Table 2.

Additional participants’ narratives about the impact of COVID-19 on maternal health in Puerto Rico

Thematic Category	Participants’ verbalizations
Pregnancy and birthing process	Participant #4 “Well, during the pregnancy process, I didn't stop going to my appointments and so on. But I did stop going out to places normally. I did not meet with anyone, like I stayed at home with my partner and the baby. But the labor process did affect me because my partner could not enter. When I gave birth, he only came in when the baby was practically outside, so I was alone throughout my entire process. And that marked me, it marked me to the point that I had surgery. That is what I am recovering from. I sterilized myself because I said that I never wanted to go through that process…again, giving birth alone, with fear and well, without anyone. So my pregnancy process did not affect me, but the labor process did.”
Orientation about the birthing process	Participant #4 “ …in reality they didn't explain a lot to us, they told us was which floor to go to and with the order, like with pre-admission and everything, like to which hospital we had to go, which floor we had to go to and so on. But about how many people were allowed, how long they were going to leave the baby with you, we were not clear about that. We did believe that it was only one person, but not even that because as I explained, my partner could not enter. So my son… I couldn't even touch him properly as soon as…he was born I did see him but they took him away. You know I couldn't breastfeed him, I couldn't like have that moment of postpartum intimacy with him. I couldn't because as soon as he came out, they showed him to me and took him away. You know, they didn't even give me a chance to be with the baby, nor did I put him on my chest or anything.”
Access to healthcare services	Participant #8 “But the government [public health insurance] kind of takes time in making the appointments. And the government [public health insurance], almost all the majority of the people have it and it is more difficult. And then, since I had the private one and I need to do those glucose studies. But since they already took away my plan (insurance), I have to look for another alternative that I can use in an emergency….Exactly, when it (insurance) was private everything was faster.”
Impact of pandemic on health	Participant #4 “Well, look, I don’t know if it is the fact that it changed all your routine and your lifestyle and the uncertainty that you don’t know if you're going to die or if your son, he's going to get Covid or what is going to happen to you that, I actually spent my time crying and crying all the time and in depression. Like I couldn't even get out of bed. No no, I couldn't even go and take a bath… things that are normally what one does on a day-to-day basis, well I couldn't do them because in reality, no, I didn't even feel like doing them out of fear, because I kind of thought like, like everything was lost. This was my first pregnancy and then I am going through something that I could lose it, because no one knew what was happening to you, if you… if you got Covid and you were pregnant because then at that time it was also that the news came out of this girl in the Manatí hospital who was pregnant and died… and I think even the baby died too. So those things started to hit me very hard and well my mental health was in decline…”
	Participant #5 “Sometimes yes. Yes, I mean, I say it because, because although I have great support from my husband, he goes out to work. Many times he is late because then he also takes care of my tasks like, go shopping, now he does everything….So although he is also tired, like everyone, you know, everyone, in every situation we are exhausted by the pandemic, but anyway I know that he gets distracted, at work, uh… he always finds himself from time to time for x or y reason with some friends. As opposed to me, I'm very locked up, when I say lock up I'm very locked up in my house.”
	Participant #7 “Yes, exactly, not having help and not being able to get together when, also when Christmas came… we were still, we couldn't celebrate it together, at that time.”
Challenges related to taking care of children	Participant #7 “We used the television a lot and that has been negative because, well…that’s what he wants from the moment he gets up is to watch the television until he goes to bed… yes, the skills that he must develop, how to paint, how to grip a pencil and that he should already be doing has taken him more time.// The boy had problems, well, it wouldn't be difficulties, in that case it was positive, because he also had, at that moment he was receiving speech therapy, and having the lockdown, in part the television helped him with that…he began to talk a lot as he was watching [TV] so he began to talk a lot, something that he did not do before.”