxerga em ti o mundo: a experiência da maternidade pela primeira vez. Temas Psicol. 2015; 23(4):959-972.. The uncertainties associated with infection, which justified the inclusion of pregnant and postpartum women in risk groups¹⁶16 Cardoso PC, Sousa TM, Rocha DS, Menezes LRD, Santos LC. A saúde materno-infantil no contexto da pandemia de COVID-19: evidências, recomendações e desafios. Rev Bras Saude Mater Infant. 2021; 21 Supl 1:221-228. Doi: https://doi.org/10.1590/1806-9304202100S100011.
https://doi.org/10.1590/1806-9304202100S... , contributed to increase stress and insecurity about the babies’ health. Studies to know the maternal emotional aspects and the repercussions of the separation between the baby and the mother diagnosed with Covid-19 have been recommended⁸8 Halvorsen E, Stamu-O’Brien C, Carniciu S, Jafferany M. Psychological effects of COVID-19 on parenting and maternal-fetal mental health. Dermatol Ther (Heidelb). 2020; 33(4):e13579. Doi: https://doi.org/10.1111/dth.13579.
https://doi.org/10.1111/dth.13579... .

The impacts of the pandemic are still undetermined, with psychosocial consequences possibly greater than are being perceived¹⁷17 Stamu-O’Brien C, Carniciu S, Halvorsen E, Jafferany M. Psychological aspects of COVID-19. J Cosmet Dermatol. 2020; 19(9):2169-2173. Doi: https://doi.org/10.1111/jocd.13601.
https://doi.org/10.1111/jocd.13601... . Analysis of previous epidemics/pandemics¹⁸18 Cameron EE, Joyce KM, Delaquis CP, Reynolds K, Protudjer JLP, Roos LE. Maternal psychological distress & mental health service use during the COVID-19 pandemic. J Affect Disord. 2020; 276:765-774. Doi: https://doi.org/10.1016/j.jad.2020.07.081.
https://doi.org/10.1016/j.jad.2020.07.08... suggests that families, especially mothers, may be at greater risk for depressive and anxiety symptoms in this context. Furthermore, the changes in family life can have a profound effect on child rearing, relationships, marital life, the relationship with the elderly, and the maternal-fetal bond⁸8 Halvorsen E, Stamu-O’Brien C, Carniciu S, Jafferany M. Psychological effects of COVID-19 on parenting and maternal-fetal mental health. Dermatol Ther (Heidelb). 2020; 33(4):e13579. Doi: https://doi.org/10.1111/dth.13579.
https://doi.org/10.1111/dth.13579... , deserving special attention¹⁸18 Cameron EE, Joyce KM, Delaquis CP, Reynolds K, Protudjer JLP, Roos LE. Maternal psychological distress & mental health service use during the COVID-19 pandemic. J Affect Disord. 2020; 276:765-774. Doi: https://doi.org/10.1016/j.jad.2020.07.081.
https://doi.org/10.1016/j.jad.2020.07.08... .

Concerns and stress caused by various factors and life events during pregnancy, such as the Covid-19 pandemic, can affect women’s well-being and negatively impact the health of mothers and children¹⁹19 Talbot J, Charron V, Konkle ATM. Feeling the void: lack of support for isolation and sleep difficulties in pregnant women during the COVID-19 pandemic revealed by Twitter data analysis. Int J Environ Res Public Health. 2021; 18(2):393. Doi: https://doi.org/10.3390/ijerph18020393.
https://doi.org/10.3390/ijerph18020393... ^,2020 Mortazavi F, Mehrabadi M, KiaeeTabar R. Pregnant women’s well-being and worry during the COVID-19 pandemic: a cross-sectional study. BMC Pregnancy Childbirth. 2021; 21:59. Doi: https://doi.org/10.1186/s12884-021-03548-4.
https://doi.org/10.1186/s12884-021-03548... . Studies regarding stress and anxiety in pregnant and postpartum women during the pandemic show that women with a history of mental health treatment, those in the first trimester of pregnancy, and those who are single or in an informal relationship tend to have high levels of psychological distress and anxiety²¹21 Lebel C, MacKinnon A, Bagshawe M, Tomfohr-Madsen L, Giesbrecht G. Elevated depression and anxiety symptoms among pregnant individuals during the Covid-19 pandemic. J Affect Disord. 2020; 277:5-13. Doi: https://doi.org/10.1016/j.jad.2020.07.126.
https://doi.org/10.1016/j.jad.2020.07.12...

