Qualitative Study of the Experience of Caring for Women During Labor and Birth During the First Wave of the COVID-19 Pandemic

Abstract

Objective

To examine the experiences of labor and delivery (L&D) nurses and certified nurse-midwives who cared for women during labor and birth in the United States during the first wave of the COVID-19 pandemic.

Design

Subgroup analysis of a larger study with a qualitative descriptive design.

Setting

Telephone interviews.

Participants

The parent study included 100 nurses across various specialty areas who provided patient care during the first wave of COVID-19 in the United States. Our subgroup analysis included 19 participants: L&D nurses (n = 11) and certified nurse-midwives (n = 8).

Methods

Semistructured interview guide.

Results

Participants described their experiences providing patient care in L&D settings during the first wave of the COVID-19 pandemic. We identified five major themes: Separation of COVID-19–Positive Mothers and Newborns, Isolation of Women in Active Labor, Disparities in Access to Care, Barriers to Communication, and Effect on the Mental Health of Members of the Care Team.

Conclusion

Our findings captured the experiences of maternity care team members who worked during the COVID-19 pandemic when standards of quality maternity care were compromised. The challenges of caring for COVID-19–positive mothers, including isolation during active labor and infant removal from mothers at birth, affected their psychological well-being and their mental health and must now be addressed to prevent burnout and turnover.

Addressing the possible mental health needs of maternity care team members who cared for COVID-19–positive mothers is a priority.

The COVID-19 pandemic has affected global health, with more than 645 million confirmed cases and more than 6.6 million deaths (World Health Organization, 2022), and has raised significant concerns about care delivery (Alcendor, 2020; Razai et al., 2021). Nurses have experienced resignations, shortages of personal protective equipment, and overt safety concerns (Patel et al., 2021; Simonovich et al., 2022). Even before the COVID-19 pandemic, researchers described inadequate working conditions, including low pay and heavy workloads among nurses (Han et al., 2015). These working conditions worsened during the pandemic, and most nurses in the United States experienced a shortage of personal protective equipment, which made their jobs riskier and affected their ability to provide patient care (Llop-Gironés et al., 2021).

The role of maternity care teams is to safeguard and optimize the health outcomes of a vulnerable population. In a metasynthesis of eight qualitative research studies, Shorey and Chan (2020) examined the experiences and needs of pregnant women, midwives, and nurses who worked in maternity wards during epidemics and pandemics. They reported that participants were negatively affected by previous infectious disease outbreaks; participants described psychological responses, challenges, coping, and support (Shorey & Chan, 2020). Altman et al. (2021) investigated how COVID-19 affected the experiences of pregnant patients and registered nurses who worked in perinatal settings in Washington State. Participants described how adaptations to care were inadequate to meet their needs and left them with a desire for more support. Similarly, in a cross-sectional survey study of the experiences of labor and delivery (L&D) nurses during COVID-19, George et al. (2021) reported substantial effects on roles, responsibilities, and adaptations necessary during the pandemic.

Narrative documentation of the experiences of nurses and midwives who provided care during the emergence of the COVID-19 pandemic is needed.

Research studies published to date indicate that the pandemic detrimentally affected the care provided by nurses to women during pregnancy and the postpartum period. However, rich descriptions of the experiences of L&D nurses and certified nurse-midwives (CNMs) during the emergence of COVID-19, when outbreaks overwhelmed the nation’s medical systems and vaccines were not developed, remain limited. Therefore, the purpose of this qualitative study was to examine the experiences of L&D nurses and CNMs who cared for women during labor and birth in the United States during the first wave of the COVID-19 pandemic.

Methods

Design

The current study was a subgroup analysis of a larger study in which we used a qualitative descriptive design with individual interviews. The interview data used in our study originated from a study of 100 nurses across various specialty areas who provided patient care during the first wave of COVID-19 in the United States, including emergency, acute, community-based, and L&D care (Simonovich et al., 2021). We selected these specialty areas based on the expertise of the members of the research team. The research team developed a broad interview protocol to examine commonalities among all participants and to conduct subgroup analyses for each nursing specialty area represented.

