Pregnancy Anxiety as a Social Symptom: Personal Accounts of Pregnant Women During the COVID‐19 Pandemic in Quebec

ABSTRACT

This article presents the results of a study conducted in Quebec (Canada), in the Montreal and Abitibi‐Temiscamingue regions, with forty pregnant women interviewed between 2020 and 2021 during the COVID‐19 pandemic. Based on interpretive phenomenological analysis, the study highlights pregnancy‐related anxiety exacerbated by reduced medical care, the exclusion of partners, social isolation, and the disruption of pregnancy‐related rituals. While pregnancy is generally a significant transition in terms of identity and social life, women experienced this period in a context marked by loneliness, uncertainty, and increased mental strain. Public health measures focused on managing biological risks have paid little attention to their psychosocial and emotional needs. The exclusion of partners from medical appointments also revealed the limited institutional recognition of their role in the perinatal journey. The article contributes to the sociological understanding of pregnancy anxiety by framing it as a socially constructed phenomenon. It emphasizes the need for interdisciplinary approaches and calls for a revision of public health policies to better support pregnant women and fully recognize what giving birth means—for them and for society.

1. Introduction

Pregnant women and new mothers are at increased risk of anxiety¹ and depression² compared to other periods of their lives (Araji et al. 2020; Sinesi et al. 2019). The prevalence of prenatal anxiety symptoms is estimated at approximately 19% in high‐income countries and 34% in low‐ and middle‐income countries (Dennis et al. 2017). In the postpartum period, these rates drop to 14% and 26%, respectively. In Canada, a study published in 2016 (Fairbrother et al. 2016) estimated that approximately 15% of pregnant women experienced an anxiety disorder during pregnancy, and that 9% of women who were unaffected during pregnancy developed an anxiety disorder within 6 months of giving birth. Overall, research on perinatal anxiety points to the same conclusion: anxiety disorders are more common in the prenatal period than in the postnatal period (Fawcett et al. 2019).

Anxiety during pregnancy also increases the risk of obstetric complications (miscarriage, hypertension, eclampsia) (Accortt et al. 2015; Kurki et al. 2020) and complications during childbirth (prolonged labour, caesarean section, preterm birth) (Saunders et al. 2006). It is closely associated with a risk of postpartum depression (Lang et al. 2022), suicidal ideation, and maternal mortality due to suicide in the year following childbirth (Boisvert et al. 2023). Perinatal mental health disorders may also increase the risk of parent‐child attachment disorders, particularly due to reduced emotional availability in anxious or depressed parents (Field 2018; Saharoy et al. 2023). These attachment disorders can have an impact on a child's development, whether in terms of language, cognition, or behaviour (Van den Bergh et al. 2020). Finally, perinatal anxiety can lead to increased tensions, which may result in a deterioration of the couple's relationship or even separation (Trillingsgaard et al. 2014).

During the COVID‐19 pandemic, several studies have highlighted a significant deterioration in the mental health of pregnant women (Charton et al. 2022; Hessami et al. 2020; Tomfohr‐Madsen et al. 2021). Yan et al. (2020) found that pregnant women during the pandemic were 1.65 times more likely to experience anxiety symptoms than in the pre‐pandemic period. The SARS‐CoV‐2 health crisis thus appears to have increased the risk of anxiety during pregnancy. This is precisely what Berthelot et al. (2020) demonstrated in Quebec by comparing cohorts of pregnant women recruited before and during the pandemic and observing clinically higher levels of anxiety and depression among those exposed to the pandemic context. Similarly, Pearson et al. (2023) estimated that 16% of pregnant women in Quebec experienced high levels of general stress during the pandemic, that 34% reported a significant impact of the pandemic on their pregnancy, and that 9% reported high stress levels relating directly to pandemic conditions. These findings show us the psychological impact of the health crisis on pregnant women and call for a revision of public health measures that were put in place to support them.

Beyond these psychological repercussions, the pandemic has reshaped the social dynamics that underpin perinatal care, revealing and amplifying pre‐existing inequalities. It has thus disrupted interactions between pregnant women and healthcare institutions (Greenfield et al. 2020; Lalor et al. 2021), and weakened the networks of solidarity and social support typically relied upon during pregnancy (Bedaso et al. 2021; Dunkel Schetter and Tanner 2012; Meaney et al. 2022), and highlighted structural inequalities—territorial (Lessard et al. 2021), socioeconomic (Lebel et al. 2020), and gender‐based (Carde 2020; Robertson et al. 2022)—requiring navigation of the perinatal experience. This article sets out specifically to explore the sociological dimension.

Based on accounts from pregnant women collected in Quebec during the pandemic, this article aims to analyse the impact of public health measures on the experience of pregnancy and to examine, through the implementation of these measures, the extent to which the specific needs of pregnant women are recognized.

2. Research Context: Key Measures Implemented in Quebec to Limit the Spread of the Virus

On March 13, 2020, Canada declared a state of emergency, triggering the closure of schools and non‐essential businesses, as well as restrictions on gatherings and travel (Madjunkov et al. 2020). Quebec, one of the provinces that was the most severely affected by the pandemic—both in terms of confirmed cases and mortality rates—quickly implemented specific recommendations for hospitals (INSPQ 2020; MSSS 2020). Non‐urgent medical consultations and follow‐up appointments, including perinatal care, were cancelled, postponed, or conducted remotely by phone or video call. In‐person appointments were kept to a minimum with strict protocols in place (no symptoms, pre‐appointment COVID testing, physical distancing, and mask‐wearing). The presence of partners during prenatal appointments was also significantly restricted, generally limited to the 20‐ to 24‐week ultrasound and delivery. These restrictions directly decreased the emotional and social support available to pregnant women.

At the same time, under the auspices of the Commission des normes, de l'équité, de la santé et de la sécurité du travail (CNESST), the Government of Quebec issued recommendations as part of the ‘Pour une maternité sans danger’ (Safe Maternity) program, allowing pregnant women working in environments deemed at risk to take preventive leave or have their working conditions adjusted (through telework). Pregnant women, as a group considered vulnerable, were also included as a priority for COVID‐19 vaccination in the spring of 2021.

