Disquiet and distress as a constant presence.

The informants described how the pandemic affected the entire world, with many living in fear of becoming seriously ill. At the onset of the pandemic, there was significant uncertainty and ambiguity regarding how COVID-19 might affect pregnant women and their fetuses. This uncertainty contributed to a persistent sense of unease, with a constant need to remain vigilant in avoiding infection, which in turn led to feelings of disquiet and distress. They described the additional emotional burden of monitoring their partner and any designated back-up individuals for signs of infection, given the potential impact on the partner’s ability to participate during labor. This vigilance extended to monitoring relatives for symptoms to ensure they could provide childcare for older siblings during labor, necessitating constant re-evaluation of family members’ health status. The potential for the partner to contract the virus at work or for children to be exposed at preschool or school led to concerns and heightened vigilance, with continuous monitoring whenever any family member exhibited symptoms.

“It’s an underlying stress, that you don’t really know how much it’s spreading in the general population, do you dare go out, are any activities available?... That underlying stress is more about always looking out for symptoms:‘Yes, but do they have runny noses?’ And myself…’is it the pregnancy that’s giving me a bit of a headache? Or am I starting to come down with a cold?’”

# Informant 5

The participants expressed concerns that the timing of their pregnancies during the pandemic may have been less than optimal. They also reflected on whether it had been wise to conceive during such uncertain times and, upon becoming pregnant, whether they should proceed with the pregnancy.

“We’ve been very worried during this whole process, and yes, this sounds terrible, but we were considering whether we should risk going through with the pregnancy or not because of the situation.”

# Informant 13

Continuously relating and adapting to the pandemic.

The informants described their life situation during the pandemic as marked by a profound sense of loss, particularly the loss of freedom in daily life. They expressed a longing for the ability to engage in ordinary activities, such as shopping or meeting friends at a café, without the accompanying worry and the restrictions imposed by the pandemic. Additionally, the limitations on opportunities to undertake practical preparations for the arrival of their baby were highlighted as a significant source of frustration and concern.

“Perhaps I would have liked to go around the shops looking at baby clothes or go buy some things I would need. It was obviously more complicated...The practical preparations were more difficult.”

# Informant 24

These reflections underscore the pervasive impact of the pandemic on both personal and social dimensions of life. The informants emphasized concerns about the risk of infection at the maternity clinic or hospital. Additionally, they described implementing preventive measures within the household to minimize the risk of viral transmission, reflecting precautionary behaviors necessitated by the pandemic.

“In the labor ward. Because in that hospital environment, with all the staff there, there are or have been people infected with corona… in that hospital environment with potentially more infections, so that’s also a risk.”

# Informant 3

Expectant parents a forgotten and invisible group.

The informants highlighted the perinatal period as both a vulnerable and crucial time, significant for the entire lifespan. It was described as a special event that occurs once or perhaps a couple of times in life. They also emphasized the postpartum period as a time of major adjustment and additional vulnerability for women, noting the need for support from their partners. They stressed that the experiences of pregnant women and expectant parents during the pandemic were largely overlooked.

“I don’t think there is very much [information]. They might not know so much either, I don’t know, but there hasn’t been very much focus either, that’s the way it feels.”

# Informant 25

They described how authorities focused on the need to protect the elderly and frail from infection, and even patient groups with chronic diseases were considered particularly vulnerable to COVID-19. However, pregnant women were largely overlooked, and it remained unclear whether they were classified as a high-risk group. Measures were introduced to protect pregnant women and their fetuses, including the suspension of work for those with occupational exposure to COVID-19 in the workplace. These factors complicated the pregnancy experience, and the informants felt that these issues were neither addressed nor represented in the media. They described a sense of belonging to a forgotten and invisible group during the pandemic.

“It’s been a bit like, ‘Well, what are the restrictions now?’. You have to read up about it yourself, like, because I can’t just assume that I’ll be told what applies to me as a pregnant woman, as much as being told that these are the restrictions for old people. The elderly are a rather permanent group, or…well it’s not temporary, you belong to that group.”

# Informant 23

Exclusion of the partner during the perinatal period.