We used thematic network analysis to construct a conceptual framework of the participants’ experiences (Attride-Stirling, 2001), and we used the Consolidated Criteria for Reporting Qualitative Studies checklist to thoroughly describe the study design and analysis (Tong et al., 2007). A thematic network is a web-like illustration that summarizes the main themes across texts and is a robust and highly sensitive tool to systemize and present the results of qualitative analyses (Attride-Stirling, 2001). Once a thematic network is developed by a research team, it serves as an illustrative tool and organizing principle for the formal interpretation of the texts (Attride-Stirling, 2001). We intentionally applied a theory-generating design in which we used no specific theory to create the interview guide, purposive sampling techniques to target specific subgroups of nurses, and standardization of interviews across all participants to enhance the validity of findings and to ensure that the results represented the true experiences of participants (Cypress, 2017).

Setting and Participants

After approval from DePaul University’s institutional review board, the study team recruited nurses and advanced practice registered nurses (APRNs) who worked in the United States. For the parent study, we used purposive recruitment measures via social media and the research team members’ personal and professional networks to encourage participation of nurses and APRNs from racial and ethnic minority groups (Webber-Ritchey, 2021). We conducted individual interviews from May to September 2020 to elicit each participant’s experiences related to the first wave of COVID-19. To be eligible for the study, prospective participants self-identified as registered nurses or APRNs who practiced in the United States, provided patient care from March 2020 forward, and agreed to be interviewed in English.

Procedure

In the parent study, prospective participants contacted the study team via e-mail. Each prospective participant completed an initial screening survey via e-mail to ascertain sociodemographic characteristics, nursing background, and appropriateness for the study (Webber-Ritchey, 2021). After screening, we sent each participant the study protocol information sheet for review and scheduled the telephone interview. At the initiation of each telephone interview, the information sheet was read verbatim, and oral consent was obtained before the recording of the semistructured interview began. We provided a digital $50 gift card to each study participant for renumeration. We used a 13-item interview protocol to ask probing questions related to the following specific topics: experiences of providing care during the beginning of the COVID-19 pandemic; preparation for caring for COVID-19 patients at the individual, leadership, and institutional levels; coping and support related to caring for COVID-19 patients; and COVID-19 implications for nursing practice, education, and policy (Simonovich et al., 2021). Specific items included, “Tell us about your experience beginning with when you first learned of COVID-19,” “How did your institution prepare you to work with COVID-19 patients?” and “How do you feel taking care of COVID-19 patients?” Members of the research team who self-identified as Black, White, Asian, and Hispanic conducted the interviews with participants of the same race as much as possible because racial and ethnic concordance between patients and their health care providers has been shown to foster trust and improve communication (Robert Wood Johnson Foundation, 2022). Interviews ranged from 20 to 45 minutes depending on the participants’ responses. We did not take field notes during the interviews, and we met weekly during data collection to discuss study progress. Each interview was audio-recorded on two identical devices and uploaded to a secure cloud-based account for storage. Each audio-recorded interview was submitted to online software for computer-based transcription. After transcription into text, trained graduate research assistants verified each transcript.

Analysis

For the purposes of this subgroup analysis, only the interviews with participants employed in L&D settings were used. The research team met formally from January 2021 to June 2022. We individually reviewed the 19 interview transcripts, created preliminary thematic networks for discussion, and then presented and discussed each thematic network. We developed final collaborative thematic networks for five themes based on consensus. Under the supervision of the first author (S.D.S.), the second author (N.M.B.) completed the formal coding of the interview data into the identified themes using a web application for mixed-methods research. The themes were derived directly from the data, and we noted no minor or diverse themes. We did not contact participants to confirm findings. In this article, we present illustrative quotes without participant identifiers because the goal in obtaining a diverse sample was to reflect the shared voice of the study participants rather than to highlight differences by race, ethnicity, or specific role on the care team. The first author (S.D.S.) and second author (N.M.B.) used IBM SPSS 27 for quantitative analysis of the demographic characteristics of the participants.