22 Stepowicz A, Wencka B, Bieńkiewicz J, Horzelski W, Grzesiak M. Stress and anxiety levels in pregnant and post-partum women during the Covid-19 pandemic. Int J Environ Res Public Health. 2020; 17(24):9450. Doi: https://doi.org/10.3390/ijerph17249450.
https://doi.org/10.3390/ijerph17249450... ^-2323 Hocaoglu M, Ayaz R, Gunay T, Akin E, Turgut A, Karateke A. Anxiety and post-traumatic stress disorder symptoms in pregnant women during the Covid-19 pandemic’s delay phase. Psychiatr Danub. 2020; 32(3-4):521-526. Doi: https://doi.org/10.24869/psid.2020.521.
https://doi.org/10.24869/psid.2020.521... , which may be exacerbated by the absence of a partner during and after childbirth²⁴24 Molgora S, Accordini M. Motherhood in the time of coronavirus: the impact of the pandemic emergency on expectant and postpartum women’s psychological well-being. Front Psychol. 2020; 11:567155. Doi: https://doi.org/10.3389/fpsyg.2020.567155.
https://doi.org/10.3389/fpsyg.2020.56715... .

Listening to women in order to reveal their perceptions about how the pandemic affected their lives, what changes were necessary in the perinatal period and in baby care²⁵25 Burgess A, Breman RB, Bradley D, Dada S, Burcher P. Pregnant women’s reports of the impact of Covid-19 on pregnancy, prenatal care, and infant feeding plans. MCN Am J Matern Child Nurs. 2021; 46(1):21-29. Doi: https://doi.org/10.1097/NMC.0000000000000673.
https://doi.org/10.1097/NMC.000000000000...

26 Lee RWK, Loy SL, Yang L, Chan JKY, Tan LK. Attitudes and precaution practices towards Covid-19 among pregnant women in Singapore: a cross-sectional survey. BMC Pregnancy Childbirth. 2020; 20(1):675. Doi: https://doi.org/10.1186/s12884-020-03378-w.
https://doi.org/10.1186/s12884-020-03378...

27 Gildner TE, Thayer ZM. Birth plan alterations among american women in response to Covid-19. Health Expect. 2020; 23(4):969-971. Doi: https://doi.org/10.1111/hex.13077.
https://doi.org/10.1111/hex.13077...

28 Ng QJ, Koh KM, Tagore S, Mathur M. Perception and feelings of antenatal women during Covid-19 pandemic: a cross-sectional survey. Ann Acad Med Singap. 2020; 49(8):543-552.^-2929 Rasmussen SA, Jamieson DJ. Caring for women who are planning a pregnancy, pregnant, or postpartum during the Covid-19 pandemic. JAMA. 2020; 324(2):190-191. Doi: https://doi.org/10.1001/jama.2020.8883.
https://doi.org/10.1001/jama.2020.8883... , as well as identifying their attitudes and practices to prevent infection, can contribute to improve healthcare. Mothers and babies cared for by the Brazilian National Health System (SUS) became more vulnerable during pregnancy and in the first days after birth, because the access to specialized health services, in the context of the pandemic, was compromised due to the need to reorganize the flow and the creation of specific sectors to meet the demand of Covid-19³⁰30 Parenti ABH, Cruz CS, Berzuini GA, Bernardo LS, Silva TGM, Clapis MJ, et al. Saúde da gestante no contexto de emergência em saúde pública: reflexos da pandemia da Covid-19. Res Soc Dev. 2022; 11(4):e59811427647. Doi: https://doi.org/10.33448/rsd-v11i4.27647.
https://doi.org/10.33448/rsd-v11i4.27647... .

It is noteworthy that organizations have invested in providing open access resources with guidelines to support families³¹31 Cluver L, Lachman JM, Sherr L, Wessels I, Krug E, Rakotomalala S, et al. Parenting in a time of Covid-19. Lancet. 2020; 395(10231):e64. Doi: https://doi.org/10.1016/S0140-6736(20)30736-4.
https://doi.org/10.1016/S0140-6736(20)30... .

Considering that understanding the mothers’ perspective can contribute to provide information and adjust the care to meet the women’s needs, the objective of the study was to know the experience of women regarding pregnancy or the puerperium in the context of the pandemic by Covid-19.

Methodology

This is a qualitative study conducted in a maternity hospital specialized in care for women and children, located in Belo Horizonte/MG. It is a model maternity hospital, which serves exclusively through the SUS, with a predominance of a low-income population. Women assisted in different programs of the hospital were recruited: pregnant women in hospital follow-up, mothers of newborns admitted to the Neonatal Intensive Care Unit (NICU) and mothers of newborns assisted in the Outpatient Clinic for the Newborn at Risk.