The informants consistently described the exclusion of the partner during the perinatal period as a significant and distressing consequence of healthcare restrictions implemented during the pandemic. Partners were often prohibited from attending key moments, such as visits to the maternity clinic, ultrasound examinations, and postpartum care at hospitals. This exclusion was consistently characterized in the interviews as a source of sadness, sorrow, and frustration, with informants lamenting the loss of these shared experiences and the inability of the partner to fully participate in this pivotal period. The presence and support of the partner during the perinatal period were emphasized as critical for the well-being of the pregnant woman. Informants highlighted the importance of the partner’s presence in fostering a sense of security and reinforcing the couple’s partnership, underscoring their interdependence during this transformative time. Furthermore, the exclusion was seen as a missed opportunity for the partner to prepare for and engage with the birth of their child, a process viewed as essential for establishing a strong bond and relationship with the baby.

Concerns were also expressed regarding the long-term effects of this exclusion on both the partner and the child, with informants reflecting on the potential impact on familial relationships and the partner’s ability to form a deep connection with the baby. These insights illustrate the profound emotional and relational consequences of partner exclusion during the perinatal period. The informants emphasized the importance of the partner’s presence during ultrasound examinations, highlighting various perspectives on its significance. Ultrasound was described as a crucial moment for the partner to experience the baby’s first signs of life, promoting emotional connection and shared anticipation of parenthood.

“It felt a bit strange because it was like the first actual sign of life, you get to see the baby. And we had waited such a long time for this, so it was rather mixed feelings to experience it on my own.”

# Informant 16

Ultrasound serves as a form of fetal diagnosis, and the informants expressed concerns about the possibility of receiving difficult or distressing news alone in the absence of their partner. This absence was perceived as emotionally challenging and detrimental to the shared support and unity of the couple during such critical moments.

“Let’s say that something turns out to be wrong with the baby, something isn’t right, or that there are twins for that matter, or something that could be... well, that you can be a bit shocked by that information, and to have to cope with that on your own. I haven’t just assumed that the baby will be healthy, like, I’ve been quite aware that there could be things that turn up during the scan.”

# Informant 21

The crucial importance of the partner’s presence during childbirth was underscored, particularly in the final months of pregnancy. Concerns centered around the possibility that partners might be prohibited from attending the birth if they exhibited symptoms associated with COVID-19. The informants highlighted the profound significance of the couple sharing the immediate postpartum period with their newborn, a time they viewed as essential for bonding and mutual support. The inability to share the perinatal experience as a team was described as a deeply felt loss that affected their emotional well-being. The informants also reflected on how this experience might differ for first-time parents compared to those who already had children, suggesting that previous parental experience may influence the coping strategies and perspectives of the couple.

Sense of responsibility and feelings of guilt towards the partner.

The informants described a profound sense of responsibility arising from the exclusion of partners from perinatal healthcare during the pandemic. This responsibility included maintaining communication with midwives at the maternity clinic and ensuring that their partners were kept informed about essential aspects of pregnancy, childbirth, and parenthood. One informant likened this role to “being the spider in the web in relation to healthcare,” underscoring the central role they played in bridging the gap between healthcare providers and their partners.

“I feel that I’ve had to do more explaining to him than if there hadn’t been a pandemic. He hasn’t been offered anything by healthcare services... there haven’t been any groups or anything. So, I’ve been the one who had to explain to him. I’ve been, like, the main contact person when it came to healthcare, and then I have to pass it on to the third party, that is, to him.”

# Informant 2

The informants also expressed significant concern about their partners’ experiences and feelings of exclusion during this period. This exclusion was perceived as an inequity that marginalized the partner’s role as an expecting parent. Many informants articulated feelings of guilt for being the sole recipient of healthcare services and support, while their partners were deprived of these experiences. These reflections highlight the emotional strain and ethical dilemmas faced by expectant mothers as they navigated the dual responsibilities of accessing care and compensating for their partners’ exclusion during the perinatal period.

“Feelings of guilt and responsibility and quite a large internal debate going on inside me, whether I should stay at the postnatal ward or not, afterwards... If I choose to go home early, we can be together, my partner will also get to [connect with the baby] right away, it’ll be more equal... In a way it felt egoistic to stay [in the postnatal ward].”

# Informant 3

Loneliness during pregnancy.

The informants reported experiencing loneliness in relation to healthcare during pregnancy. They described a pervasive sense of isolation during the pregnancy overall; however, many also noted that they eventually became accustomed to being alone and had to engage in more solitary activities. To minimize the risk of infection prior to childbirth, they chose to self-isolate, which further contributed to their feelings of loneliness, particularly during the transition to remote work.

