Birth attendants’ lived experiences of caring for pregnant women suspected to or diagnosed with Covid 19 in labor and delivery ward based on a phenomenological approach

Birth attendants’ lived experiences of caring for pregnant women suspected to or diagnosed with Covid 19 in labor and delivery ward based on a phenomenological approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Birth attendants’ lived experiences of caring for pregnant women suspected to or diagnosed with Covid 19 in labor and delivery ward based on a phenomenological approach Somayeh Alirezaei, Robab Latifnejad Roudsari, Farangis Sharifi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3344539/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Covid 19 pandemic has imposed the increased workload and challenges to birth attendants while providing the required care for delivery in mothers. However, so far, no study has been performed based on the experiences and views of this group. The present study was performed with the aim of filling the existing research gap in this field by exploring the real time experiences of birth attendants in caring for suspected/infected pregnant mothers during the pandemic. Methods The present research is a qualitative phenomenological study that was conducted on birth attendants (midwives and doctors) of pregnant women suspected/infected with covid-19 in the delivery department of teaching hospitals located in Mashhad, Iran, from March to May 2020. The qualitative data was collected about the real time experiences of the participants and was analyzed by six methodological steps proposed by Van Menen (1990). Results Interviews were performed with 12 birth attendants working in teaching hospitals. Four final themes were obtained about the real time experience of this group for caring pregnant women suspected/infected with Covid-19 in the delivery department. These themes included: "lost peace", "spirituality", "pride" and "looking forward to a better future". Conclusion The final results indicated that despite the fact that midwives/gynecologists played a valuable role as obstetricians in the frontline of the fight against the Covid-19 disease, they faced many challenges in various occupational, personal, and emotional dimensions. By the way, structural organizational policies are recommended to provide midwives/gynecologists an equal and safe position to fully perform their profession and a have healthy relationship within the family. Phenomenology Covid-19 Birth attendants Midwifery Introduction The new coronavirus (COVID-19) is a potentially fatal disease (1) and is considered by the World Health Organization (WHO) as an international emergency (2). Since the recognition of this disease in December 2019 in the city of Wuhan, China, until March 29, 2020, 664,621 people have been infected with this virus all around the world, of which 30,891 people were died and 142,368 people have been recovered (3). Among the 199 countries that are involved with this disease, Iran ranks seventh in the world (4). This sudden emergence has created difficult and challenging conditions for health care workers. Disease outbreak, unknown factors, and precautionary measures taken to protect public health could cause destructive effects (5). According to the studies, in the early stages of Covid-19 pandemic, the most important concern of health service providers was the fear of getting infected by colleagues (72.5%) and family members (63.9%), lack of protective equipment (52.3%) and increased workload (48.5%). Healthcare workers, especially women, face many professional and personal challenges when performing their role as first responders (6). Birth attendants are a large group of women who provide services that have a clear impact on the quality of health care in society, especially pregnant women (7). It has been scientifically proven that pregnant women are among the most susceptible groups at risk of viral respiratory infections (8). The risk of faster and more severe infection of pregnant women, along with the complications that occur during pregnancy and delivery, has caused maternity staff to face more challenges in the management of labor in this group (9). During medical and midwifery interventions such as collecting blood and sputum samples, labor care, and delivery, birth attendants are exposed to the risk of virus transmission (10). In addition to biomedical risks, the prevalence of infectious diseases is often accompanied by psychological pressure, stress and fear, especially if it is out of control and has adverse and irreversible consequences (11). The presence of midwives in the front line shows their constant compassion and commitment. In fact, they put their lives in danger while doing work duties. In previous similar cases such as SARS (Severe Acute Respiratory Syndrome) that occurred in 2002-2003, a number of them died during their worktimes (7). Since the emergence of epidemics similar to Covid-19 such as SARS and MERS (Middle East Respiratory Syndrome), research has been conducted primarily on psychological issues such as the level of anxiety and the psychological impact of such crises on health factors (12, 13). Studies have shown long-term psychological effects including post-accident stress until several months after the injury (14). The procedure of care for pregnant women in labor needs a complete explanation, and the real time experiences of midwifery staff are the best source of data in this field. The primary method of data collection is the opinions of birth attendants, and the phenomenological research method provides the richest and most descriptive data to the researcher (15). In this way, employees can freely express their experiences, feelings, and mental analyzes of care in labor and delivery (16). A deep understanding of feelings, perceptions, beliefs, motivations, views, needs and barriers to the participation of birth attendants plays a significant role in empowering them to take care of themselves and the pregnant women under their care and can increase their awareness, knowledge and improve their relationship with suspecting pregnant women, which ultimately lead to the improvement of the health of both groups (17). So far, no study has investigated the complexities and challenges of midwifery clinical practice in such sudden and unexpected crises. In order to fill this gap, the present study was performed by investigating the birth attendant s’ point of views with an in-depth study that can show how personnel experienced the phenomenon of caring for mothers with Covid-19 disease and how this experience can be used to help and create safety and protection programs and systems. Also, this study can demonstrate the hidden issues from the point of view of caregivers of pregnant women suspected of Covid-19 disease and help to better understand the physical, emotional, psychological, family and social needs of this group of caregivers. This study was performed with the purpose of identifying and deeply understanding the meaning of care for pregnant women suspected/infected with Covid-19 during labor based on the real time experiences of the birth attendants. Materials and Methods Aims and setting : The present research is a qualitative phenomenological study about the birth attendants (midwives and doctors) with pregnant women suspected or infected with Covid-19 in the labor department of teaching hospitals located in Mashhad, Iran, from March to May 2020. Participants : The statistical population of the present study included all midwives, gynecologists and women's assistants in the labor and delivery department of teaching hospitals located in Mashhad, Iran. The study sample consisted of 9 midwives, 2 assistants and 1 gynecologist. The participants were selected by available sampling method and based on input criteria such as birth attendant working in the birth department and willingness to participate in the study. The average age of the participants was 35 and their working experience was 10 years. The education level of all midwives was bachelor's degree, the employment status of 6 of them was official, 1 was contracted and 2 were apprentices. Data collection : Due to the complexity of real time experiences, the required data were collected through in-depth semi-structured interviews, as an efficient method in the phenomenological approach (18). Interviews were performed with open and general questions and directed towards more specific questions to gain a deeper understanding and insight into the experiences of pregnant women suspected of being infected with Covid-19. All the interviews were conducted in Persian, as the native language of the participants. Data analysis : For analyzing the qualitative data and reaching a high level of abstraction, usually hermeneutic approaches such as Van Manen's proposed approach are used (19). In this regard, the qualitative data collected about the real time experiences of the participants in this study were analyzed through the six methodological steps proposed by Van Manen (1990) (20). These six methodological stages include 1 . Orientation to the nature of lived experience. 2. Exploring the experience as we live it and not how we conceptualize it. 3. Reflecting about the main themes that reveal the characteristics of the phenomenon. 