Postpartum in a Pandemic: Using Photo-elicitation to Explore Experiences of New Mothers During COVID-19

Objective: To shed light on the post-partum experiences of women who gave birth during COVID-19 in order to identify short- and long-term opportunities for providers to address maternal-child health during this pandemic, its aftermath, and future disruptions to the postpartum experience. Methods: This qualitative photo-elicitation study asked women between 3-10 weeks postpartum to take photographs that encompassed their experience as a new mother during the pandemic, and two trained interviewers elicited elements of this experience using the photos as an anchor during virtual, hour-long interviews. Interview transcripts were analyzed using directed content analysis, including a process of open coding to identify key ideas, codebook development, and refinement. Fifty percent of transcripts were team coded to ensure coding accuracy. Following coding, the study team organized codes to inform the development of an explanatory model. Results: Interviews illuminated important stressors new mothers experienced that were worsened during the pandemic, namely fear, childcare, older children, loss, isolation, and employment. Interviews also highlighted key support structures (self-care, interpersonal, and structural supports) that were at times helpful in alleviating stressors and at others were inadequate to counter stress and even enhanced stress. The stressors caused by the pandemic exposed fault lines in support systems postpartum women need and highlight key action items that providers can utilize for supporting postpartum patients during disasters like this pandemic and in the years of its aftermath. Conclusion: For postpartum individuals overall, the pandemic posed a major strain to an already stressful time. These findings highlight key takeaways in considering care for this population both now and in the future, and suggest action items to improve quality of care in the postpartum period more broadly