Pregnant women were thus subject to a dual system of protections and constraints during the pandemic: specific measures related to their pregnancy and restrictions imposed on the general population of Quebec (regional alert system, limitations on interregional travel, and targeted curfews—particularly in urban areas—between March 2020 and July 2022) (MSSS 2021). This contextual backdrop offers insight into how the accumulation and entanglement of various public health measures have contributed to creating a particularly anxiety‐inducing environment for pregnant women, affecting their medical care, their support networks, and the course of their daily lives.

3. Theoretical Framework

Pregnancy anxiety is frequently addressed from a psychopathological perspective and using quantitative methodological approaches (Bayrampour et al. 2016). To deepen our understanding of this phenomenon, we adopted a phenomenological theoretical framework that focuses on analysing the subjective experiences of pregnant women (Hore and Smith 2019). This phenomenological perspective is based on three fundamental concepts: the lived body, intersubjectivity, and social context. The ‘lived body’ helps us understand how pregnant women experience their changing physicality and the feelings of anxiety that manifest within it. Intersubjectivity sheds light on the relational dimension of anxiety, particularly through interactions with healthcare professionals, loved ones, and other pregnant women. The social context reveals how norms, public health policies, and material conditions contribute to shaping women's experience of anxiety during pregnancy.

This approach not only allows for exploring the individual and personal dimensions of anxiety through participants' accounts, but also to understand pregnancy anxiety as a social symptom. Anxiety cannot be reduced to an individual emotional state: it also serves as an indicator of the tensions, pressures, and vulnerabilities generated by the social environment. It reflects how pregnant women are situated within the social order, the expectations placed upon them, the resources available to them, as well as the forms of recognition or invisibilization to which they are subjected. From this perspective, anxiety is understood as a context‐dependent response, shaped by structural (organization of healthcare, public health policies), cultural (maternal norms, ideals of the ‘good mother’), and relational factors (support, isolation, professional interactions).

The inductive method adopted in this research also gives the women interviewed the opportunity to freely express their feelings, thoughts, and perceptions, thereby allowing us to move beyond the conventional—primarily medical—explanations of this ‘emotional state’ and its causes. The specific context of the pandemic provides a particularly interesting setting for examining how pregnancy is viewed and managed by public authorities in an exceptional health crisis, and how these collective decisions have impacted the lived experiences of pregnant women.

4. Corpus Construction and Analysis

The corpus analysed is based on 60 interviews conducted between July 2021 and July 2022 with 40 women who were pregnant or had recently given birth, residing in the administrative regions of Montreal and Abitibi‐Temiscamingue, Quebec.

The selection of these two regions allows us to examine the measures surrounding pregnancy in contrast to their spatial and health contexts. Montreal, with a population density of 4266.8 inhabitants/km², is the urban epicentre of the pandemic in Quebec, characterized by high infection rates and strict restrictive measures. Abitibi‐Temiscamingue, a rural region with 2.6 inhabitants/km², was relatively spared during the study period. These regions also differ in terms of their perinatal infrastructure (specialized and easily accessible hospitals in Montreal, compared to more remote facilities in Abitibi‐Temiscamingue, where pregnancy complications often require transfer to an urban centre) and their demographic dynamics (the average age at first birth is 32.1 years in Montreal compared with 27.9 years in Abitibi‐Temiscamingue, and total fertility rate of 1.38 compared with 1.96).

Recruitment, which was approved upon receipt of an ethics certificate from the Institut national de la recherche scientifique (INRS June 2021), was conducted through hospital posters, social media, and snowball sampling. Inclusion criteria were being pregnant or having given birth during the pandemic, residing in one of the two regions, being able to communicate in French and to participate in a remote interview via Zoom.

Of the 40 participants, 20 were interviewed once postpartum (births occurred between April 2020 and July 2021, during the first three waves of the pandemic). The other 20 were interviewed twice: during their pregnancy (between July and December 2021, at the end of the third wave and the beginning of the fourth) and then after delivery (between July 2021 and August 2022, between the fourth and sixth waves) (see Appendix—Table 1). Of the 40 participants, 39 gave birth in a hospital (6 hospitals in Montreal and 4 in Abitibi‐Temiscamingue) and one at a birthing centre in Montreal. The corpus included 21 primiparous women (53%)—including one who had twins—14 who gave birth to a second child (35%), and 5 to a third child (12%). Participants’ ages ranged from 26 to 43, with an average of 33.8 years in Montreal and 29.8 years in Abitibi‐Temiscamingue.

The majority of participants were born in Canada (34 out of 40), while 6 women, although Canadian citizens, are originally from Europe (France, Italy, and Switzerland). With the exception of a woman who lived alone and became pregnant following gamete donation, all participants were in relationships: 38 with a man (12 married, 26 unmarried) and one with a woman (unmarried). Seven women had a secondary school diploma, 5 a college diploma, 18 an undergraduate university degree, and 9 a graduate degree. Two women were not in paid employment, while the others reported being employed. At the time of the interviews, the women who were employed were on preventive leave from their workplace or on maternity or parental leave. All names mentioned in this article are pseudonyms.

The semi‐structured interviews (lasting between 40 and 90 min) explored the emotional experience of pregnancy, concerns related to the pandemic, relationships with family members and healthcare professionals, the organization of medical appointments, and the impact of public health measures on daily life. The participants, who were interviewed twice, described the evolution of their perinatal experience. All interviews were recorded, transcribed, and anonymized.

In accordance with the interpretive phenomenological approach adopted (Pelaccia et Paillé 2009), the analysis aimed to identify the meaning that participants attributed to anxiety‐inducing situations they experienced during their pregnancy amid the pandemic. The theoretical framework, which focuses on subjective experience and its meaning for individuals, guides our understanding of how women experienced and interpreted the disruptions caused by the pandemic as sources of anxiety. The analysis was conducted in five stages: (1) immersive reading of the transcripts to identify recurrent themes; (2) inductive coding in NVivo 12 segments related to experiences of anxiety (health concerns, changes in medical care, restrictions of in‐person visits, and impacts on the support networks); (3) grouping of codes into structured themes (virus‐related anxiety, shifting medical expectations, social isolation); (4) contextual interpretation of meanings, taking into account the pandemic context, personal circumstances, and regional resources; and (5) synthesis with a comparative perspective between urban and rural settings. Saturation was reached when new interviews no longer yielded significantly different insights regarding the identified themes.