Results

Participant Characteristics

The characteristics of our participants (n = 19) are presented in Table 1 . Eleven L&D nurses and eight CNMs completed the study protocol. Their average age was 36 years (range = 27–57 years). All participants identified as female. Nine participants identified as White (47.4%), five identified as Black (26.3%), two identified as Asian (10.5 %), two identified as multiracial (10.5%), and one identified as American Indian (5.3 %). In addition, three participants identified as Hispanic (15.8%). In sum, approximately 68% of participants identified as members of a minority racial or ethnic group. Most participants had master’s degrees (52.6%) and an average of more than 8 years of nursing experience. Eight participants were employed in academic medical centers (42.1%), six participants worked at independent community hospitals (31.6%), and five were employed at multicenter hospital systems (26.3%).

Table 1.

Participant Characteristics (N = 19)

Variables	Value
Age, years
Mean	36.05
Range	30 years
Min, max	27, 57
Sex, n (%)
Female	19 (100)
Race, n (%)
White	9 (47.4)
Black	5 (26.3)
Asian	2 (10.5)
Multiracial	2 (10.5)
American Indian	1 (5.3)
Ethnicity, n (%)
Hispanic	3 (15.8)
Non-Hispanic	16 (84.2)
Education, n (%)
Bachelor’s degree	7 (36.8)
Master’s degree	10 (52.6)
DNP	1 (5.3)
PhD	1 (5.3)
Employment, n (%)
Academic medical center	8 (42.1)
Multicenter hospital system	5 (26.3)
Independent community hospital	6 (31.6)
Years of nursing experience
Mean	8.84
Range	29
Min, max	1, 30

Note. DNP = doctor of nursing practice; PhD = doctor of philosophy.

Thematic network analysis of interviews with participants revealed five overarching themes: Separation of COVID-19–Positive Mothers and Newborns, Isolation of Women in Active Labor, Disparities in Access to Care, Barriers to Communication, and Effect on the Mental Health of Members of the Care Team. See Figure 1 for a visual depiction of the study themes. Selected illustrative quotes for each theme are presented in Table 2 .

Figure 1.

Depiction of thematic network analysis findings.

Table 2.

Key Themes and Illustrative Quotes

Separation of COVID-19 Positive Mothers and Newborns

"Nursing as a whole, we’re here for our community, for our profession. And as a nurse midwife, we stand with women and their families, and their babies…A lot of things can improve with...not having to separate mom and baby at birth."

"Patients are... willing to separate without really like questioning. Which, you know, I understand like, this is scary...There is so much unknown, especially... between mom and baby transmission and what kind of long-term effects it could have on a baby and all that. So that I think that's probably been the hardest."

"So once the induction occurred and we notified [the patient that] the recommendations at that time [were] to separate mom and baby. There was a huge deterioration in communication. She became withdrawn. She became very argumentative and wanted to be tested again. The second test came up positive."

Isolation of Women in Active Labor

"It was unsettling, to be honest...I felt like it would be nice to just take a step back and look at the bigger picture and sort of slow down and make decisions that seemed appropriate, not just decisions that were rapid. And it seemed like that’s what was happening. We were just making these off-the-cuff decisions based on whatever whim somebody had that day and things were constantly changing. One of the things that was most frustrating for me was the changes to our visitor policy."

"You get one visitor for OB and... her visitor was her mom and her mom refused to go back in the room with her because she was afraid of getting COVID. And so, this woman was having a baby, her first baby, and she's sick and she’s in labor. And then she had surgery and then she went to the ICU all by herself."

"[I am] trying to consolidate my care. I'm not going to be coming in and out [all] of time because a lot of them are... symptomatic...And they're in labor."

"I [feel] like I'm not able to do my job like I should, especially if there was someone...alone."

Disparities in Access to Care

"I was more attuned...to our low threshold for taking care of people that sounded like they might have had something more going on. And in our practice, because of COVID, we have become much more [frequently] screening people...for domestic violence."