4. Art of writing and rewriting 5. Maintaining a strong and direction relation with the phenomenon; 6. Matching the field of research with the continuous consideration of components and the whole ". Trustworthiness of Findings: For ensuring validity and reliability in the present study, the four gold standards of Lincoln and Guba were used, i.e. validity, reliability, confirmability and transferability (21). By the way, the validity of the results was ensured through long-term data processing, attendance at delivery departments, effective communication with participants, and using techniques suggested by Devadas (2016) in member and peer review (22). In addition, the experiences in the midwifery profession was another factor to ensure validity. Results The present descriptive-interpretive phenomenological study was conducted on 12 birth attendants. Table 1 shows the demographic characteristics of the participants. The real-time experiences of birth attendants taking care of pregnant women suspected/infected with Covid-19 in the delivery department are summarized in Table 2 under the four themes: 'Lost Peace,' 'Spirituality,' 'Pride,' and 'Looking Forward to a Better Future. Theme 1- Lost peace This theme consists of four sub-themes, including: "social isolation", "family separation", "psychological tensions" and "occupational challenges". Subtheme 1-1 Social Isolation The birth attendants who were obliged to take care of pregnant mothers suspected/infected with Covid-19 during the pandemic period, felt lonely and isolated due to limiting and avoiding communication with others, and the pressure they suffered as a result of this isolation, made them regret not meeting their relatives and family members: "I confined myself to the hospital and home. I couldn't even visit my family for a long time. I felt lonely." (Midwife/35 years of work experiences) Several participants talked about their sense of isolation while being cautious: "Our lifestyle was changed with this isolation. Since we didn't want to expose others to danger, we gradually became an isolated person. Because for a long time, we didn't see anyone other than our classmates and maternity staff. I couldn’t visit my family and I felt very lonely." (Residents of Obstetrics and Gynecology/ 3 years of work experiences) "I don't feel very comfortable about visiting my parents or the family members. I'm afraid to make them sick or I get infected by them and then go to my house. I think all the people are somehow isolated, especially the medical staff who are on the front line, who have a lot of responsibilities and suffer from more isolation." (Midwife/12 years of work experiences) Subtheme 1-2 Family Separation Being careful about health and working in the hospital environment causes more isolation and withdrawal from social relationships in the family, and being far from their closest family members, i.e. spouses and children: "The situation at home was very difficult for me. I was going crazy. I was even afraid to hug my child and I missed him." (Midwife/14 years of work experiences) A lot of participants were concerned about infecting their family members. They talked being far from family members. One of the participating midwives noted to fear infecting her partner and that she kept away from him and didn’t visit her husband for almost 11 weeks: “I think I was right about getting distancing from my husband. I had to do this to protect him. Because if there was a possibility of his infection, it would only be because of me, and the thought that this would cause me to lose him was too much for me. So, all I could do was keep working and stay away from him so I could protect him." (4 years of work experiences) Subtheme 1-3 Psychological Tensions Being in contaminated medical environments and labor departments that housed infected or suspected pregnant women has been associated with experiencing a lot of stress and obsession in the medical staff and the birth attendants. On the one hand, the birth attendants were afraid of being infected with the virus, and on the other hand, they were worried about the health of the mother and infant. Since the health of the mother is not the same as the infant’s health, a large part of this fear and obsession has been for the safety and health of pregnancy and childbirth. "No matter how careful we are, it is still not enough, because in addition to the stress and obsessions that the birth phenomenon itself brings to us, the emergence of such unknown conditions makes the work more difficult than before, because we are in contact with mothers and infants, and sometimes we may transmit the virus to them, or as a result of the fear of transmitting the virus, we may not provide them with the care they should." (Midwife/1.5 years of work experiences) The birth attendants are worried about their performance regarding the care of mothers and infants who are suspected or infected with Covid-19, or whether the recommendations and instructions given to them were helpful or not: "When we had a delivery, no matter how successful it was, its treatment was still a challenge for us, we were constantly stressed and did not know what would happen to the newborn infant, if he/she is effected, whether is breastfeeding suitable, or about the contact between mother and infant." (Midwife/15 years of work experiences) Some other birth attendants expressed their concern about the increased sensitivity of their work during the pandemic and their greater responsibility: "There are more responsibilities and work pressure in caring for mothers infected by Covid-19. In this condition we have more responsibilities to make sure what we are doing right and they're 100% okay." (Residents of Obstetrics and Gynecology/ 3 years of work experiences) One of the psychological tensions faced by the birth attendants has been the involvement of mothers and infants in the covid-19 virus and being worry about their deterioration: "When the test result of a newborn was reported positive, it made me crying. I didn't want this to happen to any baby." (Midwife/1 years of work experiences) "we are always concerned that pregnant mothers do not get infected during labor. It would be very bad if they get infected in the hospital. We won’t forgive ourselves if we make them get infected." (Midwife/29 years of work experiences) The birth attendants became obsessed with the health of the mother and the baby, and this obsession showed itself in practice with the continuous monitoring of the mother during labor, and uncertainty about the health of the fetus: "At first, I was overdoing it. Something forced me to visit the mother a thousand times, to constantly check the infant’s heartbeat. When completing the report, I thought about the problems about the heartbeat and I was afraid of not understanding it." (Midwife/1.5 years of work experiences) "I kept reminding the mother about not taking off the oxygen mask, so that the oxygen level be enough. I knew that this kind of reminding was annoying for both of us." (Residents of Obstetrics and Gynecology/ 2 years of work experiences) "Because the sensitivity of this group is higher than all other patients, it is normal to be obsessed with them in this situation." (Obstetrician/ 10 years of work experiences) Subtheme 1-4 Occupational Challenges Midwives were aware of the challenges that the pandemic had created in their work environment. They knew that pregnant women and infants were more vulnerable to covid-19 than other people. Adapting to the new conditions, following the instructions that are constantly being updated and were accompanied by many defects, long-term placement without rest in personal protective clothing, all of them are issues that make working in this department difficult and challenging for them. "In the first days, we didn't know what to do with all that stress. How could we do our job properly in such a stressful situation? The patient load was high. In addition to the maternity ward, we also had to cover pregnant mothers hospitalized in other departments. Our workload and stress were more than ever. With such a situation, how could we help a healthy and safe childbirth?" (Obstetrician/ 10 years of work experiences) "Putting on and taking off the overall clothes was really exhausting. We also had to observe infection control. The order of putting them on and taking them off was very important in order to minimize the risk of transmission and contamination. But with all those clothes, our activity was limited. It was very difficult to work with all those masks, shields and thick clothes. We were sweating and couldn't do our work properly." (Midwife/15 years of work experiences) The lack of basic preparation and the lack of familiarity of the actors with the correct processes of caring for mothers and infants with corona virus is one of their most important challenges: "When I entered the respiratory isolation ward as a midwife in covid-19 section, it was difficult for me to work, because we were not taught anything, the lack of practice and repetition caused forgetting the processes that they explained to us, I just knew that I should not work without personal protection equipment." (Midwife/1.5 years of work experiences) The personnel who worked in large and referral hospitals have faced many problems in accepting pregnant mothers. In addition