5. Results: The Impacts of Public Health Measures on the Experience of Pregnancy and Anxiety During the Pandemic

All participants, regardless of their place of residence or the pandemic wave, reported experiencing episodes of anxiety of varying intensity during their pregnancy. The analysis highlights that this anxiety—present from the moment of the pregnancy announcement and continuing through childbirth—is rooted in three closely intertwined dimensions: the physical and physiological experience of pregnancy, the mental strain associated with risk management, and the symbolic and social transformations linked to becoming a mother. Public health measures have also restricted access to the resources typically mobilized to regulate these emotional states—including medical, relational, and preparatory or ritual forms of support—thereby reducing women's adaptive capacities and generating new challenges.

5.1. Concerns Related to the Pregnancy Experience and Medical Follow‐Up

5.1.1. Early Pregnancy Anxiety and the Effects of Public Health Measures

The early stages of pregnancy are accompanied by significant concerns, as women interpret both the presence and absence of physical symptoms as potentially worrisome. Lea (Abitibi‐Temiscamingue), for example, states: ‘I had signs that my period was coming… I thought I was having an ectopic pregnancy. I was really in worst‐case‐scenario mode.’ In contrast, Gabrielle (Abitibi‐T.) shares her concerns about the absence of symptoms: ‘There were no symptoms… I was really nervous: “Did it work?”’ Even with positive home tests, doubt lingers until medical confirmation.

The long wait times for appointments during the pandemic thus prolonged this uncertainty, with sometimes serious consequences, as seen in Roxanne's (Montreal) account: ‘When the pandemic hit, I was pregnant with the baby I later miscarried […] I started working 70 h a week. I had a miscarriage—I remain convinced that it was linked to the fact that my workload nearly tripled.’ This account highlights how postponing medical checkups can have serious health repercussions.

For women who were able to have their pregnancy recognized by their employer, access to preventive leave or workplace accommodations proved beneficial for their well‐being. Teleworking, in particular, allowed for better management of the physical symptoms frequently associated with the first trimester of pregnancy. Amélie (Abitibi‐T.) shares her experience: ‘Telework really helped me get through the first trimester; I was able to sleep, and it was much easier than being in the office.’ Lara (Montreal) also highlights the positive effects of this flexibility: ‘Telework allowed me to take 10‐ or 15‐min breaks when I needed them. At work, I wouldn't have been able to put my legs up on a footstool or something to give myself a break.’ By allowing working conditions to be adapted to the physical and emotional needs of pregnant women, rather than the other way around, these measures have helped highlight the importance of adjusting work arrangements early in pregnancy to improve the experience.

5.1.2. Fears Related to COVID‐19 Infection

Public health measures specifically targeting pregnant women have also generated new forms of anxiety among these women, particularly regarding a perceived increased risk of medical complications in the event of COVID‐19 infection. This perception of danger is pervasive in the accounts collected. Isabelle (Abitibi‐T.) says: ‘It probably worried me more than if I hadn't been pregnant, because they [the doctors] said that COVID increased the risk of hospitalization and preterm birth.’ This anxiety was further amplified among women with pre‐existing conditions deemed medically concerning. Ariane (Abitibi‐T.), who has mild asthma, confides: ‘I kept thinking: “Well, am I going to be ‘lucky’ enough and hit the jackpot and end up in hospital?”’ Roxanne (Montreal) speaks of her vulnerability due to her weight: ‘I'm worried about catching it [the virus] because I'm obese. So I was already at higher risk of dying.’ Stories from other women, shared by friends and family or on social media, also fuel this anxiety. Ariane (Abitibi‐T.) adds: ‘I had a close friend… She caught COVID, and she was really stressed […] Since then, she's been seeing a doctor every week; every 2 weeks she has an ultrasound… it must be serious.’ This fear of infection has made women more vigilant about their surroundings. Caroline (Abitibi‐T.) says: ‘Going out made me anxious; running into people made me anxious.’

Healthcare facilities have also become sources of concern. Alexandra (Montreal) explains: ‘I felt like the place where you were most at risk of catching COVID […] was the hospital. My main stress was seeing that there were a lot of people there, including medical staff who didn't respect physical distancing.’ For some women, physical distancing measures provided a sense of security. Stéphanie (Abitibi‐T.) describes her relief at being able to isolate herself: ‘I was in my family bubble, my bubble of love […] nothing could happen to me.’ The feeling of being protected and of being in a ‘bubble’ perceived as a shield against potential infection provided a psychological benefit for many participants, particularly during the early waves of the pandemic.

5.1.3. Anxiety Stemming from Reduced Medical Care and a Sense of Abandonment

The reduction of in‐person medical appointments also prolonged periods of anxiety for women. Caroline (Abitibi‐T.) notes: ‘Instead of 5, it was every 8 weeks at first. It felt like a long time; I was really stressed out.’ In addition to the longer wait times between medical follow‐ups, the brevity of appointments also created a climate of uncertainty and frustration, as Roxanne's (Montreal) account suggests: ‘They were extremely short 15‐min appointments […] he [her doctor] never had time to answer questions.’

Although telephone consultations were preferred to limit contact, some women expressed a need for in‐person interaction with healthcare professionals in order to better manage their stress. Gabrielle (Abitibi‐T.) explains: ‘I asked to come in person to work through that stress. I said to myself: “I have stress elsewhere that I can't manage. This one, I'd like to listen to the heartbeat together with you.”’ The fear of having appointments cancelled due to COVID‐related symptoms was an additional source of anxiety. Gabrielle goes on: ‘What COVID brought was all the inconveniences—as soon as you had a symptom, you were turned away everywhere […] I was so afraid of missing my follow‐up appointments that I didn't even see my whole family.’ These accounts highlight the importance of regular, in‐person medical care in managing perinatal anxiety, as well as the harmful effects of interrupting or shifting such care to virtual formats during a health crisis.