"There is a disparity. I noticed that when it comes to younger generations, the health care community shunned their behavior...For example, we had a mom who was 19, went to a birthday party...where there was a known COVID positive patient... So, the staff said, 'Well, she deserved it.' You know, if you're pregnant, why would you do that?' So, then you have another spectrum where you have the mom... of two or three that goes to the park and goes to get ice cream afterwards and ends up COVID positive from that. There's more empathy towards a mom who was unfortunate to catch it in the community as opposed to one who went to a family birthday party."

"Even though it's scary to work with [COVID positive patients] who may be able to transmit something to you that obviously you don't want anywhere near you, I still think it's really important to treat everybody the same."

"I still want people to feel human, right? So, I don't want to treat people like they're dirty, especially at... a birth, which is so... critical to who you are as a person... mostly trying to make sure that people still feel like they're not dirty."

Barriers to Communication

"There's all these precautions that sometimes...make it harder...You're not looking at somebody's face. It's harder to see the expressions all the time. So, you have to be even more tuned into patients, to listening to what they're saying... and interpreting that...The social needs are more. So, you have to make sure that you're allowing time for those."

"I think [COVID-19] reinforces the importance of hands-on care and the importance of touch, and it's hard, you know? I mean, there's...a barrier between nurses and their patients now."

"So, we're supposed to wear a mask and our face shield in any room, even if we've tested the patient and they are negative. And then for delivery, specifically for third stage of delivery, for pushing and delivery, we put up a plastic shield in front of the patient with the hope that that is preventing some of their breath and coughing etcetera from getting in our faces."

Effect on the Mental Health of Members of the Care Team

"I had a lot of anxiety just driving into work. And it seemed like it increased as I... walked into the hospital."

"When my hand just hit the doorknob, like to push the door open, to go into the room, my heart basically jumped out of my chest... I just started praying to myself, 'God, please protect me. Please... don't let me go in here and catch something that I'm going to give to my friends or family...Keep me safe. Help me not to be scared of her and not to treat her differently than other people, but please protect me, because I'm afraid,' and then I walked into the room."

"I felt more nervous in the beginning about... my family's health than I do now. And I wonder if part of that the exhaustion just, pandemic exhaustion is, or worry exhaustion."

"Every time I encounter a patient and they turn up COVID positive, I immediately panic. Like, did I wear it with my first encounter? Did I not? It's like a mind game."

"I actually… considered reaching out to one of my primary docs because I thought I needed Xanax or something because I had just chest pain and anxiety. Full blown anxiety which I [had] never experienced."

Separation of COVID-19–Positive Mothers and Newborns

Participants described the physical removal of newborns from their mothers at birth under the theme Separation of COVID-19–Positive Mothers and Newborns. During the first wave of the COVID-19 pandemic, pregnant women were tested for COVID-19 before or upon admission to the L&D unit. Health care systems across the country created policies to remove newborns from COVID-19–positive mothers immediately after birth to protect newborns from contracting the virus. Many participants felt conflicted by this practice, distressed, and worried about the harm it may cause in relation to the emotional well-being of the mother, the bonding of the dyad, and breastfeeding. They described the physical and emotional challenges of removing newborns, especially from mothers who previously experienced perinatal loss:

It’s really frustrating, especially if . . . you have somebody that [had] a prenatal death before, and it’s like you have to separate mom . . . because she’s COVID positive . . . mom wears her mask and [is] an asymptomatic carrier. But still, you have to be separated . . . The mom, in the end, is the one who loses . . . because she’s not able to hold her baby or breastfeed her baby.

