Table 2.

Summary of Thematic Analysis of New Parent Support Needs in the Time of COVID-19 and Illustrative Quotes

	Quote
Theme: Mental health amid the dual stressors of infant and pandemic
Section A: Mothers and fathers struggle	I think that I was going to be more anxious [as a mother] than I realized. But it was definitely compounded by the virus… I think being isolated, not having anyone else to talk to, not being able to just like go to a restaurant and not think of it, I think that was like a pretty big, a big part.
	He kind of like broke down and was like, you know, that the pandemic had really been affecting him like mentally as well. And, you know, that he was like so scared about everything and, you know, that he had been kind of distancing himself from, you know, me and our daughter and he didn’t even realize he was doing it you know, but then like when I said that to him he…like kind of had this realization.
Section B: Clinical and sub-clinical mental health challenges	When the pandemic hit and him not being able to go back to work, you know, because they shut down… I think it was really hard for him… He really struggled with coming to terms with fatherhood… I felt like if he could have left the house and have more alone time to figure out his new identity and, you know, feel like he’s more than just a father at this time, [it would have helped]… He developed um, postnatal depression um for fathers…
	I wish there was something for those of us who are like sort of fine, but not actually… Like I’m not [clinically] depressed. I don’t have more anxiety than the average person has during a pandemic… And no, I’m not really okay… I’m not so okay that I don’t need anything, so I wish that there was something for those of us who are like sort of struggling.
Section C: Distinguishing “normal” from excessive worry in the context of a pandemic	I mean I was diagnosed as [having] post-partum anxiety and OCD, but it’s like, is this really [anxiety and OCD] or is this pandemic … It actually took me a while to get kind of the care that I needed to because I was just like well, this is a pandemic, everybody is feeling this way…
Section D: Disruption to plans for protecting and promoting postpartum mental health	As an anxious person, I tend to release a lot of that anxiety by hanging out with friends, by going on walks or doing some sort of exercise. With my son, my first son, I went to… yoga classes. … [I couldn’t do that this time] and I felt that lack, like very, very, very acutely.
Section E: COVID-related trauma surrounding birth	[When I had to go back into the hospital due to infection after the baby was born] there was absolutely no visitors allowed um, and yeah, so no family, no husband, no baby, I was just literally alone. … It was four days and like when you say it, it sounds short, but to be alone and so sick it felt like such a long time you know… It was extremely emotional especially to be away from the baby… I wanted to hold the baby. I wanted to touch the baby… That experience like it really traumatized me.
Theme: Grieving changed circumstances of birth and early parenting due to COVID-19
Section F: Loss of social support, including support of extended family	This is my parent’s first grandchild… We wanted actually my parents to be here before the birth to help support um, to support us since there is a lot of postpartum traditions that Chinese families subscribe to… And they still haven’t met the baby, so I think that was an area of support that I felt lacking the most; not being able to share my happiness and share my joy and share, you know, the stresses of being a mother with my family who I have always been really, really close to.
Section G: Loss of opportunities to be together and create community with other parents of infants	With my first son, I went to a lot of prenatal yoga classes… and then I went to a breastfeeding support group… So I was like pretty much weekly surrounded by other people in a similar situation. And I felt that lack, like very, very, very acutely [when I gave birth to my second son during the pandemic]… That was like a really strong feeling that I had back in April was that loneliness in terms of like friendship and being around other, other birthing people, other people that were kind of going through the same experience.
Section H: Parent perception of losses for infant due to being born during a pandemic	[For me,] I can always text my friends and that kind of stuff and get some sense of solidarity and camaraderie in this process. But like, [for my daughter], … having her feel close to [other people], like actually being held by someone else, is totally absent.
Section I: Losses continue and accumulate	At the beginning [when baby was born in March], it was like I’m not thinking about [BABY]’s Christmas being ruined… He has a 93-year-old great grandpa, we were supposed to meet him at a family reunion, like we were supposed to introduce the baby to my husband’s entire amazing family in June. When it got cancelled it was like a punch to the gut, but I’m trying to just like take one punch at a time…
Theme: Burden of weighing COVID exposure risk and making decisions
Section J: No respite from risk assessment	The daycare decision is just so hard because it’s one that’s like never done, you can revisit it every day.
Section K: Navigating differences in assessment of risk with co-parent	He definitely has a much higher risk tolerance in terms of COVID than I do… [He’s been] kind of deferring to me, but letting me know, hey I think you’re being too stringent.
Section L: Disproportionate responsibility of mothers to make decisions about risk	It was really difficult to figure out if our family could come and visit… It was like this, you know, this kind of balancing act of it would really be helpful for them to be here, because they could help with childcare, but then also there’s a pandemic, do we want our 60-plus year old parents to fly? Do we want our newborn to be at risk for having people in the house? So I think that was really hard, and my husband just kind of deferred to me… He was like whatever you feel comfortable with, I’m happy to support.
Section M: Risk of COVID exposure as a factor in deciding when to access health care for the infant	We had a visiting nurse coming at the very beginning. I, we ultimately opted out of that program fairly quickly, because we just were too afraid of the risk that it posed as far as COVID goes.