Some pregnant women with symptoms, particularly respiratory ones, also reported feeling stigmatized in healthcare settings. Valérie (Abitibi‐T.) shares her experience: ‘Because I was coughing, even though I'd put on a mask and it wasn't yet mandatory, almost all the secretaries [at the hospital] were glued to their filing cabinets, even though there was a plexiglass screen. I really felt like I was the plague.’ Beyond affecting her morale, this rejection also made her feel guilty: ‘At one point I asked myself: “Am I in the wrong?” “Maybe I really am sick, maybe I could make my daughter sicker?”’

High turnover among medical staff and conflicting medical guidelines also contributed to confusion and a sense of insecurity. Camille (Abitibi‐T.) describes it this way: ‘It's never the same doctor. I always had to unpack everything and say: “I'm scared, it makes me anxious.”’ Isabelle (Abitibi‐T.) adds: ‘There are so many contradictions; that's what's unsettling. What are the measures, really?’ Lea (Montreal) reveals: ‘Access to information, I find it hard to get because I don't know what I need to know.’ Faced with this lack of support, several women turned to the Internet for information. Nancy (Montreal) explains: ‘It wasn't my doctor who gave me information; I was the one who went looking for it.’ This reliance on self‐directed research also heightened their anxiety, particularly in the absence of professional validation.

5.1.4. Exclusion of Partners and Loneliness in the Face of Complications

The ban on partners being present was a major source of distress for pregnant women. A sense of injustice was often expressed. Élodie (Abitibi‐T.) reflects on her experience: ‘I found it unfair because it was just as much his baby as mine… and technically, if he had COVID, I have it too.’ The confusion was all the greater given that some practices with no risk of infection and that had previously been allowed were now prohibited. Lara (Montreal) conveys this frustration: ‘We weren't allowed to show the baby [at the ultrasound] via FaceTime… [even though my sister had been able to do so 2 years earlier]. To me, that part just didn't make sense.’

Excluding partners also deprived women of moments of intimacy with their partners, further isolating them. Eve (Montreal) expresses her disappointment: ‘Everything that made pregnancy enjoyable, prenatal appointments… suddenly, we're all alone.’ Coline (Montreal) also notes: ‘The first few times we heard the heartbeat, I was all alone… it's a bummer.’ Audrey (Abitibi‐T.) shares her sadness: ‘It really hurt me to go there alone.’ The absence of a partner during medical appointments also increased the vulnerability of these women, who feared having to face potential complications alone. Laurie (Abitibi‐T.) explains how she felt: ‘My fear was that I'd get there, get bad news, or have to deal with it all by myself.’ For some women, these fears actually came true. Élodie (Abitibi‐T.) recounts: ‘We couldn't hear the baby's heartbeat […] my partner couldn't come, I was in tears on the phone […] I was really scared, and he couldn't be with me.’ Lara (Montreal) also shares: ‘My daughter wasn't big enough. It was very worrying, and I was the only one when I found out. It caused me a lot more anxiety about her birth.’

Faced with these institutional restrictions, some women chose—when they could—to opt for private ultrasound services. Roxanne (Montreal) explains: ‘I had to pay for a private ultrasound so my boyfriend could be there… we paid for a private ultrasound, which is very expensive, by the way.’ These strategies and workarounds also highlight the socioeconomic inequalities in access to care.

5.1.5. Childbirth Preparation Compromised by Public Health Measures

Childbirth is already a major source of anxiety, which is exacerbated by the pandemic. Chloé (Montreal) clearly expresses this fear: ‘Honestly, what scares me in all of this—being pregnant and giving birth—it's the birth that gives me nightmares at night. Giving birth really terrifies me.’ The cancellation of prenatal classes heightened this concern, particularly among primiparous mothers. Élodie (Abitibi‐T.) says: ‘We were really looking forward to going [to prenatal classes]—unfortunately, they were all cancelled.’ Julia (Abitibi‐T.) also emphasizes how important these classes are to her and her partner: ‘I would have liked us to have a class together, just to say we're preparing and knew what we're getting into.’

Some women have therefore sought to fill this gap with private online classes—a solution considered helpful but not financially accessible to all. Lea (Abitibi‐T.) remarks: ‘I think it's a great option [the private online classes], I'd recommend it. The only downside is that it's maybe not accessible to all budgets.’ Ariane shares a similar feeling: ‘It was great [the private online classes], but there are girls who are poor or whatever—it must be stressful [not being able to take those classes].’

The fear of giving birth alone was also a major source of anxiety. Ariane shares: ‘Before giving birth, there was a bit of uncertainty; you never knew, once you got to the hospital, what the measures would be […] It's just one more thing you can't control when you're giving birth for the first time.’ She continues: ‘There are girls who say that supposedly you give birth all alone with masks on, that supposedly your partner can't come… it creates a bit of anxiety, not knowing in advance what it's going to be like.’

The requirement to wear a mask during childbirth has also sparked strong reactions. Sarah (Abitibi‐T.) says she is outraged: ‘I find it absolutely appalling to have to wear a mask during childbirth […] breathing and getting air, that's basic. […] I think it's a violation of the rights of the women giving birth.’ The health information and precautions surrounding childbirth during the pandemic have thus contributed to heightening anxiety among pregnant women, in a context already marked by the uncertainty and vulnerability inherent in this experience.

5.2. Increased Mental Load for Pregnant Women

The pandemic has also placed an additional mental load on pregnant women, stemming from the constant need to assess the risks associated with everyday life. Gabrielle (Abitibi‐T.) sums it up well: ‘It added another weight to the pregnancy, to family management, to managing everything, to weigh the risk of every action.’ Alexandra (Montreal) describes a mental load fuelled by the guilt she feels at the thought that her anxiety might affect her baby: ‘I feel some guilt […] I hope he won't suffer too many consequences from this stress. I feel guilty for stressing out, and I tell myself I mustn't stress; it's a vicious cycle.’