to being forced to accept corona virus mothers, they should also accept healthy mothers in this sense, and managing these two groups together is often considered a serious challenge: "Because most hospitals prevented the admission of infected pregnant mothers, only this hospital and another one were referrals for Covid-19. We had to accept infected mothers under any circumstances. The environment was really unsafe and contaminated, and respiratory triage was not performing properly. Unfortunately, the situation was like this. In addition to infected mothers, other pregnant mothers were also referred to here for any reason. There was not even enough space for them to sit. A lot of them had to wait behind the door. There was only one isolated room for hospitalization, and if the mother was suspected and infected, she had to be hospitalized in a normal room. This would put both the midwives, and even other mothers and other infants into danger." (Residents of Obstetrics and Gynecology/ 2 years of work experiences) Carrying out the duties of the maternity staff, along with witnessing the cases of mothers and infants suffering from covid-19, especially the severe course of the disease, has made the working environment more difficult for them: "It was very difficult and painful to witness the corona virus mothers dying, to see them getting sick in front of your eyes and you did everything you could and couldn't save her. The virus activity was unknown to us. Some of them had clinical symptoms unrelated to Corona, but over time the patient's condition worsened. We did everything we could, but we lost a lot of people. It was one of the worst memories of my work experience. Losing Mother and infant are always hard, but losing them like this is the hardest." (Obstetrician/ 10 years of work experiences) Theme 2- Spirituality Most of the participants mentioned the spiritual dimensions of working as a factor in giving birth in pandemic conditions. This theme consists of two sub-themes "in the field of divine test" and "demanding from God". Subtheme 2-1 in the field of divine test Midwives or gynecologists, whether during labor care, childbirth or postpartum, sometimes have to communicate with mothers despite the dangerous conditions, and in this condition test their patience and tolerance: "When I entered the isolation room, I tried to keep calm. I shouldn't have let myself get nervous and stressed." (Midwife/14 years of work experiences) "Being calm and increasing the tolerance are essential elements in therapeutic relationships. Working with mothers infected with corona virus showed that it is more important to have patience and tolerance in these conditions. Everyone needs to be strong for working in these conditions." (Midwife/20 years of work experiences) "Personally, I am a very energetic person. I am not afraid of such events. Corona made me understand why God chose me as a midwife. I was chosen to be here and help mothers in this situation." (Midwife/4 years of work experiences) "I am here for a reason. God has great goals and dreams for me. The emergence of this virus, my profession as a midwife, my specialty, all of these are tied together, what God has planned for me." (Midwife/29 years of work experiences) Subtheme 2-2 Demanding from God Almost all the personnel and participants of the present study mentioned their relationship with God. They understood the presence of God in all stages of their work and by more trust, they found the ability to deal with the conditions and provide the best services: One of the midwives described the relationship with God very well: "The profession of midwifery is a sign of God's power. We see this sign every day, and now we can't do anything without God’s help. We move forward in all the steps with the name and remembrance of God. We constantly ask God for help. First, we ask him to keep the mother and the baby healthy, and then to keep us, our colleagues, and our family healthy." (Midwife/12 years of work experiences) Another midwife described God as a source of strength and guidance: "The source of our strength is God. If we have been able to endure so far and have not collapsed, it is because of the strength we get from God. I always ask God to fix my work. It is not easy, the health of two people with a dangerous disease is dependent on us." (Midwife/20 years of work experiences) "I only know that God is always here and helps us. I always ask God to help us achieve our goals." (Midwife/1.5 years of work experiences) Some other birth attendants are grateful to God for having such an opportunity to help the women and mothers of their country in these difficult times: "I consider this situation as an opportunity to be grateful to God. Even if our hospital had not become a corona treatment center, I would have volunteered to work in the corona wards. I am really thankful that God gave me such an opportunity." (Midwife/4 years of work experiences) Theme 3- Pride Since the beginning of the pandemic, the efforts, sacrifices and tireless work of health care workers have made them real heroes and the respect they have received from society has brought them feelings of pride and honor. This theme consists of two sub-themes "a result of a hero" and "a manifestation of self-sacrifice". Subtheme 3-1 A result of a hero The participants described the feeling of respect they received from the people and society more intensely than before. They appreciated such respect and saw it as a sign of recognition for their round-the-clock efforts. "Midwives have always been respected by the people and in the society, because of the sanctity of this field. But when we put ourselves in danger and continued to work despite the corona virus, this sense of respect doubled. Everywhere you go, everyone thanks the medical staff, and the media and television also thank you very much." (Midwife/14 years of work experiences) "For me, the fact that I can be in a position where mothers trust my words and believe in our power to protect themselves and their children is enough." (Obstetrician/ 10 years of work experiences) Another participant, despite the challenging nature of working in a dangerous and unknown therapeutic environment, considers it an opportunity to get closer to pregnant mothers and points to the unquestioning obedience of mothers: "The instructions that came to us were new and there were many challenges. But these mothers trusted in us and our work so much that they listened to everything you told them. Their cooperation with us during this period was very good. For example, when we explained about our clothes, separating the infant from them, how to breathe or anything else, they accepted from us and cooperated with us." (Midwife/15 years of work experiences) Subtheme 3-2 A manifestation of self-sacrifice Birth attendants working during the pandemic, despite the unprecedented risks and threats, stress and high workload, described feelings such as commitment and positivity, freedom from selfishness and supporting the mothers: "The best part of the job for me, which of course was accompanied by many internal contradictions, was that I had the power to hold the hands of the mothers with corona virus when they were in pain or put my hands on their shoulders. Maybe on the one hand, the possibility of transmitting the virus to me increased, I was in danger, but at that moment I was only thinking about how much I could calm that mother." (Midwife/1.5 years of work experiences) During the interview, the birth attendants positively evaluated their overall experience of care and by overcoming their personal challenges, they removed the feeling of selfishness: "Our skills and competencies have allowed us to take care of corona patients. I know that the women of my country need this knowledge and skills. Therefore, it was not just me, my colleagues or my family. We were involved in a war and we must go beyond ourselves." (Midwife/29 years of work experiences) "These mothers had no support but us. No hospital except university hospitals would accept them. The pain of childbirth was enough for them at that moment, adding the pain of rejection was too much for them. It was our duty to admit them here. And we would do everything we could for them." (Midwife/12 years of work experiences) Theme 4- Looking forward to a better future Birth attendants, while referring to the many hardships, high workload and job stress that they suffered during the Corona period, to their needs and expectations regarding "improvement of working environment conditions", "enhancement of career field" and "improvement of employment conditions". Subtheme 4-1 Improvement of working environment conditions Some of the birth attendants complained about the high workload and lack of personnel: "At one time, the patient load was very high, especially during peak periods, there were many patients, our work shifts were long, but the number of staff in the shift did not change. The lack of staff was annoying at times like this. We needed more staff." (Midwife/15 years of work experiences) The lack of proper knowledge of midwives or obstetricians in taking PCR samples to confirm the Covid-19 is considered a challenge for them and requires them to practice or get help from experts in this field: "We had a lot of difficulty in taking PCR samples. We