Table 3 Overarching themes, sub-themes and coding tree

Dealing with public health restrictions

1.1. Limited support networks from health care system and providers

- Lack of support

- Missing out on experiences

“When we went into lockdown I couldn't get hold of the midwife, all my appointments and training was cancelled, the hospital didn't have any information, and everybody was panicking. It took about 4 weeks for information to get to me. I didn't see my midwife from week 24 and had different ones every time because of COVID.” (Harrison 2021) [60]

1.2. Balancing exposure risk and need for healthy behaviours

- Wanting to reduce risk

- Acknowledging restrictions and its influence on health decision-making

- Needing to plan ahead

- Delay in healthcare seeking

“I was very anxious leading up to the birth. Just because everything was changing, you didn’t know what was happening, the hospital policies kept changing. At one point the hospital I was delivering at said your partner could only stay for two hours after the delivery. That made me really upset and I didn’t know if I could end up having a c-section or what would happen.” (Rice 2022) [74]

“I had a slight bleeding at first, I didn't know what to do, should I go or not? If I go, there is a risk of getting a virus … I postponed going to the doctor as much as possible.” (Aydin &Aktas 2021) [50]

1.3. Missing out on social opportunities

- Missing out on traditions that usually occur during pregnancy, e.g. baby showers

- Missing interactions with family and friends

“I think I just feel like we’re not celebrating as much being pregnant. I know that sounds kind of funny, but it almost feels like I’m not pregnant because, I don’t know, not many people are seeing me.” (Charvat 2021) [52]

1.4. Breastfeeding challenges and triumphs

- Undisrupted time to establish breastfeeding

- Difficulties in establishing breastfeeding with limited healthcare provider support

- Stopping breastfeeding early

“I was able to breastfeed without feeling really exposed and thinking about it now I think if there had been people around, strangers marching in and out of the ward I would have had the curtains pulled all the time.” (Panda 2021) [71]

“We are unable to have face‐to‐face support to help me to feed my baby who is struggling to gain weight due to possible tongue tie which is unable to be treated. Because of the pressure to have him gain weight or be admitted to hospital and having little support with improving his latch and expressing milk I have had to top up with formula which is something I have not wanted to do and did not need to do with my first child.” (Brown & Shenker 2021) [51]

Navigating changing health policies

2.1. A birthing experience filled with uncertainty and unknowns

- Limited knowledge during the pandemic

- Loss of autonomy

- Uncertainties about early discharge

- Attempting, but often failing to plan ahead

“It was really abrupt… they said ‘your choices are now limited. You are choosing between not the scenarios you wanted, but this is where we are, and you need to get it together’” (Silverio 2021) [77]

2.2. Reduced support and partner presence in healthcare settings

- Partners not present during antenatal appointments

- Partners not being about to support mothers post-birth

“How did it come to that it was allowed for fathers to be with the mothers but not their infants? It is tough to have a premature infant, and being the only parent with access, or being the one who is not allowed to have a father who feels that he is not a father [crying]. It was really tough! All the questions and things he was wondering. Such practical things with the infant’s development, but also how to know the infant; feeling safe and not feeling scared every time he visited the infant… We were never allowed to be there together…” (Kyno 2021) [67]

2.3. Transitioning to telehealth, virtual and remote care

- Being able to access telehealth

- Receiving remote care post-birth

- Questioning the quality of care

“There have been many improvements with digital meetings, which meant that you didn’t have to take time off work. So, I think it has been a much more positive experience, easy accessibility” (Linden 2022) [68]

“I never had a six week postpartum appointment … I have not had a doctor look at me since I left the hospital … you’re on a virtual call and you can’t really explain things, you’re taking pictures that aren’t clear, it’s really, it’s not helpful.” (Kolker 2021) [66]

Barriers to accessing health services

- Limited access to non-essential healthcare providers, e.g. physiotherapists, chiropractors, gym and pools

- Delayed or reduced healthcare provision

- Limited information about where to get support

“My two-week follow-up with the OB was over the phone. They would not see me in-person, which I was really upset about because I would rather have a doctor see if everything is healing properly.” (Rice 2022) [74]