"I guess it’s about that I’ve been very alone in it all, that’s what I would say. I think there’s generally a lot to deal with, both this, how you feel and when you’ve been working from home and the pregnancy, and there’s a lot of loneliness for a lot of people, for me too, when I’ve been working alone at home.”

# Informant 30

Loss of sharing the pregnancy with relatives and others.

A particular concern was the potential impact on the baby’s social relationships, with some informants expressing worry that their child might become forgotten within the broader network of family and friends. The informants expressed a profound sense of loss regarding the inability to share the experience of pregnancy with relatives and friends due to pandemic restrictions. They highlighted the limited opportunities for their social circle to engage with the pregnancy and to form meaningful connections with the unborn child.

“We started to pluck up the courage to spend more time with others at the beginning of autumn, but […] I know my siblings said that they essentially haven’t seen (laughs) this pregnancy at all.”

# Informant 19

The informants reported a longing to participate in parent groups with other expectant parents at the maternity clinic. These activities were cancelled during the pandemic, and expectant parents were offered alternative resources, such as websites or midwife-facilitated online groups and this virtual alternative did not adequately substitute for in-person interactions.

“Your first pregnancy that you really… or that I really would have wanted to share with more people, you know, share while being physically together [……] It’s such a shame, I mean both the parental education (sighs) and childbirth preparation. We’ve moved to our town relatively recently, and it would have been a way to… we had been looking forward to meeting other parents in the same situation, in order to create a social network also.”

# Informant 3

Incomprehensible and inconsistent healthcare restrictions.

The restrictions in perinatal healthcare were described as incomprehensible when compared with those applied to the rest of society. The recommendations from authorities and the adaptation of information changed rapidly due to the evolving nature of the pandemic. This led to feelings of insecurity and questions such as, “Am I doing the right or wrong thing?” The informants expressed that the healthcare system should have handled the interpretation and implementation of restrictions differently to enable partner participation in healthcare during the perinatal period. The restriction on partner involvement was perceived as outdated and inequitable, failing to acknowledge that the partner is also becoming a parent.

“They’ve gone back to the sixties, like, ‘The partner isn’t worth anything, he isn’t going to be a parent, you’re the parent, full stop.’ So, it feels very outdated somehow, how they’ve handled the whole corona situation. Also, somehow, that there should be more understanding that he’s also going to be a parent.”

# Informant 17

They noted that restrictions in perinatal healthcare differed across regions in Sweden, which led to frustration, uncertainty, and concerns about giving birth in another region. They also described the rationale behind the decisions as vague and unclear, expressing a need to understand the background and the authorities responsible for making these decisions.

“And I haven’t gotten an answer to why... who actually made the decision, that your partner can’t go with you to the postnatal ward, even though he can go with you to the labor ward. Has this been discussed with specialists in this area or is it a regional Västmanland politician that made the decision and... without consulting specialists in the area?”

# Informant 8

It would have been more understandable if all regions in Sweden had adhered to national guidelines, thereby promoting greater equality and avoiding inconsistent restrictions. Furthermore, the informants noted that society interpreted the recommendations from authorities differently, which sometimes led to conflicts in workplaces or within families.

Uncertainty about the pandemic’s impact on healthcare.

Many of the pregnant women reported that antenatal care deviated from routine practices, appearing more perfunctory and procedural in nature. The informants expressed uncertainty about whether the healthcare system would be sufficient to meet their needs and capable of prioritizing women in labor in relation to patients who were seriously ill with COVID-19.

“Maybe you’re not such a priority when you’re pregnant... the hospitals are full of people that are seriously ill with COVID and are dying. That’s when you feel like, ‘Yes, but me, (laughs) I’m just here to have a baby’.”

# Informant 23

They also expressed concerns about the potential shortage of healthcare professionals if the healthcare staff were to fall ill as well. Further apprehensions were linked to the availability of personal protective equipment for healthcare providers, with participants worrying that inadequate protection might increase the risk of infection for both staff and patients. Many participants feared being unable to establish a meaningful connection with healthcare professionals due to the perceived depersonalization of care and the presence of physical barriers.

“When they start to talk about masks for visitors, I think it would be incredibly difficult to give birth wearing a mask. Because you get, like, a feeling of being suffocated, and then you’re meant to lie there for maybe 24 hours and try to give birth to a baby and be feeling that you’re being smothered the whole time...[….]..”