didn’t train for this. We didn't know if the sample we were taking was correct or not. We couldn't trust the results of our samples. We needed someone who knew how to get PCRs samples, so that we didn’t do it without training and in a stressful way.” (Midwife/12 years of work experiences) According to some participants, one of the prerequisites for getting ready to provide services in pandemic conditions is access to clear instructions and updates on how to deal with patients, especially mothers infected with Covid-19, in order to protect them from confusion and ambiguity: "At first, everyone said whatever they wanted. Treatments was performed based on the interests. The training unit posted the information in the group, and we would act based on that. They should have issued instructions or a protocol much earlier. This way, both mothers and infants were in danger." (Midwife/4 years of work experiences) Team cooperation in the care and midwifery processes of pregnant women with covid-19 is one of the other requirements of the medical staff based in the maternity hospital: " The issue of giving birth and taking care of children and newborns with corona should not be done by one person. I had a problem with doing all the work alone from the beginning to end. I understand that it was for preventing the contamination of others, but in this way, the number of deaths would increase. Everyone should cooperate, because we didn’t have enough information. For example, gynecologists on one hand, neonatologists and anesthesiologists on the other hand had to do their jobs. The issue of taking care of high-risk mothers is a matter of teamwork." (Midwife/15 years of work experiences) "It's not possible to isolate a room and hospitalize the mother with Covid-19 and do all her works there. The facilities must be enough. The issue of air conditioning is very important. Our exhaust fans are mostly weak. Every time you had a Covid-19 mother, there were many shortages in the room. Once there was no Sonicaide, once there was no NST tape. Once there was a shortage of birthing kits. No matter what you did, no one would help us. We had to take them by yourself. This also caused the infection to spread. At first, they didn’t give the masks to us. They said it’s based on quota. For a long work shift, they gave a mask for 12 hours. There were many shortages and problems." (Midwife/20 years of work experiences) Subtheme 4-2 Enhancement of career field The participants pointed to their organizational and job needs from the government and other government organizations, and consider solving their problems and needs at the critical time, and receiving practical support as a type of appreciation. "What I am most unsatisfied about is that no one supports the midwives. We expected the Ministry of Health and the University to at least support us here, but I remember that at the beginning they didn’t provide masks for us. Midwives don’t receive any support. Their position is always threatened. This situation showed how effective our existence can be, so it's time to show us our true position." (Midwife/15 years of work experiences) "Some things may be very small and insignificant, but these things make us feel valued. For example, free parking, giving food packs during the work time, these kinds of things really help to make us feel better. We don’t need them, but doing these things for the staff makes them feel that their needs are respected and that they are valuable to the hospital, and this is very important. There is no need to always thank them with payment. Appreciation from authorities at the maternity hospital or the written encouragement is a great encouragement." (Midwife/1.5 years of work experiences) Subtheme 4-3 Improvement of employment conditions "It is not enough for us to get appreciation. It will even make us disappointed. They think this is enough for us. But we want safe working conditions and payments for our risks. They should pay attention to the needs of doctors and midwives. Our income should be fare. We risk our lives and our families’ lives." (Midwife/14 years of work experiences) Some midwives defined the support plan they need in the stability of their job position: "I spent the whole time at Corona Center Hospital. Hiring us is the least they can do for us. They should contract with us for a long time or hire us. There should be a quota for medical staff who are on the frontline in this situation." (Midwife/1.5 years of work experiences) Discussion The purpose of this qualitative phenomenological study was to explore the real time experience of birth attendants in caring for pregnant mothers who are suspected or infected with Covid-19, in the labor and delivery departments. The results consisted of four themes: "lost peace", "spirituality", "pride" and "looking forward to a better future". Although no study has been conducted in the field of midwives' experiences in caring for mothers with covid-19 disease, but in some similar studies, the experiences of medical staff have been investigated. The theme of "lost peace" includes the sub-themes: "feeling of social isolation", "being separated from the family", "psychological tension", “job challenges". Similar themes were also expressed in other studies. In a study entitled "Nurse's report of stressful situations during the COVID-19 epidemic", the negative emotions of nurses included fatigue, discomfort and helplessness due to high-intensity work, fear and Anxiety and worry for patients and family members were among the themes. Other themes included pandemic-related limitations and feelings of inadequacy/helplessness regarding patients and their treatment, and more than half of all stress-related comments related to difficulties in responding to the pandemic at work ( 23 ). In another qualitative study conducted in 2021 regarding healthcare providers' experience of service delivery during the COVID-19 pandemic, which analyzed the data, four main themes including, "Working during the pandemic," "Change In personal life and increasing negative emotions", “experience, normalization and adapting to the epidemic" and "mental health considerations" were extracted. The present results showed that the deterioration of mental illnesses is revealed through a stepwise process with the spread of the epidemic ( 24 ). In another study with a phenomenological approach, the real time experience of nurses in caring for patients with covid-19 in Iran showed that nurses who worked in covid-19 wards suffered from mental and emotional distress. Mental state (subthemes including "anxiety and stress" and "fear"), emotional state (subthemes including "suffering" and "expectation to die"), and context of care (subthemes including "confusion" and "lack of support and equipment") were extracted as the main themes ( 25 ). In a study on the experiences and perceptions of healthcare workers during the coronavirus pandemic in Oman (2020), the main themes included "perceptions of mental disorders as consequences of social distancing", "cadaver management", "healthcare worker fatigue" and "being at risk of disease" ( 26 ). On the other hand, according to another similar study, while nurses are on the front line of fighting against the pandemic, they had problems in their personal-emotional dimension and in the maternal dimension ( 27 ). "Difficulty in adapting to a demanding environment" ( 28 ) is one of the experiences in dealing with new work environments. Since this pandemic is an emerging situation, the experience of people's first encounter with the disease, seeing heartbreaking scenes and social distancing, the loss of peace was not far from the mind. Among other main themes extracted from the present study was "spirituality". The midwives present in the study, faced with this disease, saw themselves in the field of divine test and always asked help from God. Midwifery is one of the professions that is always mixed with spirituality ( 29 , 30 ). One of the well-established values ​​of spirituality is that it helps people cope with major life stresses ( 31 ). Although the present theme was a new finding in the studies, but since midwifery is a profession based on helping others, however, long working hours and their exposure to traumatic birth events affects the level of spiritual care and compassion ( 32 ). In a study about the experience of being a mother and a nurse during a pandemic, the participants' religious themes were found to be valuable in coping with the experienced chaos ( 27 ). Spiritual awareness of the birth experience emerges through relationships and is influenced by the spatial environment. Spiritual midwifery is a relational approach to childbirth care that recognizes and values ​​the existential importance and meaning of childbirth ( 33 ). The quality of the relationship between the midwife and the woman is widely recognized as a critical factor in pregnancy and childbirth. Some authors argue that it is the presence of a spiritual force that enables midwives to fully actualize their communicative capacity with pregnant women ( 29 ). In the current study, both pregnant women as service receivers and midwives as service providers are under pressure and many challenges. In dealing with a new situation and an emerging disease, there was a spiritual management experience in all stages of service