Data were collected from August to October 2020, using a demographic questionnaire, answered by consulting the woman’s or the newborn’s medical records, and a semi-structured interview containing guiding questions³⁰30 Parenti ABH, Cruz CS, Berzuini GA, Bernardo LS, Silva TGM, Clapis MJ, et al. Saúde da gestante no contexto de emergência em saúde pública: reflexos da pandemia da Covid-19. Res Soc Dev. 2022; 11(4):e59811427647. Doi: https://doi.org/10.33448/rsd-v11i4.27647.
https://doi.org/10.33448/rsd-v11i4.27647... , presented in Frame 1.

The identification of the participants was done through the daily census of the units, in the case of hospitalized women, and the outpatient appointment schedule, for those at home. The interviews were conducted by researchers inserted in the study setting, who had previous contact with the mothers, reducing the risk of embarrassment and facilitating the interviews, that were conducted at times that did not interfere with the baby’s routines and care. In the outpatient clinic, the mothers were interviewed after the baby’s appointment.

Theoretical saturation was considered for the interruption of data collection, when new elements to support the intended theorization were no longer encountered, and the researchers identified that the data collected allowed answering the objective in a deep and comprehensive way and empirical saturation, when the interaction between the research field and the researcher no longer provided elements to deepen the theorization through the information provided by the participants³²32 Fontanella BJB, Luchesi BM, Saidel MGB, Ricas J, Turato ER, Melo DG. Amostragem em pesquisas qualitativas: proposta de procedimentos para constatar saturação teórica. Cad Saude Publica. 2011; 27(2):389-394. Doi: https://doi.org/10.1590/S0102-311X2011000200020.
https://doi.org/10.1590/S0102-311X201100... ^,3333 Minayo MCS. Amostragem e saturação em pesquisa qualitativa: consensos e controvérsias. Rev Pesqui Qual. 2017; 5(7):1-12..

The interviews were recorded, transcribed in full, and submitted to content analysis³⁴34 Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. 13a ed. São Paulo: Hucitec; 2013.. Two researchers (AL and CM) did the in-depth reading, independently, identifying the central themes, grouped by similarity, forming thematic categories. Each category was conceptualized, and a new meeting was held with the participation of two other researchers (RHVTJ and ESD), aiming for consensus.

After categorizing the themes, the data produced were related to the object of study and discussed based on the literature³⁴34 Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. 13a ed. São Paulo: Hucitec; 2013.. As for the methodological rigor, credibility was sought through the interviews being conducted by five researchers (AL, CM, LA, PRC, and ESD) who worked at the site of the study. Confirmability was achieved by describing the methodological route, to allow other researchers to reproduce it³⁵35 Lévano ACS. Investigación cualitativa: diseños, evaluación del rigor metodológico y retos. Liberabit. 2007; 13(13):71-78..

The Study was approved by the Research Ethics Committee according to the determinations of Resolution 466/2012 (Brazil, 2012) and 510/2016 (Brazil, 2016), under Number 4.182.769 CAAE: 35590920.9.0000.5132

Results

Eighteen women participated, ten primiparous and eight multiparous, with ages ranging from 19 to 42 years and mean education of 11.4(±1.7) years. Among the pregnant women, the degree of gestation ranged from 26 weeks and 4 days to 35 weeks and 3 days. Among the postpartum mothers, newborns had gestational ages ranging from 26 weeks to 39 weeks and 3 days, with a mean birth weight of 1,487(±693.25) grams. The family structure was mostly composed of the husband/partner and the support network included the mother, partner, and family members (Table 1).

In the analysis of the interviews, three thematic categories were identified (Frame 2).

Repercussions on pregnancy and puerperium

The pandemic situation led pregnant women to experience feelings such as fear, worry, anxiety, and insecurity. These feelings are associated with the lack of knowledge about the disease, the possibility of affecting the baby, the need to change habits and behaviors, and the restrictions to social life¹⁶16 Cardoso PC, Sousa TM, Rocha DS, Menezes LRD, Santos LC. A saúde materno-infantil no contexto da pandemia de COVID-19: evidências, recomendações e desafios. Rev Bras Saude Mater Infant. 2021; 21 Supl 1:221-228. Doi: https://doi.org/10.1590/1806-9304202100S100011.
https://doi.org/10.1590/1806-9304202100S... .