Participants described significant emotional challenges with separating newborns from their mothers immediately after birth and inconsistencies in the implementation of related policies. With policies changing rapidly, traumatic mistakes occurred. One participant recalled that she informed a COVID-19–positive mother that her newborn would be removed directly after birth. However, an error was made by the physician who attended the vaginal birth and briefly forgot the separation policy:

[Upon] delivery, the OB [obstetrician] . . . lifted the child to place it on mom’s stomach. And when [COVID-19–positive] mom reached out to touch her baby, he [remembered and] told her, “I’m sorry, they’re telling me I can’t give you your baby.” And that’s when he cut the cord and gave the baby to us. That mom shrieked so loudly that it was a shriek of pain, a pain of loss. So at that moment, I was able to realize we’re no longer deal[ing] with the happy . . . . Whatever vision that mom had in her head of a perfect delivery [had] gone to the wayside. . . . So for me, it was vitally important to make sure we [could] get mom and baby connected as much as [possible]. . . . We decided to give her a teddy bear that had the same weight as the baby. So every time I fed the baby, the mom was instructed to grab her teddy bear and hug the teddy bear tight. And as I would rock the baby to sleep, she could rock the teddy bear to sleep too.

The participants noted that these negative birth experiences of separation may have had long-lasting effects for mothers and their newborns because of the interrupted bonding for the mother–newborn dyads during the critical first hours of life.

Isolation of Women in Active Labor

The theme Isolation of Women in Active Labor represented the physical distancing of the care team from the woman during labor. During the first wave of the pandemic, participants reported that women in labor were isolated upon admission to L&D while awaiting the results of their COVID-19 testing. Isolation continued for the duration of labor for COVID-19–positive patients and, in some cases, for COVID-19–negative patients as well. Participants described inconsistencies in the way hospitals approached the isolation of patients in labor. Generally, care team members were advised to reduce the time spent at the bedside to protect themselves from contracting COVID-19, and participants described physically distancing themselves from women in active labor. Some participants chose to not distance themselves despite hospital policy, and one described how she prioritized the need to support women who were in labor alone: “I know I need to . . . be in there. . . . These women are by themselves [and they] didn’t plan to be [alone during their births].” Another participant described her decision not to isolate COVID-19–positive patients in labor:

I’m not keeping my distance with patients. . . . Women need a lot of emotional support in labor or through miscarriages. I mean, we see that so much. And to stand at the doorway and talk to someone is so impersonal and . . . to see laboring COVID patients with no family member. . . . Labor is so emotionally taxing. They need someone there. And so I do find myself saying, I think their emotional needs are higher than my risk of getting infected.

Although it is contrary to customary practice in L&D to isolate women in labor, these interviews describe that the practice took place across the United States during the first wave of the COVID-19 pandemic.

Participants reported that L&D care was disrupted during COVID-19 and included separation of mothers and newborns, disparities in quality of care, and increased barriers to communication.

Disparities in Access to Care

Participants said they witnessed factors that inhibited equitable access to quality care among pregnant patients from underserved populations as represented by the third theme, Disparities in Access to Care. Participants described the disparities that affected some pregnant people during COVID-19, such as lack of social support and inadequate access to medical supplies, and how these matters contributed to inequitable birth experiences:

[COVID-19] has all shed so much light on how dysfunctional our system is. . . . Our population is very, very much underserved. And so those disparities that exist that combined with the antiracism movement as well, I think, like, the fact that those two things are coincided is super important and hopefully move the needle a little bit or a lot. . . . [As a] nurse-midwife . . . I think being even more of a patient advocate and thinking through how the whole person is sitting in front of you, and that it’s not just her pregnant belly but also like, did she just lose her job? What stress is going on in her life? Being an advocate in terms of . . . supporting . .. if a patient is positive, working with the peds [pediatrics] team in terms of isolation with the baby. . . . Patients need more advocacy and more support.

Another participant shared the following:

One disparity point is that we’ve been trying to keep pregnant people out of the office as much as possible. And to do that, [patients] need to be able to take their blood pressure at home. And so people who can afford a blood pressure cuff don’t have to come in as much. People who can’t afford a blood pressure cuff have to come in for all their appointments. So their exposure to the virus is much worse compared to people who could pay 30 dollars for a blood pressure cuff. So should institutions be giving away free blood pressure cuffs? Yes.