# Informant 24

Additional concerns centered on the potential risks to the newborn if the mother were to contract COVID-19 during labor, as well as the uncertainty about how the healthcare system would respond to such situations. The sense of guilt and fear of being a nuisance to the professionals, who had extreme and strained working conditions, also emerged as a recurring theme in the interviews.

Giving birth alone.

The informants consistently described the emotional turmoil caused by the uncertainty regarding their partners’ presence during labor, and the prospect of giving birth under such uncertain circumstances was highly distressing. Hospital policies, often subject to sudden changes, dictated whether partners could attend, leaving many individuals feeling unprepared, vulnerable, and unsupported. Even minor symptoms, such as a cough or low-grade fever in the partner, could lead to their exclusion, intensifying the anxiety of an already challenging experience.

“Not terrified when it comes to me having serious complications and so on, but that I’ll infect my partner. I hope my lungs can handle a COVID-19 illness. But it’s more that I would... infect my partner who wouldn’t be allowed to be there when I give birth… Because that’s something I don’t want to experience on my own. I don’t want to be in the labor ward alone... or with some other family member than my partner.

# Informant 14

This uncertainty was reported as having significant psychological consequences, heightening feelings of isolation and vulnerability during a time when emotional support is crucial. Some informants reported a pre-existing fear of childbirth prior to the pandemic, while for others, the ambiguity surrounding partner attendance gave rise to entirely new fears—even among those who had previously approached childbirth with confidence. These feelings of unease were not limited to first-time parents but were also experienced by individuals who had previously given birth, underscoring the unique stressors associated with the pandemic context. The uncertainty of giving birth alone in that situation was consistent in the interviews and was described as deeply distressing and terrifying.

“I think the word ‘worry’ is too small to use, because I feel… yes, it’s a huge worry, a huge… yes, I would almost… well, maybe not terror either, but something in between.”

# Informant 27

Importance of relevant information.

The informants attempted to search for information but found it difficult to locate resources specifically tailored and adequate for pregnant women. They relied on information from friends who were also pregnant or on rumors about healthcare restrictions on social media.

“I think it’s more that, like, all the stuff that’s been written has affected me, as many other people picked up things and said things to me, like, ‘Have you heard that it’s like this now? And did you read that?’”

# Informant 21

There was also a perception that the media engaged in scaremongering and were seen as unprofessional and lacking credibility. However, they felt that, at times, there was an overwhelming amount of information, which they described as “chaotic noise”. It was difficult to sift through the information, with numerous possible interpretations.

“Many media write headlines that are meant to scare you. And I’ve tried both to read it, but to still disregard some things, just that the headlines are meant to be scary, and I’ve tried to watch more Swedish public service TV and read DN [major daily newspaper]… where it’s a bit more neutral”

# Informant 17

Despite this, the women expressed that receiving some information was still preferable to having no information at all. At the same time, the informants were satisfied with the general information about the pandemic provided by Swedish authorities. There was a clear need for uniform, consolidated information from healthcare authorities, specifically tailored to pregnant women and their partners regarding current restrictions.

Resilience as a helpful ability.

The informants reflected on the COVID-19 pandemic as an unprecedented and unique situation, highlighting the initial absence of research and knowledge regarding its impact on pregnancy. They demonstrated an acceptance of this uncertainty, recognizing that the lack of information was an inevitable consequence of the novel nature of the virus. Despite the many difficulties brought about by the pandemic, the informants described their ability to navigate these challenges as being influenced by their personality and previous experiences with adversity. Those who had received useful guidance in relation to previous mental ill-health expressed that it was helpful in this situation and found these coping strategies beneficial in the context of the pandemic. Moreover, the informants expressed an understanding of the need for restrictive measures and conveyed their trust that healthcare professionals were doing their utmost to provide optimal care under the circumstances. This acknowledgment of healthcare workers’ efforts, coupled with their own resilience, enabled the informants to face the challenges of the pandemic with composure and adaptability.

“…I went there [the scan] and he didn’t, and maybe he would have wanted to once, to come with me in order to listen to the baby’s heartbeat. But then he could also feel it moving, and that almost meant more actually.”

# Informant 15

They also expressed a high level of acceptance of the pandemic’s challenges and empathy for healthcare professionals, acknowledging their workload and constraints. Informants reported employing various strategies to shield themselves from the negative impact of media coverage, coupled with an understanding that the situation was beyond their control. Informants described how they were navigating pregnancy during the pandemic, noting that their attitudes and approaches were effective in managing the situation. Additionally, the anticipation of the baby was highlighted as a protective factor, providing emotional relief and positivity amid challenging circumstances and serving as an important coping mechanism.