delivery. The midwives who participated in the present study were full of pride and honor and felt a sense of heroism and of self-sacrifice. In a study examining the psychology of nurses caring for COVID-19 patients, participants expressed that they experienced growth under pressure, which included increased affection and appreciation, development of professional responsibility, and self-reflection ( 34 ). In the difficult conditions caused by the epidemic and based on the beliefs that exist among health care providers in Iran ( 35 ), the emergence of such a theme was expected. The theme of “looking forward to a better future” included the need to improve the work environment, seeking to improve the field of midwifery, and looking forward to improving individual job conditions. Studies have shown that improving the working conditions of midwives contributes to the quality of maternal health care ( 32 ). The doctors who were working in the NHS center required receiving privileges such as rest spaces against mere gratitude ( 36 ). In another qualitative study on health and social care workers' experiences and views of psychosocial support during the Corona pandemic, the results showed that people's experiences and views on psychosocial support are complex. Support from frontline peers was the expectation of many people. Health care workers were ambivalent about support from organizations, the media, and the public, and while they valued mental health support services, there were large differences in provision and barriers to access ( 37 ). From the data analysis, it organizational issues and support for novice nurses were related to fear and concerns ( 38 ). In the real time experience of novice midwives, the results showed themes for describing the meaning of clinical practice for newly qualified midwives. Preparation, meeting expectations, knowledge and practice gaps, need for clinical support and guidance, and continuing professional education of midwifery educators should be addressed when reviewing and revising midwifery education programs to prepare midwifery students for workplace ( 39 ). Another phenomenological study in the field of midwives' real time experience of care during childbirth in 2014, the general structure of the phenomenon of care in midwifery during childbirth included the key components of division of responsibility, active and real presence, creating a relaxed atmosphere in a mutual relationship, having clinical knowledge. ( 40 ). Performing any behavior in humans is in the hope of achieving some kind of benefit ( 41 ). In the present study, due to dealing with a critical situation and also the participation of some young people in the study, a better future was one of the motivations for hard work and facing the dangers of the epidemic. Strengths & limitation The present research is valuable for providing a real insight into the causes of the covid-19 pandemic. Among other strengths of this study, we can mention the detailed analysis of qualitative data and all the measures taken to maximize the reliability and trustworthiness of the findings. However, it should be acknowledged that due to the qualitative research design and the small sample size, the generalizability of the findings is not possible. According to the time of the study, the available samples were only limited to two hospitals. In addition, it is important to mention that the meaning of the real time experience of birth attendants caring for pregnant mothers with Covid-19 may be beyond their experience only in the hospital work environment. Implications for practice Seeking for a better and deeper understanding of the experiences and concerns of birth attendants in crises such as the Covid-19 pandemic can be helpful in better understanding their needs and developing support and protection programs for this group. More research is recommended in the field of clinical experiences of birth attendants in the context of the Covid-19 pandemic. In addition, the necessity of increasing cooperation and providing support and consulting services to the medical staff is emphasized. Conclusion In this article, participants experienced a wide range of emotions during the pandemic. Although they were valuable as specialists in the front line of fighting the disease, they faced challenges in different aspects such as professional, personal and emotional. Providing mental health assistance should be an essential part of services for health care providers during a pandemic. Based on the results obtained in the present study, assistance should be focused on different stages and be person-centered, because such interventions are very important to maintain the ability of midwives/gynecologists during the pandemic. This study shows the need for structural organizational policies so that midwives/gynecologists are in an equal and safe position to fulfill their profession and have a healthy relationship within the family, especially in the face of difficulties such as the Corona pandemic. Training courses increases the self-confidence of midwives in dealing with new diseases and providing better quality care. On the other hand, medical and health care organizations should provide opportunities for midwives to discuss their experience, support each other and offer suggestions for improving services at the workplace during this epidemic. Midwives/gynecologists can share their experiences for continued professional development. More research is needed to implement and evaluate the impact of different service practices in relation to midwifery care and whether this can benefit the care of women in the Covid-19 pandemic. Declarations Ethics approval and consent to participate The present research was approved by the ethics committee of Mashhad University of Medical Sciences, Iran, with code IR.MUMS.REC.1399.124. In addition, before the final selection, complete explanations were given to participants about the objectives of the study, data collection method, the confidentiality of information and the right to withdraw from the study at each stage. Also, informed consent was obtained from all the participants for engaging in the study and recording the interviews. Finally, a unique code was assigned to each participant (midwife 1, midwife 2, assistant 1, etc.) to ensure anonymity. For the sake of confidentiality, the file containing their audio interviews has been kept in a safe place. Consent for publication This manuscript does not contain personal data, such as individual details, images, or videos. The authors confirm that all research participants provided informed consent for the publication of this manuscript . Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Financial resources were provided by Mashhad University of Medical Sciences. Authors' contributions SA provided the conceptual framework and designed the study. SA conducted the interviews, performed initial data analysis, and drafted the manuscript. FSH and RLR collaborated on further data analysis, interpretation, and manuscript drafting. All authors reviewed and approved the final manuscript Acknowledgment The research team is sincerely grateful for the support of the Vice Chancellor for Research of Mashhad University of Medical Sciences and all the mothers who shared their experiences with the researchers. 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Tables Table 1- Demographic characteristics of Participants Num Job Position Age Work Experiences 1 Midwife 35 15 2 Midwife 45 20 3 Midwife 54 29 4 Midwife 25 1.5 5 Midwife 38 12 6 Midwife 36 14 7 Midwife 24 1 8 Midwife 33 4 9 Midwife 35 15 10 Residents of Obstetrics and Gynecology 3 11 Residents of Obstetrics and Gynecology 2 12 Obstetrician 42 10 Table 2- The summary of Themes and Subthemes Subthemes Themes Social Isolation Lost peace Family Separation Psychological Tensions Occupational Challenges In the field of divine test Spirituality Demanding from God A result of a hero Pride A manifestation of self-sacrifice Improvement of working environment conditions Looking forward to a better future A manifestation of self-sacrifice Enhancement of career field Improvement of employment conditions Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3344539","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":236337184,"identity":"5664959e-2184-41be-919f-1ae9b694b1d5","order_by":0,"name":"Somayeh Alirezaei","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Somayeh","middleName":"","lastName":"Alirezaei","suffix":""},{"id":236337185,"identity":"6f5adb34-2c9d-4161-8661-5b6b69625f79","order_by":1,"name":"Robab Latifnejad Roudsari","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Robab","middleName":"Latifnejad","lastName":"Roudsari","suffix":""},{"id":236337186,"identity":"92c30fc5-2cc2-4e6b-8eed-d1f38d945caf","order_by":2,"name":"Farangis Sharifi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYBAC+wMMbEBKgp+N4UDiAwaGA4S1GDBAtEi2MR54bECKFgbJBuaDzySI1ML+7MHPPRYSfGyH06p5au7I8TMwP3x0A48WewYec8OeZxISbDzH0m7zHHtmLNnAZmycg9cWHjYJngMSdWwSZ4Ba2A4nbjjAwyaNXwv7M8k/B4C2yL//VszzjygtDGbSPCAtDAfSmHnbiNLCYyYtA9GSLDm377CxZDNBvwAd9uZAnYR8w4HED2++HZbjZ29++BifFgb5Bwg2Ew+IZManHB0w/iBF9SgYBaNgFIwYAADAnUgOlgOhsQAAAABJRU5ErkJggg==","orcid":"","institution":"Shahrekord University