In this way, a moment so desired and imagined by pregnant and postpartum women, important for the exchange of affection and formation of bonds through baby care, may have been harmed by the pandemic, which limited or prevented the various possibilities of sensory and interactive exchanges between mothers and their babies.

The repercussions in the lives of pregnant women can be intensified since they are a risk group for complications and death from Covid-19, demanding more rigorous and restrictive preventive measures³⁷37 Souza ASR, Amorim MMR. Mortalidade materna pela Covid-19 no Brasil. Rev Bras Saude Mater Infant. 2021; 21 Suppl 1:253-256. Doi: https://doi.org/10.1590/1806-9304202100S100014.
https://doi.org/10.1590/1806-9304202100S... . As a consequence, there are exacerbated worries and fears, although justified, changes in social behavior, reduced family contact and support, and frustration of expectations and experiences of a unique moment in the life of the woman and her family. It may be also mentioned the reduction or cancellation of prenatal appointments and tests, which can affect the health of the mother and baby and increase the risk of pregnancy³⁷37 Souza ASR, Amorim MMR. Mortalidade materna pela Covid-19 no Brasil. Rev Bras Saude Mater Infant. 2021; 21 Suppl 1:253-256. Doi: https://doi.org/10.1590/1806-9304202100S100014.
https://doi.org/10.1590/1806-9304202100S... ^,3838 Souza JB, Heidemann ITSB, Vendruscolo C, Pitilin EDB, Maestri E, Madureira VSF. Reflexões sobre o enfrentamento da doença do coronavírus 2019: diálogos virtuais com gestantes. Rev Enferm Cent-Oeste Min. 2020; 10:e3792. Doi: https://doi.org/10.19175/recom.v10i0.3792.
https://doi.org/10.19175/recom.v10i0.379... .

Puerperal women expressed that the concern with the baby being premature was intensified during the pandemic, making evident the fear and uncertainty about the future.

The birth of a baby that requires admission to the NICU is a challenging experience that generates feelings of sadness, fear, uncertainty, anxiety, and stress³⁹39 Correia LA, Rocha LLB, Dittz ES. Contribuições do grupo de terapia ocupacional no nível de ansiedade das mães com recém-nascidos prematuros internados nas unidades de terapia intensiva neonatal. Cad Bras Ter Ocup. 2019; 27(3):574-583. Doi: https://doi.org/10.4322/2526-8910.ctoAO1694.
https://doi.org/10.4322/2526-8910.ctoAO1... ^,4040 Contim D, Ranuzi C, Gonçalves JRL, Bracarense CF, Amaral JB, Costa NS. Dificuldades vivênciadas por mães de recém-nascidos prematuros durante a permanência prolongada em ambiente hospitalar. Rev Enferm Atenção Saude. 2017; 6(1):31-38. Doi: https://doi.org/10.18554/reas.v6i1.1684.
https://doi.org/10.18554/reas.v6i1.1684... . Parental stress is greater when associated with prematurity, due to the long hospitalization of the child and the increased risk of clinical complications⁴¹41 Kegler JJ, Neves ET, Silva AM, Jantsch LB, Bertoldo CS, Silva JH. Estresse em pais de recém-nascidos em uma Unidade de Terapia Intensiva Neonatal. Esc Anna Nery Rev Enferm. 2019; 23(1):e20180178. Doi: https://doi.org/10.1590/2177-9465-EAN-2018-0178.
https://doi.org/10.1590/2177-9465-EAN-20... . Premature birth has repercussions on the mother and the family waiting for a baby, who did not arrive at the expected time and conditions. This, by itself, generates anxiety and fear, including about the baby’s survival⁴²42 Joaquim RHVT, Wernet M, Leite AM, Fonseca LMM, Mello DF. Interações entre mães e bebês prematuros: enfoque nas necessidades essenciais. Cad Bras Ter Ocup. 2018; 26(3):580-589. Doi: https://doi.org/10.4322/2526-8910.ctoAO1051.
https://doi.org/10.4322/2526-8910.ctoAO1... . Prematurity during the pandemic time adds more fears, since mothers are not welcomed by family or friends due to social isolation. Being weakened, they find themselves alone and without support.

The frustration of not being able to share the pregnancy and the birth of the baby and to fulfill the rituals of the moment were expressed in the reports.

Mothers who remain in the hospital with their hospitalized child are away from family life, which can contribute to a worsening in their emotional state⁴³43 Rocha ALS, Dittz ES. As repercussões no cotidiano de mães de bebês internados na Unidade de Terapia Intensiva Neonatal no isolamento social devido à Covid-19. Cad Bras Ter Ocup. 2021; 29:e2158. Doi: https://doi.org/10.1590/2526-910.ctoAO2158.
https://doi.org/10.1590/2526-910.ctoAO21... .