“Everyone is stressed, and all the services are stretched, you just don’t want to feel like you want to not waste their time, but normally you would be able to go to someone or go to a service like your midwife and ask them and they would have time to speak with you […] but because they are so stretched now you just don’t feel like you want to…” (Anderson 2021) [16]

Adapting to alternative ways of receiving social support

3.1. Accessing support through different avenues

- Using social media to connect with others

- Having remote emotional support from family and friends

- Valuing increased partner presence

“Thanks to lockdown my partner is here 24-7… even though he is working… we actually had the beauty of sharing both of our love with the baby, so if I am tired I can take a nap and he can take care of the baby for half-an-hour” (Riley 2021) [75]

3.2. Desiring connection with family and friends

- Needing practical support

- Inability to interact with family and friends physically

“It was really rough for the first few weeks – my parents live a few hours away so they didn’t meet him until he was 6 weeks old, and the plan had originally been that mum would come up and support us, obviously that didn’t happen” (Sweet 2021) [81]

Impacts on own mental health

4.1. Managing anxiety due to virus-related fears and concerns

- Emotionally dealing with the unknown impact on mother and baby

- Negative impact on mental health

- Being anxious about accessing hospitals

“I want to do what’s best for me. But, at the same time, my anxiety about being in a doctor's office or being in a space where I know there are potentially sick people nearby… I didn’t want to be there” (Farrell 2021) [57]

4.2. Feeling lonely and isolated

- Increased levels of depression

- Being alone and away from friends and family

- Feeling abandoned by the public health system

“You haven’t got any friends or family that can necessarily come into your home and support you in case, they, you know, also contract or are carrying it. So, erm. Yeah. It is isolation” (Jackson 2022) [61]

Managing the new and changing information

5.1. Constantly changing advice and information

- Adapting to the constantly changing rules and public health restrictions

- Drowning under the overload of information

“The rules kept changing kind of minute by minute as they got more information, and it was really unsettling” (Sweet 2022) [82]

“I’m an information seeker for sure but I found, with COVID, it was just almost too much information” (Kolker 2021) [66]

5.2. Inadequate information from healthcare providers

- Lack of information caused anxiety and worry

- Felt poorly communicated with and to

- Dealing with contradictory information

“When we went into lockdown I couldn't get hold of the midwife, all my appointments and training was cancelled, the hospital didn't have any information, and everybody was panicking. It took about 4 weeks for information to get to me” (Harrison 2021) [60]

“Contradicting statements saying yes it can get to your baby through the womb and no it can’t, and so there was not much information that was 100% certain” (Sweet 2021) [81]

Being resilient and optimistic

6.1. Self-help strategies to overcome challenges of the pandemic

- Being more conscious and taking control of their mental health

- Being an advocate for yourself and your baby

- Weighing up the risks of breaking public health restrictions

- Strengthening coping strategies

“You have to be your own best advocate because nobody is really advocating for you which sounds really depressing – and just sort of be mindful of the fact that the system is overstretched so … don’t be afraid to be annoying” (Kolker 2021) [66]

“I think that’s what a lot of mums are doing behind closed doors, sort of weighing up… you’ve gotta weigh up risks, a lot of people at this point now. Some people have moved in with their mums...” (Jackson 2022) [61]

6.2. Making the most out of the positive encounters

- Spending more time to bond as a family unit

- Valuing fewer disruptions to new motherhood

- Enjoying the peaceful health services

“It’s been great… we have this opportunity to bond as a family and he [partner] is here for every moment during the newborn stage! It has been amazing not having to worry about visitors coming and going and cleaning out home and me worrying about breastfeeding in front of others - instead we have a very relaxed atmosphere for everything!” (Joy 2020) [64]

6.3. Information seeking and desire for more information

- Utilising online and public resources

- Wanting more information

“You do feel a little bit stressed in there, and I think probably one thing that maybe could be improved is just that extra information of what you are doing with the COVID stuff in terms of precautions, what it’s going to look like when I come in to have bubs, just what to expect” (Atmuri 2022) [49]

“It was pages of reading, there’s no videos, no nothing, and then you have all these questions, and you try to call to find out some answers and no one can give you any answers and there was no one to talk to” (Davis 2021) [54]