“My own coping with pain, how I’ll manage it, and so on. But then I trust healthcare and healthcare staff to an extreme extent, that they’ll help me and so on, and that also makes my fear... the fear has really gone down a whole lot, and as I said before, looking forward more to the baby also made me less scared.”

# Informant 17

Support and sense of security.

The informants emphasized the pivotal role of midwives in antenatal healthcare, particularly in providing support that significantly enhanced the sense of security among expectant parents. Midwives were recognized for their ability to foster trust and reassurance through their professional expertise and empathetic approach. In some cases, midwives implemented individualized solutions to facilitate the involvement of partners in antenatal care, even amidst restrictive circumstances. These tailored measures were described as highly valuable and contributed to a more inclusive experience. The sense of trust in the healthcare services provided during childbirth and the postpartum period was a significant source of reassurance for expectant parents.

“I choose to believe that the necessary staff and resources will be available there at the labor ward, regardless of the corona situation, despite the exhaustion that I’ve heard the staff has had after the spring and summer. But I also think that the staff are super-competent, so that everything will be ok.”

# Informant 3

Experienced mothers expressed a sense of security about the prospect of being alone during childbirth, citing previous experience and familiarity with the process as key sources of confidence.

“I’ve gone through a delivery before, so I know how important a partner’s support is, but at the same time I know that there are very competent staff in the labor ward.”

# Informant 16

However, they also expressed empathy for first-time parents who faced the added emotional and logistical challenges of navigating childbirth under similar conditions. Informants who participated in online parental support groups and engaged in virtual sessions with perinatal psychologists reported positive experiences and expressed appreciation for these digital services, which were particularly valued during the pandemic’s restrictive circumstances. Additionally, virtual meetings with friends who also had children were described as helpful for sharing experiences.

Positive effects of the pandemic.

Despite the challenges imposed by the COVID-19 pandemic, the informants reported that they were able to identify several positive aspects arising from the circumstances. One notable benefit was the opportunity to rest while working or studying from home, a flexibility that proved especially advantageous for individuals experiencing pregnancy-related physical discomforts. This arrangement allowed some to remain professionally active in their pregnancies longer than might have otherwise been possible, providing a significant advantage in terms of both career continuity and personal well-being.

“In that case, I probably would have had to go on leave, and so I can see that it was more positive to work from home. I want to work, you see.”

# Informant 30

The restructured daily routines during the pandemic also facilitated shared responsibilities within couples, particularly in managing childcare and preschool drop-offs, as both partners were able to coordinate and support each other more effectively from home. Additionally, for those who commuted, it provided relief as the commuting time was reduced. The opportunity to spend more time together with the family or as a couple was also highly appreciated by the informants. The increased time at home was also positively associated with family and relationship dynamics. The relationship was described as improving and becoming stronger, developing into a sense of “we against the world”. This period served as an affirmation of the positive atmosphere in the home and strengthened relationships, which many informants described as being significantly enhanced during this time. An additional positive outcome of remote work was the reduced exposure to unsolicited advice on pregnancy and parenting from others, which some informants found to be intrusive and unhelpful. Working from home created a buffer that allowed them to navigate pregnancy and early parenting with fewer external pressures, contributing to a more autonomous and peaceful experience.

“Then I can divide up my day in another way, so I have time to rest, and I have time to work, I have time to get things done, more then I might have had if there hadn’t been corona. I would have been at work much more. I think I might have been more tired in that case.”

# Informant 5

Desire for alternative solutions for expectant parents.

The informants expressed a strong desire for perinatal healthcare to handle restrictions, and they advocated for personalized and flexible measures to facilitate greater involvement of partners during the perinatal period. Several alternative solutions were proposed to mitigate the exclusion of partners, including the implementation of special adaptations that consider the unique needs and circumstances of expectant and new parents. For example, specific suggestions involved designated time slots for partner presence, digital engagement options for situations where physical presence might be constrained, and enhanced communication to ensure partners remain informed and involved.

“Why don’t they just do everything they can so that the dad can be part of it? Especially when it’s your first baby. I think it’s very important when it comes to the second and third baby also, but… most of all the first.”

# Informant 10