Participants also described discrimination against young pregnant people, lack of resources for care and home-monitoring devices for low-income patients, and the need for more respectful interactions with pregnant patients from all backgrounds. Participants universally described how the COVID-19 pandemic worsened disparities in the care of pregnant patients.

Barriers to Communication

The theme Barriers to Communication represented circumstances that interrupted communication between L&D patients and the maternity care team. Participants described how implementation of COVID-19 hospital policies restricted communication and connection with women in labor:

[I was] very uncomfortable as a nurse. In L&D, we’re in our patients’ rooms every 15 to 30 minutes. We’re very close to our patients. We cannot keep 6-foot distance, especially if the woman is pushing, you know, we’re [in] the middle of a delivery.

Participants reported barriers to communication as a concern that affected the quality of care and “injected uncertainty into the patient–provider relationship.” One participant described how wearing a mask impaired communication:

I am a very facial expression kind of person. And so the fact that people can’t see my face, I think is a little bit of a communication barrier. . . . I had a patient a couple of weeks ago who [was] from Ukraine, and her English is good, but it wasn’t great, and she could not understand people when they have masks on because she couldn’t see their mouths.

The interviews revealed that COVID-19 policies around mandatory masking of patients and care team members and social distancing created barriers to communication and changed the level of connection between patients and the L&D care team.

Effect on the Mental Health of Members of the Care Team

Participants described how providing care during labor and birth during the first wave of the COVID-19 pandemic affected them mentally, which was represented by the theme Effect on the Mental Health of Members of the Care Team. Participants described how placing themselves at risk of contracting an infectious disease that remained largely unknown was a significant stressor and source of anxiety. They reported concern for their own personal safety, the safety of their families, and the safety of L&D patients: “I feel like the mental, the psychological part is just the number one for us in the health care field. . . . It’s . . . the fear of the unknown . . . it just throws everyone over the edge.”

At the time of the interviews, knowledge regarding the sequelae of the COVID-19 disease process remained largely unknown and was a source of fear for participants who were concerned they would be infected while at work: “I actually . . . considered reaching out to one of my primary docs [doctors] because I thought I needed Xanax or something because I had chest pain and anxiety. Full-blown anxiety, which I [had] never experienced.” They worried about contracting COVID-19 and becoming ill:

Because of the unknown and the rabbit hole that I’ll go down . . . I don’t [want to] freak myself out going down the rabbit hole. . . . Like, is it even worth it because what we know changes every day? So I feel like to protect my own feelings and emotions, I just have to keep going.

During the first wave of the COVID-19 pandemic, the high degree of uncertainty around the virus and its transmission led to heightened fear in L&D nurses and CNMs who provided direct patient care. All of the participants were fearful of work exposure and the potential transmission of the virus to their own families.

Discussion

The findings from our study show the challenging experiences of participants during the first wave of COVID-19. Overall, participants perceived that the COVID-19 pandemic negatively affected the quality of care provided in L&D settings. These findings are consistent with the work of George et al. (2021), who described changes in roles and responsibilities and the adaptation required of L&D nurses during the COVID-19 pandemic. Research shows that disrupted care to patients results in poor outcomes and that less time at the bedside and delays in care are associated with negative labor and birth outcomes (Simpson & Lyndon, 2017). Overall, the participants expressed frustration with the changes in policies and practices that took place during the pandemic. Most participants felt that the changes brought about by COVID-19 were difficult and troubling, and they worried about their patients who experienced labor alone without the presence of family members and were separated from their newborns.