Some women also mention having to deal with significant family tensions, particularly regarding access to their older children. Gabrielle (Abitibi‐T.) recounts: ‘I had constant stress because there was also pressure from the family who wanted to see your other child […] They'd say: “Well, we're missing all the beautiful moments; we won't experience the little one turning two.” […] I found that to be a lot of pressure from the family.’ For women who already have children, the pandemic has added an extra layer of complexity to managing their families and their anxiety. Gabrielle continues: ‘You let your child live, you want him to live their life, and then you're stressing a lot because you're pregnant and you don't know, and it's starting to come out that it's dangerous for pregnant women—what are we going to do with that?’ The responsibility for decisions about whether older children should attend daycare, school, or visit grandparents fell primarily to women, adding to their duty to protect their unborn child.

While pregnant women are generally viewed as a vulnerable group who typically receive family support, the pandemic has often reversed this dynamic. Roxanne (Montreal) speaks of this paradox: ‘[My boyfriend's parents] they are 75 years old […] we really didn't see them much during the pandemic because we were very afraid of transmitting something to them.’ Alexandra's (Montreal) account echoes this sentiment: ‘My parents and Louis’ parents are very old […] we had to be careful.’ For some participants, this role reversal had even more significant consequences. Clara (Abitibi‐T.) recounts how she had to be temporarily separated from her partner: ‘My partner, at one point, had to go back to the foundry […] My mother was panicking; she said: “Now, what are you going to do, you'll be home alone with your partner; we won't be able to see each other anymore.” In the end, we made a big decision: I would stay at my parents’ for the rest of my pregnancy. My partner stayed home, so we saw each other, but from a distance or outdoors, until I gave birth.’ Thus, the family, traditionally viewed as a source of support, has become an additional source of stress for some pregnant women. Their mental load has increased as they take on the responsibility of protecting their older children, their partners, and their loved ones, often at the expense of their own wellbeing. These experiences also highlight the persistence of social expectations placed on women, regardless of their socially recognized vulnerability or the exceptional nature of the pandemic.

5.3. The Transition to Motherhood: Identity Shifts and Social Challenges

5.3.1. Identity Shifts Against a Backdrop of Social Pressure

The transition to motherhood is a period of identity transformation, marked by a reshaping of one's sense of self. Participants frequently describe a feeling of being stripped of their body and identity. Sophie (Abitibi‐T.) states: ‘Being pregnant, you are not yourself… You're lending your body.’ Claudia (Montreal) echoes this feeling: ‘I'm not myself.’ This sense of changed identity is accompanied by a feeling of constraint due to physical limitations, as Lucie (Montreal) explains: ‘What I don't like is this limitation […] I'm usually able to achieve my goals, but right now, that capacity is restricted.’

Adjusting to this new role of mother‐to‐be is sometimes accompanied by a process of mourning one's former life, as Lea (Abitibi‐T.) states it: ‘It was my own little mourning; my life was going to change […] I said goodbye to my previous life.’ For many women, this transition is marked by deep emotional ambivalence. Émilie (Abitibi‐T.) puts it succinctly: ‘I was disoriented […] happy and anxious at the same time.’ Doubts about their ability to take on their future role are common. Sophie (Abitibi‐T.) confides: ‘It's so much unknown […] I had a little 2‐min cry […] that we'll never be able to do it.’

Several participants also reported feeling significant social pressure (from doctors, family, etc.) regarding their behaviours and lifestyle habits as soon as they announced their pregnancy. The recommendations and increased attention from those around them are sometimes experienced as an additional burden. Bianca (Montreal) explains: ‘I felt restricted: I no longer smoked, I couldn't drink anymore […] I didn't like receiving unsolicited advice.’ This account also illustrates how pregnancy tends to transform the female body into an object of social scrutiny (Charton 2026). Furthermore, the responsibilities associated with pregnancy appear to rest almost exclusively on women, as none of the participants mentioned comparable expectations of their partners. This gendered asymmetry in the distribution of responsibilities during pregnancy reflects and helps reinforce the social stereotypes traditionally associated with the roles of women and mothers (Charton 2025).

5.3.2. Professional Concerns and Limited Social Recognition of Women's Contributions During the Transition to Motherhood

The transition to motherhood is also accompanied by concerns about career paths, particularly in Abitibi‐Temiscamingue, where the shortage of daycare spots is a major source of anxiety. In this region, several participants expressed that the uncertainty surrounding access to a daycare spot was a major source of anxiety, sometimes even greater than that linked to the pandemic itself. Émilie (Abitibi‐T.) confirms: ‘The lack of daycare stresses me out more than COVID. I don't even know if I'll be able to go back to work.’ This concern, which is absent from participants’ accounts in Montreal, reveals a significant regional disparity in the sources of perinatal anxiety and highlights marked territorial inequity in work‐family balance.

Physical distancing measures also affected the social aspect of pregnancy, depriving women of the interactions that typically contribute to the recognition and celebration of their pregnancy. While some participants saw benefits in this situation—notably the avoidance of intrusive behaviours, as highlighted by Stéphanie (Abitibi‐T.): ‘No one touched my belly’ or Ariane (Abitibi‐T.): ‘No one dares to touch your belly because of COVID’; others have experienced this lack of interaction as a form of social disregard of their pregnancy and the commitment it entails. Clara (Abitibi‐T.), already a mother, explains: ‘I had much less contact with people […] with my first, I often received compliments, but this time, nothing.’

This lack of recognition and social validation has sometimes also led to a deep sense of disappointment. Amélie (Abitibi‐T.) confides: ‘I thought to myself: “OK, I'm going through the pregnancy alone, nobody has seen my belly” […] It was a big shock.’ Sarah (Abitibi‐T.) shares a similar feeling: ‘It was really disappointing that I couldn't show off my baby bump to everyone.’ These accounts highlight the importance of viewing the transition to motherhood not only as a physical transformation, but also as a symbolic and social process. Recognition by others appears to be a fundamental factor in enabling women to fully embrace their new identity as a mother‐to‐be. This aspect has not been considered in public health guidelines.

5.3.3. Disruption of Rituals Marking the Transition to Motherhood during the Pandemic

Public health restrictions have also disrupted the rituals that mark the pregnancy period (Lemieux 2009). The activities of material preparation, such as setting up the nursery, buying clothes and so on, are symbolic acts marking the gradual transition into parenthood (of a first child, a second, a third, etc.). Store closures have hindered these practices, creating additional obstacles in the process of establishing a sense of identity and managing perinatal anxiety. Sarah (Abitibi‐T.) recounts: ‘All the stores were closed, and we didn't have a nursery […] my plan was to go shopping for baby clothes. It was a dream that turned into a nightmare.’