The repercussions of the pandemic on women’s lives during pregnancy and the puerperium period are challenging, causing the reduction or suspension of baby showers, photo shoots, and participation in groups for pregnant women. The physical distancing measures influence the daily life and mothers need to adapt to this new model of behavior³⁸38 Souza JB, Heidemann ITSB, Vendruscolo C, Pitilin EDB, Maestri E, Madureira VSF. Reflexões sobre o enfrentamento da doença do coronavírus 2019: diálogos virtuais com gestantes. Rev Enferm Cent-Oeste Min. 2020; 10:e3792. Doi: https://doi.org/10.19175/recom.v10i0.3792.
https://doi.org/10.19175/recom.v10i0.379... ^,4343 Rocha ALS, Dittz ES. As repercussões no cotidiano de mães de bebês internados na Unidade de Terapia Intensiva Neonatal no isolamento social devido à Covid-19. Cad Bras Ter Ocup. 2021; 29:e2158. Doi: https://doi.org/10.1590/2526-910.ctoAO2158.
https://doi.org/10.1590/2526-910.ctoAO21... .

Repercussions of Covid-19 in the practical life of pregnant women and new mothers

Disease prevention measures became part of the participants’ daily lives. The birth of the baby and the need to stay in the hospital intensified the use of the mask and hand hygiene.

When responding to the demands to reduce the risk of contagion, mothers started to adopt new routines and habits, characteristic of this new daily life that causes changes in their way of life. The participants report preventive measures consistent with the preventive recommendations to contain the spread of the virus¹⁰10 Bar MA, Jarus T. The effect of engagement in everyday occupations, role overload and social support on health and life satisfaction among mothers. Int J Environ Res Public Health. 2015; 12(6):6045-6065. Doi: https://doi.org/10.3390/ijerph120606045.
https://doi.org/10.3390/ijerph120606045... . They also report restrictions of their and their family members’ circulation to the home or hospital space.

The daily life with new hygiene habits imposed by the pandemic changed everyone’s lives, especially when a new baby arrives in the family, because there is the fear that the baby will be contaminated. The care is intensified with the use of alcohol gel in all spaces and objects and with the restriction of visits. This change has a great impact on family life and, mainly, on the mental health⁴⁴44 Noal DS, Passos MFD, Freitas CM. Recomendações e orientações em saúde mental e atenção psicossocial na Covid-19. Rio de Janeiro: Fiocruz; 2020.

45 Schmidt B, Crepaldi MA, Bolze SDA, Neiva-Silva L, Demenech LM. Saúde mental e intervenções psicológicas diante da pandemia do novo coronavírus (Covid-19). Estud Psicol. 2020; 37:e200063. Doi: https://doi.org/10.1590/1982-0275202037e200063.
https://doi.org/10.1590/1982-0275202037e... ^-4646 World Health Organization. Mental health and psychosocial considerantions during Covid-19 outbreak [Internet]. Geneva: WHO; 2020 [citado 18 Jul 2022]. Disponível em: https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf
https://www.who.int/docs/default-source/... of the mothers, since culturally it is something contrary to what is expected for the birth of a child.

Being necessary to prevent the circulation of the virus, the social distance weakens the woman’s contact with her support network, especially when she needs to stay away from her husband and other children to accompany the hospitalization of the newborn⁴⁷47 Exequiel N, Milbrath V, Gabatz R, Vaz J, Hirschmann B, Hirschmann R. Vivências da família do neonato internado em unidade de terapia intensiva. Enferm Atual. 2019; 89(27):1-9. Doi: https://doi.org/10.31011/reaid-2019-v.89-n.27-art.466.
https://doi.org/10.31011/reaid-2019-v.89... . When members of this network belong to the risk group for severe forms of the Covid-19, a more intense and conscious distancing on the part of the mothers is observed.

In many families it is usual for grandmothers to be present at the birth and the first moments of the child’s life. The pandemic prevented these exchanges, as many grandmothers are from the risk group and because protocols have been established in the ICU that do not allow visits to avoid contamination. Although justifiable, this generates impacts and insecurity for the mother who finds herself alone in an environment very different from the one she prepared to receive the baby.

Mothers report concern in performing the precautionary measures against Covid-19 during pregnancy and when establishing contact with the baby.