of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Farangis","middleName":"","lastName":"Sharifi","suffix":""}],"badges":[],"createdAt":"2023-09-11 10:44:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3344539/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3344539/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94056095,"identity":"4fe9176f-10a2-4485-93b2-05357161c774","added_by":"auto","created_at":"2025-10-22 03:46:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":883309,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3344539/v1/7096b3a4-52be-42ab-b8a1-3359e36374cd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Birth attendants’ lived experiences of caring for pregnant women suspected to or diagnosed with Covid 19 in labor and delivery ward based on a phenomenological approach","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe new coronavirus (COVID-19) is a potentially fatal disease (1) and is considered by the World Health Organization (WHO) as an international emergency (2). Since the recognition of this disease in December 2019 in the city of Wuhan, China, until March 29, 2020, 664,621 people have been infected with this virus all around the world, of which 30,891 people were died and 142,368 people have been recovered (3). Among the 199 countries that are involved with this disease, Iran ranks seventh in the world (4). This sudden emergence has created difficult and challenging conditions for health care workers. Disease outbreak, unknown factors, and precautionary measures taken to protect public health could cause destructive effects (5). According to the studies, in the early stages of Covid-19 pandemic, the most important concern of health service providers was the fear of getting infected by colleagues (72.5%) and family members (63.9%), lack of protective equipment (52.3%) and increased workload (48.5%). Healthcare workers, especially women, face many professional and personal challenges when performing their role as first responders (6). Birth attendants are a large group of women who provide services that have a clear impact on the quality of health care in society, especially pregnant women (7). It has been scientifically proven that pregnant women are among the most susceptible groups at risk of viral respiratory infections (8). The risk of faster and more severe infection of pregnant women, along with the complications that occur during pregnancy and delivery, has caused maternity staff to face more challenges in the management of labor in this group (9). During medical and midwifery interventions such as collecting blood and sputum samples, labor care, and delivery, birth attendants are exposed to the risk of virus transmission (10). In addition to biomedical risks, the prevalence of infectious diseases is often accompanied by psychological pressure, stress and fear, especially if it is out of control and has adverse and irreversible consequences (11). The presence of midwives in the front line shows their constant compassion and commitment. In fact, they put their lives in danger while doing work duties. In previous similar cases such as SARS (Severe Acute Respiratory Syndrome) that occurred in 2002-2003, a number of them died during their worktimes (7). Since the emergence of epidemics similar to Covid-19 such as SARS and MERS (Middle East Respiratory Syndrome), research has been conducted primarily on psychological issues such as the level of anxiety and the psychological impact of such crises on health factors (12, 13). Studies have shown long-term psychological effects including post-accident stress until several months after the injury (14). The procedure of care for pregnant women in labor needs a complete explanation, and the real time experiences of midwifery staff are the best source of data in this field. The primary method of data collection is the opinions of birth attendants, and the phenomenological research method provides the richest and most descriptive data to the researcher (15). In this way, employees can freely express their experiences, feelings, and mental analyzes of care in labor and delivery (16). A deep understanding of feelings, perceptions, beliefs, motivations, views, needs and barriers to the participation of birth attendants plays a significant role in empowering them to take care of themselves and the pregnant women under their care and can increase their awareness, knowledge and improve their relationship with suspecting pregnant women, which ultimately lead to the improvement of the health of both groups (17). So far, no study has investigated the complexities and challenges of midwifery clinical practice in such sudden and unexpected crises. In order to fill this gap, the present study was performed by investigating the birth attendant s\u0026rsquo; point of views with an in-depth study that can show how personnel experienced the phenomenon of caring for mothers with Covid-19 disease and how this experience can be used to help and create safety and protection programs and systems. Also, this study can demonstrate the hidden issues from the point of view of caregivers of pregnant women suspected of Covid-19 disease and help to better understand the physical, emotional, psychological, family and social needs of this group of caregivers. This study was performed with the purpose of identifying and deeply understanding the meaning of care for pregnant women suspected/infected with Covid-19 during labor based on the real time experiences of the birth attendants.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eAims and setting\u003c/strong\u003e: The present research is a qualitative phenomenological study about the birth attendants (midwives and doctors) with pregnant women suspected or infected with Covid-19 in the labor department of teaching hospitals located in Mashhad, Iran, from March to May 2020.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e: The statistical population of the present study included all midwives, gynecologists and women\u0026apos;s assistants in the labor and delivery department of teaching hospitals located in Mashhad, Iran. The study sample consisted of 9 midwives, 2 assistants and 1 gynecologist. The participants were selected by available sampling method and based on input criteria such as birth attendant working in the birth department and willingness to participate in the study. The average age of the participants was 35 and their working experience was 10 years. The education level of all midwives was bachelor\u0026apos;s degree, the employment status of 6 of them was official, 1 was contracted and 2 were apprentices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e: Due to the complexity of real time experiences, the required data were collected through in-depth semi-structured interviews, as an efficient method in the phenomenological approach (18). Interviews were performed with open and general questions and directed towards more specific questions to gain a deeper understanding and insight into the experiences of pregnant women suspected of being infected with Covid-19. All the interviews were conducted in Persian, as the native language of the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e: For analyzing the qualitative data and reaching a high level of abstraction, usually hermeneutic approaches such as Van Manen\u0026apos;s proposed approach are used (19). In this regard, the qualitative data collected about the real time experiences of the participants in this study were analyzed through the six methodological steps proposed by Van Manen (1990) (20). These six methodological stages include \u003cspan dir=\"RTL\"\u003e1\u003c/span\u003e. Orientation to the nature of lived experience. 2. Exploring the experience as we live it and not how we conceptualize it. 3. Reflecting about the main themes that reveal the characteristics of the phenomenon. 4. Art of writing and rewriting 5. Maintaining a strong and direction relation with the phenomenon; 6. Matching the field of research with the continuous consideration of components and the whole \u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrustworthiness of Findings:\u0026nbsp;\u003c/strong\u003eFor ensuring validity and reliability in the present study, the four gold standards of Lincoln and Guba were used, i.e. validity, reliability, confirmability and transferability (21). By the way, the validity of the results was ensured through long-term data processing, attendance at delivery departments, effective communication with participants, and using techniques suggested by Devadas (2016) in member and peer review (22). In addition, the experiences in the midwifery profession was another factor to ensure validity.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe present descriptive-interpretive phenomenological study was conducted on 12 birth attendants. Table 1 shows the demographic characteristics of the participants. The real-time experiences of birth attendants taking care of pregnant women suspected/infected with Covid-19 in the delivery department are summarized in Table 2 under the four themes: \u0026apos;Lost Peace,\u0026apos; \u0026apos;Spirituality,\u0026apos; \u0026apos;Pride,\u0026apos; and \u0026apos;Looking Forward to a Better Future.