The inability to have a maternity photo shoot was also a source of frustration. Clara (Abitibi‐T.) says: ‘I wanted to wait to have my photo shoot, but there are no photographers left… [sighs] so I didn't get my photo shoot.’ These rituals, often shared with the partner, help to mark the transition to motherhood and strengthen the couple's identity as parents. Disruption to these processes, beyond causing disappointment, can hinder psychological adjustment and social recognition.

Becoming part of a community of peers is also an essential aspect of preparing for parenthood. Physical distancing measures have deprived many pregnant women of opportunities to share experiences and receive emotional support. Prenatal classes, in particular, are seen as spaces for learning and socializing. Mélinda (Montreal) explains: ‘I felt like we could create a small community of women […] that I could have spoken with people, expressed my worries, my questions.’ Their cancellation was therefore experienced as a source of disappointment. Other activities, such as prenatal yoga or water aerobics, were also mentioned as specific opportunities for social interaction. The fact that they were unavailable sometimes reinforced a sense of isolation, as Stéphanie (Abitibi‐T.) notes: ‘I was very disappointed not to be able to do that and to meet other women.’

The baby shower, a key moment of social recognition of the pregnancy and the mother‐to‐be, held particular importance for most primiparous women. Amélie (Abitibi‐T.) emphasizes its significance: ‘The shower was important […] It was really important to celebrate our happiness.’ This ritual not only celebrates the mother‐to‐be but also symbolically acknowledges the couple as parents (‘our happiness’). Stéphanie (Abitibi‐T.) speaks about the importance of showcasing her pregnant body: ‘I had my big belly […] I wanted it to last. I didn't want it to be just a short half‐hour, here are the gifts, goodbye. […] The shower, it had eight people for an hour and a half […] We'd started the day at 9 in the morning and finished at 6 in the evening.’ The cancellation or alteration of this occasion was generally viewed negatively. Élodie (Abitibi‐T.) recounts: ‘I didn't have a baby shower. That too was cancelled, we did nothing. People would come and leave a gift on my porch and text me to say they'd dropped it off.’ These accounts highlight how social recognition of pregnancy relies on ritualized practices that formalize and support the transition to motherhood. The disruption of these practices during the pandemic has undermined these processes of symbolic validation, making it more difficult to gradually embrace a new parental identity.

6. Discussion

The results of this study highlight that pregnancy anxiety experienced during a pandemic cannot be reduced to an individual reaction to a health threat. Rather, it emerges as a deeply situated phenomenon, shaped by the interplay of structural, relational, and symbolic conditions. In this sense, our data support and enrich the phenomenological perspective adopted, which views anxiety not merely as a medical or psychological condition, but as a social symptom, revealing the tensions running through the social order in which pregnant women are embedded.

The three foundational concepts of our theoretical framework—the lived body, intersubjectivity, and the social context—find empirical illustration in the results presented here, which warrants further elaboration. The lived experience of the body features prominently in the participants’ accounts, echoing Young's (1984) analysis. The experience of the pregnant body in a pandemic context cannot be reduced to a mere physiological transformation: it is experienced as a physicality under surveillance, constrained, and sometimes stigmatized. The obligation to wear a mask—sometimes even during childbirth—along with mobility restrictions and the shift toward virtual care, has altered the way women relate to and experience their bodies. Traditionally a space of care and attention, the pregnant body has become a potential source of infection, leading to a form of bodily alienation that manifested as increased anxiety. Accounts describing a sense of disempowerment—such as Sophie's statement that ‘being pregnant, you are not yourself’—also highlight a bodily experience caught between two forces: the internal changes associated with pregnancy and external constraints imposed by public health measures.

Intersubjectivity—understood as the relational and co‐constructed dimension of experience (Merleau‐Ponty 1976 [1945])—is also central to the accounts collected. The quality of interactions with healthcare professionals, the presence or absence of a partner during appointments, and limited interaction with other pregnant women are key aspects of the experience of anxiety. The shift to virtual care, the exclusion of partners, and the cancellation of prenatal activities have profoundly diminished these spaces of mutual connection, depriving women of the reassurance that comes from direct contact during moments of vulnerability. Gabrielle's request to be seen in person—'I'd like to listen to the heartbeat with you’—illustrates this need for an embodied presence, which cannot be reduced to a remote interaction.

Finally, the social context—as theorized by Giddens (1984) through the concept of social structuration and by Fraser (1995) through that of recognition—allows us to situate pregnancy anxiety within a set of structural conditions that produce and sustain it. Public health policies, maternal norms, and territorial and socioeconomic inequalities are not merely the backdrop to individual experience: they are active determinants. Pregnant women's anxiety during the pandemic is thus the result of a specific social context, which simultaneously amplified preexisting vulnerabilities and gave rise to unprecedented anxiety‐inducing situations.

The three dimensions identified by the analysis—concerns about medical care, mental load, and identity‐related shifts—are also consistent with previous research on perinatal anxiety (Dennis et al. 2017; Fawcett et al. 2019), while extending it into an unprecedented context. The pandemic has not only exacerbated existing vulnerabilities; it has also simultaneously disrupted the resources typically available for managing anxiety: medical support, social networks, transitional rituals, and social recognition.