Concurring with this study⁴³43 Rocha ALS, Dittz ES. As repercussões no cotidiano de mães de bebês internados na Unidade de Terapia Intensiva Neonatal no isolamento social devido à Covid-19. Cad Bras Ter Ocup. 2021; 29:e2158. Doi: https://doi.org/10.1590/2526-910.ctoAO2158.
https://doi.org/10.1590/2526-910.ctoAO21... , mothers have stopped performing some types of care such as touching or holding the baby in their laps and have intensified the basic personal care, to avoid contagion. As mentioned, sensory experiences have decreased in this period, being restricted to basic care. This may bring future consequences for these babies, because touch is an important need in this period of development⁴⁸48 Montagu A. Tocar: o significado humano da pele. São Paulo: Grupo Editorial Summus; 1988..

The mothers’ reports show that the care to avoid contracting Covid-19 changed their daily lives and the way they started to perform their routine activities, such as work, affective contact with people close to them, and living with others.

It can be noticed that there are concerns with the issue of work, which also affects caregiving, since with one more member in the family, the responsibility of maintenance is fundamental, generating more insecurity. Another point is the mother’s own affective need to feel touched and welcomed, willing to exchange experiences in this unique moment: that of being a mother.

The social distancing measures to reduce the spread of the disease influenced the distance from family members and the need to stay longer at home, and some women showed fewer difficulties in adapting than others.

The way in which women carried out their daily activities was influenced, with alternatives being incorporated for commuting and for using services such as pharmacies and supermarkets.

It can be stated that as Covid-19 spread, it made it necessary for people to adopt objective actions and changes in behavior to stay healthy and feel safer.

Coping strategies created by pregnant women and new mothers due to the pandemic context by Covid-19

The pregnant and postpartum women reported coping strategies that contributed to their mental health, such as meditation and courses with themes of their interest, expanding their occupational repertoire.

Another strategy was to look for activities, reading books, listening to music, watching movies and sleeping, to distract and keep themselves occupied.

Corroborating the strategies used by mothers to reduce the impact of the pandemic on mental health, health authorities, researchers, and organizations related to health recommend exercises and actions that help reduce stress, such as meditation, reading, and breathing exercises, as well as the search for pleasurable activities, moments to rest and relax, and the search for trusted people to talk to, recognizing and accepting their own fears and fears⁴⁴44 Noal DS, Passos MFD, Freitas CM. Recomendações e orientações em saúde mental e atenção psicossocial na Covid-19. Rio de Janeiro: Fiocruz; 2020.

45 Schmidt B, Crepaldi MA, Bolze SDA, Neiva-Silva L, Demenech LM. Saúde mental e intervenções psicológicas diante da pandemia do novo coronavírus (Covid-19). Estud Psicol. 2020; 37:e200063. Doi: https://doi.org/10.1590/1982-0275202037e200063.
https://doi.org/10.1590/1982-0275202037e... ^-4646 World Health Organization. Mental health and psychosocial considerantions during Covid-19 outbreak [Internet]. Geneva: WHO; 2020 [citado 18 Jul 2022]. Disponível em: https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf
https://www.who.int/docs/default-source/... .

In the search for distraction, puerperal women were clear in avoiding watching television and news to avoid the increase of concern and fear.

The spread of myths, misinformation, and difficulty in understanding the health authorities’ guidelines can cause fear, anxiety, and depression⁴⁵45 Schmidt B, Crepaldi MA, Bolze SDA, Neiva-Silva L, Demenech LM. Saúde mental e intervenções psicológicas diante da pandemia do novo coronavírus (Covid-19). Estud Psicol. 2020; 37:e200063. Doi: https://doi.org/10.1590/1982-0275202037e200063.
https://doi.org/10.1590/1982-0275202037e... ^,4949 Bú EA, Alexandre MES, Bezerra VAS, Sá-Serafim RCN, Coutinho MPL. Representações e ancoragens sociais do novo Coronavírus e do tratamento da Covid-19 por Brasileiros. Estud Psicol. 2020; 37:e200073. Doi: https://doi.org/10.1590/1982-0275202037e200073.
https://doi.org/10.1590/1982-0275202037e...

50 Zandifar A, Badrfam R. Iranian mental health during the Covid-19 epidemic. Asian J Psychiatr. 2020; 51:101990. Doi: https://doi.org/10.1016/j.ajp.2020.101990.
https://doi.org/10.1016/j.ajp.2020.10199... ^-5151 Crispim D, Silva MJP, Câmara WCM, Gomes SAG. Comunicação difícil e Covid-19: Recomendações práticas para comunicação e acolhimento em diferentes cenários da pandemia [Internet]. Rio de Janeiro: SBMFC; 2020 [citado 18 Jul 2022]. Disponível em: https://www.sbmfc.org.br/wp-content/uploads/2020/04/comunicao-Covid-19.pdf
https://www.sbmfc.org.br/wp-content/uplo... .

