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 She became withdrawn.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."