One of the key findings of this study is that it emphasizes the role played by the deterioration of medical care in the onset and persistence of anxiety. The spacing out of appointments, their shift to virtual formats, and staff turnover have profoundly altered the quality of the therapeutic relationship, depriving women of a reassuring anchor at a time of heightened vulnerability. These findings echo the literature on the importance of emotional availability in perinatal care and serve as a reminder that the continuity of care is not merely a medical issue but also a psychological one. They also align with the concept of intersubjectivity in our theoretical framework: the therapeutic relationship is not limited to an exchange of medical information; it rather constitutes a space for recognition and reassurance, the dematerialization of which has produced specific anxiety‐inducing effects. The care provider–patient relationship is indeed based on a physical and emotional co‐presence that grounds trust and fosters a sense of security (Todres et al. 2009). Previous studies have already shown that the continuity and quality of this relationship are major protective factors against prenatal anxiety (Rollans et al. 2013; Sword et al. 2012), and that disruptions to this relationship are associated with lower satisfaction among pregnant women and increased emotional distress (Greenfield et al. 2020). In the specific context of the pandemic, several studies have also documented that the shift to virtual consultations, while it helped maintain minimal access to care, was perceived by pregnant women as insufficient to meet their needs for reassurance and emotional support (Lalor et al. 2021). This intersubjective dimension of perinatal care, which is difficult to replicate remotely (Todres et al. 2009), thus underscores the need to preserve, even in times of crisis, opportunities for direct contact between pregnant women and their healthcare providers.

The exclusion of partners from prenatal consultations was one of the measures that most significantly affected the participants’ emotional experience. The accounts collected reveal a twofold loss: that of shared intimacy and that of concrete support when faced with potentially bad news. These findings build on previous research regarding the importance of social support in regulating perinatal anxiety (Bedaso et al. 2021; Dunkel Schetter and Tanner 2012; Rini et al. 1999), while highlighting the unique nature of crisis, in which such support is precisely limited at the very moment when it is most needed. From a social perspective, this exclusion illustrates how decisions made at the collective level—and justified by public health imperatives—have different effects on groups whose specific vulnerabilities have not been sufficiently taken into account (Fraser 1995; Giddens 1984). The use of private ultrasound scans to mitigate the exclusion of partners, as mentioned by some participants, points to a phenomenon of compensatory privatization of healthcare that raises significant equity concerns. This coping strategy, available only to women with sufficient financial resources, has thus introduced a form of socioeconomic differentiation in access to emotional support during pregnancy, echoing documented concerns about health inequalities.

The findings on the mental load reveal a particularly pronounced gender imbalance in the distribution of family responsibilities during the pandemic. Pregnant women took on the majority of decisions regarding risk management within their social circles, while simultaneously having to protect their fetus and manage their own anxiety. This configuration echoes feminist analyses of care work (Hamrouni 2015) and illustrates how a collective crisis can reinforce, or even exacerbate, pre‐existing gender inequalities. This mental load cannot be interpreted as merely a reflection of individual characteristics or personal choices: it is the product of social structures that assign women responsibility for family care, regardless of their own vulnerability (Giddens 1984; Hamrouni 2015). The pandemic has served here as both a catalyst and an amplifier of these structures, bringing to light gender inequalities that, under normal circumstances, tend to remain normalized and invisible. Furthermore, while pregnancy usually grants women a status of vulnerability that entitles them to increased support, several participants described taking on a protective role toward those around them, thereby reversing the usual caregiving dynamic.

The disruption of rituals associated with the transition to motherhood—baby showers, maternity photo shoots, prenatal classes, and social activities—is a relatively under‐documented aspect in the literature, even though our findings show that these practices serve essential psychological and social functions. In terms of the lived body, these rituals constitute spaces where the pregnant body is acknowledged, showcased, and socially validated: their disruption affected the way women inhabited and expressed their transformed physicality. In terms of intersubjectivity, these rituals are moments of shared presence and emotional connection that cannot be reduced to virtual interactions, as illustrated by Amélie's account: ‘I'm experiencing this pregnancy alone; no one has seen my baby bump.’ In terms of social context, their cancellation reveals how collective decisions made without regard for the symbolic functions of these practices have created a sense of invisibility among women whose identity transition has not been socially recognized (Fraser 1995). These findings suggest that these practices should be viewed not merely as luxuries, but as integral components of perinatal wellbeing.

A comparison of the participants’ accounts from Montreal and Abitibi‐Temiscamingue reveals variations in the sources and manifestations of anxiety. While women in Montreal were more exposed to severe restrictive measures, those living in Abitibi‐Temiscamingue more frequently expressed concerns regarding access to specialized care and childcare services. These regional variations illustrate the analytical scope of the concept of social context: perinatal anxiety does not unfold in a homogeneous space but rather in differentiated contexts marked by specific infrastructures, resources, and constraints that shape the lived experience (Giddens 1984). It should nonetheless be emphasized that these differences must not obscure the common ground of anxiety shared by all participants: the pandemic has served to amplify the vulnerabilities inherent to the perinatal period, all of which are marked by the shared experience of loss of control and restriction of usual resources.

This study has a number of limitations that should be clarified. The use of a convenience sample—consisting of hospital posters, social media, and snowball sampling—does not allow us to claim that the study is representative of the full range of experiences of pregnant women in Quebec. The women interviewed likely have a specific profile in terms of reflexive capacity, comfort with digital tools, and availability. The sociodemographic composition of the sample—which consists primarily of women born in Canada, who are French speakers, in a relationship and have a relatively high level of education—also limits the consideration of the experiences of women belonging to more marginalized groups: recent immigrant women, Indigenous women, and women in precarious economic situations. Although the comparative approach between Montreal and Abitibi‐Temiscamingue is a strength of this study, the relatively small sample size in each region calls for caution when generalizing the observed differences. Furthermore, since the interviews were conducted between July 2021 and July 2022, the experiences of the first waves can only be assessed retrospectively, which introduces a risk of memory bias. Finally, while the phenomenological approach adopted allows access to the richness of lived experiences, it does not aim to establish causal links or to quantify the magnitude of identified effects. Mixed‐method research combining qualitative data and standardized measures of anxiety could help to supplement and expand upon the findings presented here.

In terms of practical implications, these findings suggest several avenues for further exploration. The need to maintain, even in crisis contexts, direct contact between pregnant women and their healthcare providers is clear. Crisis protocols would similarly benefit from incorporating support measures accessible to all women, regardless of their socioeconomic status, in order to prevent the compensatory privatization of care from further widening existing inequalities. Finally, consideration should be given to ritual substitutes that could preserve the symbolic functions of the rites of passage—for example, through collective digital spaces dedicated to pregnant women—and this should be integrated into the planning of perinatal care in emergency situations.