Another strategy listed to face social distancing was the use of mobile devices for phone calls.

The use of technology, such as the internet and video calls, is recommended to maintain contact and bonding between patients and significant others in situations of isolation⁴⁵45 Schmidt B, Crepaldi MA, Bolze SDA, Neiva-Silva L, Demenech LM. Saúde mental e intervenções psicológicas diante da pandemia do novo coronavírus (Covid-19). Estud Psicol. 2020; 37:e200063. Doi: https://doi.org/10.1590/1982-0275202037e200063.
https://doi.org/10.1590/1982-0275202037e... ^,5151 Crispim D, Silva MJP, Câmara WCM, Gomes SAG. Comunicação difícil e Covid-19: Recomendações práticas para comunicação e acolhimento em diferentes cenários da pandemia [Internet]. Rio de Janeiro: SBMFC; 2020 [citado 18 Jul 2022]. Disponível em: https://www.sbmfc.org.br/wp-content/uploads/2020/04/comunicao-Covid-19.pdf
https://www.sbmfc.org.br/wp-content/uplo... . This strategy can be used in situations of isolation for mothers who accompany their hospitalized children, favoring the support and support of the family that is far away.

Mothers who remain in the hospital with their inpatient child during a pandemic are away from family life, which can be enhanced by the contingency plan. For Heller⁵²52 Heller A. O cotidiano e a história. 10a ed. São Paulo: Paz e Terra; 2014., “there is no everyday life without imitation” (p. 55). Thus, knowledge acquired based on personal experiences and examples of people we take as models, are impeded in the context of family isolation, which also reduces effective support and backing, impacts the management of expectations, plans, and dreams related to the arrival of the baby and the pregnancy itself³⁸38 Souza JB, Heidemann ITSB, Vendruscolo C, Pitilin EDB, Maestri E, Madureira VSF. Reflexões sobre o enfrentamento da doença do coronavírus 2019: diálogos virtuais com gestantes. Rev Enferm Cent-Oeste Min. 2020; 10:e3792. Doi: https://doi.org/10.19175/recom.v10i0.3792.
https://doi.org/10.19175/recom.v10i0.379... ^,4242 Joaquim RHVT, Wernet M, Leite AM, Fonseca LMM, Mello DF. Interações entre mães e bebês prematuros: enfoque nas necessidades essenciais. Cad Bras Ter Ocup. 2018; 26(3):580-589. Doi: https://doi.org/10.4322/2526-8910.ctoAO1051.
https://doi.org/10.4322/2526-8910.ctoAO1... ^,4343 Rocha ALS, Dittz ES. As repercussões no cotidiano de mães de bebês internados na Unidade de Terapia Intensiva Neonatal no isolamento social devido à Covid-19. Cad Bras Ter Ocup. 2021; 29:e2158. Doi: https://doi.org/10.1590/2526-910.ctoAO2158.
https://doi.org/10.1590/2526-910.ctoAO21... ^,5353 Silva MR, Silva PC, Rabelo HD, Vinhas BCV. A terapia ocupacional pediátrica brasileira diante da pandemia da Covid-19: reformulando a prática profissional. Revisbrato. 2020; 4(3):422-437. Doi: https://doi.org/10.47222/2526-3544.rbto34171.
https://doi.org/10.47222/2526-3544.rbto3... .

The women reported that staying in the institution with other women who were in similar conditions, allowed the construction of new friendships, configuring a new form of support and coping.