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1- Lost peace\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme consists of four sub-themes, including: \u0026quot;social isolation\u0026quot;, \u0026quot;family separation\u0026quot;, \u0026quot;psychological tensions\u0026quot; and \u0026quot;occupational challenges\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme 1-1 Social Isolation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe birth attendants who were obliged to take care of pregnant mothers suspected/infected with Covid-19 during the pandemic period, felt lonely and isolated due to limiting and avoiding communication with others, and the pressure they suffered as a result of this isolation, made them regret not meeting their relatives and family members:\u003c/p\u003e\n\u003cp\u003e\u0026quot;I confined myself to the hospital and home. I couldn\u0026apos;t even visit my family for a long time. I felt lonely.\u0026quot; (Midwife/35 years of work experiences)\u003c/p\u003e\n\u003cp\u003eSeveral participants talked about their sense of isolation while being cautious:\u003c/p\u003e\n\u003cp\u003e\u0026quot;Our lifestyle was changed with this isolation. Since we didn\u0026apos;t want to expose others to danger, we gradually became an isolated person. Because for a long time, we didn\u0026apos;t see anyone other than our classmates and maternity staff. I couldn\u0026rsquo;t visit my family and I felt very lonely.\u0026quot; (Residents of Obstetrics and Gynecology/ 3 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I don\u0026apos;t feel very comfortable about visiting my parents or the family members. I\u0026apos;m afraid to make them sick or I get infected by them and then go to my house. I think all the people are somehow isolated, especially the medical staff who are on the front line, who have a lot of responsibilities and suffer from more isolation.\u0026quot; (Midwife/12 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme 1-2 Family Separation\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBeing careful about health and working in the hospital environment causes more isolation and withdrawal from social relationships in the family, and being far from their closest family members, i.e. spouses and children:\u003c/p\u003e\n\u003cp\u003e\u0026quot;The situation at home was very difficult for me. I was going crazy. I was even afraid to hug my child and I missed him.\u0026quot; (Midwife/14 years of work experiences)\u003c/p\u003e\n\u003cp\u003eA lot of participants were concerned about infecting their family members. They talked being far from family members. One of the participating midwives noted to fear infecting her partner and that she kept away from him and didn\u0026rsquo;t visit her husband for almost 11 weeks:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;I think I was right about getting distancing from my husband. I had to do this to protect him. Because if there was a possibility of his infection, it would only be because of me, and the thought that this would cause me to lose him was too much for me. So, all I could do was keep working and stay away from him so I could protect him.\u0026quot; (4 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme 1-3 Psychological Tensions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBeing in contaminated medical environments and labor departments that housed infected or suspected pregnant women has been associated with experiencing a lot of stress and obsession in the medical staff and the birth attendants. On the one hand, the birth attendants were afraid of being infected with the virus, and on the other hand, they were worried about the health of the mother and infant. Since the health of the mother is not the same as the infant\u0026rsquo;s health, a large part of this fear and obsession has been for the safety and health of pregnancy and childbirth.\u003c/p\u003e\n\u003cp\u003e\u0026quot;No matter how careful we are, it is still not enough, because in addition to the stress and obsessions that the birth phenomenon itself brings to us, the emergence of such unknown conditions makes the work more difficult than before, because we are in contact with mothers and infants, and sometimes we may transmit the virus to them, or as a result of the fear of transmitting the virus, we may not provide them with the care they should.\u0026quot; (Midwife/1.5 years of work experiences)\u003c/p\u003e\n\u003cp\u003eThe birth attendants are worried about their performance regarding the care of mothers and infants who are suspected or infected with Covid-19, or whether the recommendations and instructions given to them were helpful or not:\u003c/p\u003e\n\u003cp\u003e\u0026quot;When we had a delivery, no matter how successful it was, its treatment was still a challenge for us, we were constantly stressed and did not know what would happen to the newborn infant, if he/she is effected, whether is breastfeeding suitable, \u0026nbsp;or about the contact between mother and infant.\u0026quot; (Midwife/15 years of work experiences)\u003c/p\u003e\n\u003cp\u003eSome other birth attendants expressed their concern about the increased sensitivity of their work during the pandemic and their greater responsibility:\u003c/p\u003e\n\u003cp\u003e\u0026quot;There are more responsibilities and work pressure in caring for mothers infected by Covid-19. In this condition we have more responsibilities to make sure what we are doing right and they\u0026apos;re 100% okay.\u0026quot; (Residents of Obstetrics and Gynecology/ 3 years of work experiences)\u003c/p\u003e\n\u003cp\u003eOne of the psychological tensions faced by the birth attendants has been the involvement of mothers and infants in the covid-19 virus and being worry about their deterioration:\u003c/p\u003e\n\u003cp\u003e\u0026quot;When the test result of a newborn was reported positive, it made me crying. I didn\u0026apos;t want this to happen to any baby.\u0026quot; (Midwife/1 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u0026quot;we are always concerned that pregnant mothers do not get infected during labor. It would be very bad if they get infected in the hospital. We won\u0026rsquo;t forgive ourselves if we make them get infected.\u0026quot; (Midwife/29 years of work experiences)\u003c/p\u003e\n\u003cp\u003eThe birth attendants became obsessed with the health of the mother and the baby, and this obsession showed itself in practice with the continuous monitoring of the mother during labor, and uncertainty about the health of the fetus:\u003c/p\u003e\n\u003cp\u003e\u0026quot;At first, I was overdoing it. Something forced me to visit the mother a thousand times, to constantly check the infant\u0026rsquo;s heartbeat. When completing the report, I thought about the problems about the heartbeat and I was afraid of not understanding it.\u0026quot; (Midwife/1.5 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I kept reminding the mother about not taking off the oxygen mask, so that the oxygen level be enough. I knew that this kind of reminding was annoying for both of us.\u0026quot; (Residents of Obstetrics and Gynecology/ 2 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u0026quot;Because the sensitivity of this group is higher than all other patients, it is normal to be obsessed with them in this situation.\u0026quot; (Obstetrician/ 10 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme 1-4 Occupational Challenges\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMidwives were aware of the challenges that the pandemic had created in their work environment. They knew that pregnant women and infants were more vulnerable to covid-19 than other people. Adapting to the new conditions, following the instructions that are constantly being updated and were accompanied by many defects, long-term placement without rest in personal protective clothing, all of them are issues that make working in this department difficult and challenging for them.\u003c/p\u003e\n\u003cp\u003e\u0026quot;In the first days, we didn\u0026apos;t know what to do with all that stress. How could we do our job properly in such a stressful situation? The patient load was high. In addition to the maternity ward, we also had to cover pregnant mothers hospitalized in other departments. Our workload and stress were more than ever. With such a situation, how could we help a healthy and safe childbirth?\u0026quot; (Obstetrician/ 10 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u0026quot;Putting on and taking off the overall clothes was really exhausting. We also had to observe infection control. The order of putting them on and taking them off was very important in order to minimize the risk of transmission and contamination. But with all those clothes, our activity was limited. It was very difficult to work with all those masks, shields and thick clothes. We were sweating and couldn\u0026apos;t do our work properly.\u0026quot; (Midwife/15 years of work experiences)\u003c/p\u003e\n\u003cp\u003eThe lack of basic preparation and the lack of familiarity of the actors with the correct processes of caring for mothers and infants with corona virus is one of their most important challenges:\u003c/p\u003e\n\u003cp\u003e\u0026quot;When I entered the respiratory isolation ward as a midwife in covid-19 section, it was difficult for me to work, because we were not taught anything, the lack of practice and repetition caused forgetting the processes that they explained to us, I just knew that I should not work without personal protection equipment.