7. Conclusion

This study aimed to move beyond conventional approaches to perinatal anxiety and offer a phenomenological and social interpretation of it. By giving a voice to forty pregnant women or new mothers who lived through the COVID‐19 pandemic in Quebec, it has documented a unique collective experience and revealed both its most intimate and its most structural dimensions.

The accounts collected points to a central finding: pregnancy‐related anxiety experienced during the pandemic is the result of a unique set of circumstances in which several factors contributing to vulnerability have overlapped and reinforced one another: the disruption of medical care and of rites of passage into motherhood, the exclusion of partners, relational isolation, and the mental load associated with managing family risk. This situation had the effect of depriving pregnant women, precisely at a time when they were most vulnerable, of the resources typically available to help them navigate this period.

The findings also highlight a fundamental tension that has run through the collective management of the pandemic: the tension between the imperative to protect public health and the need to ensure adequate support for groups with specific vulnerabilities. Pregnant women, formally recognized as a priority group, have nonetheless been subject to restrictions whose psychological effects have not always been sufficiently anticipated or mitigated. Beyond the pandemic context, this study invites a broader reflection on the role assigned to pregnant women in collective decision‐making during crises, and on the need to systematically include an assessment of the specific impacts on populations during the perinatal period. From a theoretical perspective, this research helps to strengthen the conceptual framework of pregnancy anxiety as a social symptom—a sensitive indicator of the conditions under which societies support, or fail to support, women in their experience of motherhood.

Several avenues for research emerge from this work. Longitudinal studies could examine the longer‐term effects of perinatal anxiety experienced during the pandemic context on women, children, and marital and family relationships. Research focusing on populations that have been underrepresented in the literature to date (Indigenous women, recently immigrated women, women in precarious situations, etc.) would help to enrich and deepen our understanding of the inequalities that shape the perinatal experience in times of crisis.

Ultimately, this study has shown that caring for pregnant women in times of crisis is not limited to protecting them from a viral risk. It also means recognizing the uniqueness and significance of what they are going through, ensuring conditions that allow for compassionate and continuous support, and giving them a voice in collective decision‐making that reflects the importance—for them and for society—of bringing a new life into the world.

Conflicts of Interest

The author declares no conflicts of interest.

1.

TABLE 1.

Sociodemographic characteristics of the 40 women interviewed.

Women (pseudonyms)	Age (years)	Occupation	Marital status	Birth order	Month of pregnancy (interview date)	Delivery date (age of newborn at the time of interview)
Abitibi‐Témiscamingue
Sarah	32	Educator	Married	1	NA	05/2021 (2 months)
Jessica	26	Sales clerk	Common‐law	3	NA	03/2021 (4 months)
Stéphanie	30	Speech Therapist	Common‐law	1	NA	09/2020 (10 months)
Catherine	27	Caregiver	Common‐law	2	NA	04/2020 (16 months)
Élodie	32	Caterer	Common‐law	1	NA	07/2020 (13 months)
Audrey	31	Office worker	Common‐law	1	NA	08/2020 (12 months)
Julie	29	Educator	Common‐law	1	NA	02/2021 (2 months)
Clara	28	Stay‐at‐home mother	Married	2	NA	06/2020 (15 months)
Gabrielle	28	Educator	Common‐law	2	NA	11/2020 (10 months)
Valérie	30	Teacher	Common‐law	2	NA	04/2020 (18 months)
Isabelle	33	Teacher	Married	3	7 (07/2021)	09/2021 (6 months)
Ariane	29	Accountant	Common‐law	1	6.5 (07/2021)	10/2021 (5 months)
Sophie	27	Engineer	Common‐law	1	8.5 (07/2021)	08/2021 (11 months)
Amélie	32	Educator	Common‐law	1	8.5 (07/2021)	07/2021 (8 months)
Caroline	30	Teacher	Common‐law	2	6 (08/2021)	11/2021 (5 months)
Lea	28	Educator	Common‐law	1	7 (08/2021)	10/2021 (5 months)
Camille	33	Municipal employee	Married	3	8 (09/2021)	10/2021 (5 months)
Laurie	30	Social worker	Common‐law	2	8 (09/2021)	10/2021 (5 months)
Émilie	33	Sales clerk	Common‐law	2	8 (09/2021)	10/2021 (7 months)
Vanessa	28	Educator	Married	2	6.5 (09/2021)	10/2021 (5 months)
Montréal
Alexandra	37	Educator	Common‐law	2	NA	07/2021 (12 months)
Roxanne	31	Social worker	Married	2	NA	04/2020 (17 months)
Véra	32	Teacher	Common‐law	1	NA	10/2020 (9 months)
Lara	43	Accountant	Single	1	NA	10/2020 (9 months)
Claudia	34	Engineer	Common‐law	2	NA	03/2021 (4 months)
Bianca	32	Teacher	Common‐law	1	NA	04/2020 (16 months)
Nancy	31	Educator	Married	1	NA	03/2021 (17 months)
Joanie	34	Programmer	Married	3	NA	06/2021 (2 months)
Mélinda	31	City employee	Married	1	NA	07/2021 (3 months)
Noémie	34	Manager	Married	1	NA	05/2020 (16 months)
Coline	34	Entrepreneur	Common‐law	2	5 (07/2021)	11/2021 (5 months)
Nathalie	39	IT specialist	Common‐law	3	8 (07/2021)	09/2021 (5 months)
Élise	36	Doctor	Common‐law	1	8.5 (08/2021)	09/2021 (5 months)
Lisa	36	Lawyer	Common‐law	1	9 (09/2021)	09/2021 (5 months)
Juliane	35	Engineer	Married	1	8 (09/2021)	09/2021 (7 months)
Pascale	36	Educator	Common‐law	2	6 (10/2021)	12/2021 (5 months)
Chloé	26	Secretary	Common‐law	1	4.5 (10/2021)	08/2022 (4 months)
Eve	34	Stay‐at‐home mother	Married	2	5 (10/2021)	03/2022 (12 months)
Lucie	30	Teacher	Common‐law	1	7 (10/2021)	11/2021 (5 months)
Maude	34	Designer	Common‐law	1 & 2 (twins)	7 (11/2021)	12/2021 (5 months)

Abbreviation: NA, not applicable.