Although the interviews were not diagnostic in nature, all of our participants described common symptoms of anxiety. Fernández-Castillo et al. (2021) described similar findings when they interviewed nurses in intensive care units in Spain during COVID-19. The nurses in their study sample described a high degree of anxiety symptoms that affected their daily living activities and their sleeping patterns (Fernández-Castillo et al., 2021). Jun and Rosemberg (2022) explored the shared professional experiences of nurses who worked in hospitals during the first surge of COVID-19 in the United States. Similar to our findings regarding mental health concerns, they reported that fear was the primary response described by their participants regardless of work experience (Jun & Rosemberg, 2022). These findings across multiple subgroups of nurses indicate that mental health screening should be available for all nurses who provided patient care during the pandemic. Diagnostic screening tools, such as the General Anxiety Disorder seven-item survey for anxiety (Anxiety & Depression Association of America, n.d.) and the Patient Health Questionnaire nine-item survey for depression (American Psychological Association, n.d.) are available for free online and may serve as important tools for nurses to self-monitor symptoms and identify the need for further mental health support. It is necessary to put resources in place to ameliorate physical and emotional burnout, particularly among nurses, who are among the most essential group of workers.

Limitations

The study design was cross-sectional in nature, and interviewing each participant at one single point in time limited our ability to capture how their experiences may have changed over time. The themes presented were not discussed or confirmed with participants, which may limit the trustworthiness of the reported findings because no feedback was elicited. However, the themes were credible to the maternity care team members on the research team and contribute valuable narrative experiences to our understanding of maternity care during the emergence of the COVID-19 pandemic in the United States.

Implications for Research and Practice

Researchers can translate our themes into survey items that can be used to describe how challenging experiences (e.g., the separation of mothers and newborns after birth, the isolation of women in active labor, disparities in access to care) affect the mental health of the maternity care team. Results could indicate the need for more emotional and mental health support services for the maternity care workforce across the United States. The experiences of mothers who gave birth during the pandemic, were isolated during active labor, and were separated from their newborns at birth warrant further exploration. Finally, the disparities in access to care described by participants convey the importance of increasing financial and programmatic support for underserved pregnant women during pandemics to ensure equitable pregnancy and postpartum care.

Maternity care team members who provided care during COVID-19 should be screened for anxiety and depression, and mental health resources should be readily available.

Our results suggest a need for reflection on how the COVID-19 pandemic has affected the well-being of the L&D and CNM workforce. The collective trauma endured by maternity care teams and their patients has yet to be properly addressed. Healing is needed for the maternity care team members and the patients who suffered traumatic experiences during COVID-19. A fundamental concern for maternity care is that seasoned nurses who experience the strains of the COVID-19 pandemic will leave the profession, which will further exacerbate the nationwide nursing shortage and contribute to the estimated half-million nursing jobs that will go unfilled by 2030 (Zhang et al., 2018). The lessons learned from the experiences of nurses and CNMs during COVID-19 and past infectious disease outbreaks, such as Ebola, H1N1, and severe acute respiratory syndrome (SARS), suggest that creating policies to enhance emotional well-being and address resilience in nurses can help decrease burnout rates, enable coping skills, and increase retention in the profession (Shorey & Chan, 2020). Health care systems should prioritize sweeping policy changes that holistically support building healthy work environments that promote the mental health and safety of the nursing workforce, including paid leave for mental health concerns and counseling services free of charge.

Conclusion

Our findings strongly support the need for improved access to emotional and mental health support for L&D nurses and CNMs who provided patient care during the first wave of the COVID-19 pandemic. Addressing the possible mental health needs of maternity care team members who experienced the challenge of caring for COVID-19–positive mothers, including the isolation of women in active labor and removal of newborns from their mothers at birth, is a priority.

Biographies

Shannon D. Simonovich, PhD, RN, is an associate professor, School of Nursing, College of Science and Health, DePaul University, Chicago, IL.

Nichelle M. Bush, DNP, APRN-FPA, FNP-C, ENP-C CEN, is a family and emergency nurse practitioner and part-time faculty member, School of Nursing, College of Science and Health, DePaul University, Chicago, IL.

Lucy Mueller Wiesemann, DNP, CNM, APN, is a clinical assistant professor and simulation lab educator, School of Nursing, College of Science and Health, DePaul University, Chicago, IL.

María Pineros-Leano, PhD, MSW, MPH, is an assistant professor, School of Social Work, Boston College, Chestnut Hill, MA.