If, on the one hand, the hospital stay leads to the removal of the family and the support network, on the other, there is the possibility of socializing with other mothers who are in similar conditions, effective in a relational space that extrapolates the technical care of the hospital⁵⁴54 Kalichman AO, Ayres JRCM. Integralidade e tecnologias de Atenção à Saúde: uma narrativa sobre contribuições conceituais à construção do princípio da integralidade no SUS. Cad Saude Publica. 2016; 32(8):e00183415. Doi: https://doi.org/10.1590/0102-311X00183415.
https://doi.org/10.1590/0102-311X0018341... . This environment and this opportunity to socialize favor the reduction of anxiety, worry, and fear levels, since they allow the exchange of experiences and information, providing a momentary distancing from stressful situations³⁸38 Souza JB, Heidemann ITSB, Vendruscolo C, Pitilin EDB, Maestri E, Madureira VSF. Reflexões sobre o enfrentamento da doença do coronavírus 2019: diálogos virtuais com gestantes. Rev Enferm Cent-Oeste Min. 2020; 10:e3792. Doi: https://doi.org/10.19175/recom.v10i0.3792.
https://doi.org/10.19175/recom.v10i0.379... ^,4343 Rocha ALS, Dittz ES. As repercussões no cotidiano de mães de bebês internados na Unidade de Terapia Intensiva Neonatal no isolamento social devido à Covid-19. Cad Bras Ter Ocup. 2021; 29:e2158. Doi: https://doi.org/10.1590/2526-910.ctoAO2158.
https://doi.org/10.1590/2526-910.ctoAO21... , as observed in this study. These exchanges should be considered as a powerful “health care device” to be encouraged by professionals and service managers.

Practical recommendations and limitations of the study

The reports of pregnant and postpartum women and mothers reveal different repercussions of the pandemic in the lives of women and their families. The adjustments in expectations regarding pregnancy and childbirth, the changes in daily routines and the distance from the support network, as well as the frustration and fear of the unknown were evident. On the other hand, the reports reveal strategies and care used to mitigate the adverse effects of the restrictions imposed by the pandemic.

Combining this information, and based, as Kalichman and Ayres⁵⁴54 Kalichman AO, Ayres JRCM. Integralidade e tecnologias de Atenção à Saúde: uma narrativa sobre contribuições conceituais à construção do princípio da integralidade no SUS. Cad Saude Publica. 2016; 32(8):e00183415. Doi: https://doi.org/10.1590/0102-311X00183415.
https://doi.org/10.1590/0102-311X0018341... state, on overcoming the limits set by the traditional clinic for a health work that recognizes the subjects and their needs, values their knowledge, and takes co-responsibility for their therapeutic projects⁵⁴54 Kalichman AO, Ayres JRCM. Integralidade e tecnologias de Atenção à Saúde: uma narrativa sobre contribuições conceituais à construção do princípio da integralidade no SUS. Cad Saude Publica. 2016; 32(8):e00183415. Doi: https://doi.org/10.1590/0102-311X00183415.
https://doi.org/10.1590/0102-311X0018341... , it is possible to derive some suggestions for structuring good practices in health services in the investigated context, based on meanings assumed by comprehensive care⁵⁴54 Kalichman AO, Ayres JRCM. Integralidade e tecnologias de Atenção à Saúde: uma narrativa sobre contribuições conceituais à construção do princípio da integralidade no SUS. Cad Saude Publica. 2016; 32(8):e00183415. Doi: https://doi.org/10.1590/0102-311X00183415.
https://doi.org/10.1590/0102-311X0018341... . It is suggested to ensure the integrality of the care through the intersectoral articulation of the health and social services; implement guidelines on health and safety as to the risks of physical distance for women, children, and families, considering the needs of affective contact in the family context; offer informative material about Covid-19 with detailed and updated guidelines, in language accessible to the women; maintain the social support network by encouraging the use of technological tools: telephone, cell phone, internet, to maintain access of the pregnant and puerperal women to the necessary support; support the reorganization of daily routines, with inclusion of strategies for stress reduction and identification of pleasurable activities, for maintenance of physical and emotional health.

One of the limitations of this study is the socioeconomic and cultural homogeneity of the participants, since the access to the women was given by their link to a health service that covers a peripheral and metropolitan region of a state capital. The small number of participants and the variability of gestational age and birth weight of the baby restrict generalizations, but reflect the population assisted in a hospital that provides exclusive care to the SUS in Brazil. Another limitation is the cross-sectional aspect of the data collection, which occurred during a phase of the pandemic. However, the goal was to give voice to women in situations of social vulnerability, who receive limited support from health services.

Closing remarks

It is well-known that Covid-19 intensifies the danger, especially for pregnant and postpartum women who are part of vulnerable groups, and generally have limited access to health services. This context of insecurities and adaptations becomes more impacting during pregnancy and puerperium, due to the natural transformations of this period, which the pandemic has accentuated.

Preventive measures and public health policies that reduce the risk of transmission of Covid-19 should be prioritized for pregnant and postpartum women. In the same measure, efforts should be made to recognize and welcome the subjective issues involved at this time in women’s lives.

Acknowledgments

The authors wish to thank the participating mothers and the institution Hospital Sofia Feldman

References

Publication Dates

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