\u0026quot; (Midwife/1.5 years of work experiences)\u003c/p\u003e\n\u003cp\u003eThe personnel who worked in large and referral hospitals have faced many problems in accepting pregnant mothers. In addition to being forced to accept corona virus mothers, they should also accept healthy mothers in this sense, and managing these two groups together is often considered a serious challenge:\u003c/p\u003e\n\u003cp\u003e\u0026quot;Because most hospitals prevented the admission of infected pregnant mothers, only this hospital and another one were referrals for Covid-19. We had to accept infected mothers under any circumstances. The environment was really unsafe and contaminated, and respiratory triage was not performing properly. Unfortunately, the situation was like this. In addition to infected mothers, other pregnant mothers were also referred to here for any reason. There was not even enough space for them to sit. A lot of them had to wait behind the door. There was only one isolated room for hospitalization, and if the mother was suspected and infected, she had to be hospitalized in a normal room. This would put both the midwives, and even other mothers and other infants into danger.\u0026quot; (Residents of Obstetrics and Gynecology/ 2 years of work experiences)\u003c/p\u003e\n\u003cp\u003eCarrying out the duties of the maternity staff, along with witnessing the cases of mothers and infants suffering from covid-19, especially the severe course of the disease, has made the working environment more difficult for them:\u003c/p\u003e\n\u003cp\u003e\u0026quot;It was very difficult and painful to witness the corona virus mothers dying, to see them getting sick in front of your eyes and you did everything you could and couldn\u0026apos;t save her. The virus activity was unknown to us. Some of them had clinical symptoms unrelated to Corona, but over time the patient\u0026apos;s condition worsened. We did everything we could, but we lost a lot of people. It was one of the worst memories of my work experience. Losing Mother and infant are always hard, but losing them like this is the hardest.\u0026quot; (Obstetrician/ 10 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2- Spirituality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost of the participants mentioned the spiritual dimensions of working as a factor in giving birth in pandemic conditions. This theme consists of two sub-themes \u0026quot;in the field of divine test\u0026quot; and \u0026quot;demanding from God\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme 2-1 in the field of divine test\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMidwives or gynecologists, whether during labor care, childbirth or postpartum, sometimes have to communicate with mothers despite the dangerous conditions, and in this condition test their patience and tolerance:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026quot;When I entered the isolation room, I tried to keep calm. I shouldn\u0026apos;t have let myself get nervous and stressed.\u0026quot; (Midwife/14 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u0026quot;Being calm and increasing the tolerance are essential elements in therapeutic relationships. Working with mothers infected with corona virus showed that it is more important to have patience and tolerance in these conditions. Everyone needs to be strong for working in these conditions.\u0026quot; (Midwife/20 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u0026quot;Personally, I am a very energetic person. I am not afraid of such events. Corona made me understand why God chose me as a midwife. I was chosen to be here and help mothers in this situation.\u0026quot; (Midwife/4 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I am here for a reason. God has great goals and dreams for me. The emergence of this virus, my profession as a midwife, my specialty, all of these are tied together, what God has planned for me.\u0026quot; (Midwife/29 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme 2-2 Demanding from God\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlmost all the personnel and participants of the present study mentioned their relationship with God. They understood the presence of God in all stages of their work and by more trust, they found the ability to deal with the conditions and provide the best services:\u003c/p\u003e\n\u003cp\u003eOne of the midwives described the relationship with God very well:\u003c/p\u003e\n\u003cp\u003e\u0026quot;The profession of midwifery is a sign of God\u0026apos;s power. We see this sign every day, and now we can\u0026apos;t do anything without God\u0026rsquo;s help. We move forward in all the steps with the name and remembrance of God. We constantly ask God for help. First, we ask him to keep the mother and the baby healthy, and then to keep us, our colleagues, and our family healthy.\u0026quot; (Midwife/12 years of work experiences)\u003c/p\u003e\n\u003cp\u003eAnother midwife described God as a source of strength and guidance:\u003c/p\u003e\n\u003cp\u003e\u0026quot;The source of our strength is God. If we have been able to endure so far and have not collapsed, it is because of the strength we get from God. I always ask God to fix my work. It is not easy, the health of two people with a dangerous disease is dependent on us.\u0026quot; (Midwife/20 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I only know that God is always here and helps us. I always ask God to help us achieve our goals.\u0026quot; (Midwife/1.5 years of work experiences)\u003c/p\u003e\n\u003cp\u003eSome other birth attendants are grateful to God for having such an opportunity to help the women and mothers of their country in these difficult times:\u003c/p\u003e\n\u003cp\u003e\u0026quot;I consider this situation as an opportunity to be grateful to God. Even if our hospital had not become a corona treatment center, I would have volunteered to work in the corona wards. I am really thankful that God gave me such an opportunity.\u0026quot; (Midwife/4 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3- Pride\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince the beginning of the pandemic, the efforts, sacrifices and tireless work of health care workers have made them real heroes and the respect they have received from society has brought them feelings of pride and honor. This theme consists of two sub-themes \u0026quot;a result of a hero\u0026quot; and \u0026quot;a manifestation of self-sacrifice\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme 3-1 A result of a hero\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants described the feeling of respect they received from the people and society more intensely than before. They appreciated such respect and saw it as a sign of recognition for their round-the-clock efforts.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026quot;Midwives have always been respected by the people and in the society, because of the sanctity of this field. But when we put ourselves in danger and continued to work despite the corona virus, this sense of respect doubled. Everywhere you go, everyone thanks the medical staff, and the media and television also thank you very much.\u0026quot; (Midwife/14 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u0026quot;For me, the fact that I can be in a position where mothers trust my words and believe in our power to protect themselves and their children is enough.\u0026quot; (Obstetrician/ 10 years of work experiences)\u003c/p\u003e\n\u003cp\u003eAnother participant, despite the challenging nature of working in a dangerous and unknown therapeutic environment, considers it an opportunity to get closer to pregnant mothers and points to the unquestioning obedience of mothers:\u003c/p\u003e\n\u003cp\u003e\u0026quot;The instructions that came to us were new and there were many challenges. But these mothers trusted in us and our work so much that they listened to everything you told them. Their cooperation with us during this period was very good. For example, when we explained about our clothes, separating the infant from them, how to breathe or anything else, they accepted from us and cooperated with us.\u0026quot; (Midwife/15 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme 3-2 A manifestation of self-sacrifice\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBirth attendants working during the pandemic, despite the unprecedented risks and threats, stress and high workload, described feelings such as commitment and positivity, freedom from selfishness and supporting the mothers:\u003c/p\u003e\n\u003cp\u003e\u0026quot;The best part of the job for me, which of course was accompanied by many internal contradictions, was that I had the power to hold the hands of the mothers with corona virus when they were in pain or put my hands on their shoulders. Maybe on the one hand, the possibility of transmitting the virus to me increased, I was in danger, but at that moment I was only thinking about how much I could calm that mother.\u0026quot; (Midwife/1.5 years of work experiences)\u003c/p\u003e\n\u003cp\u003eDuring the interview, the birth attendants positively evaluated their overall experience of care and by overcoming their personal challenges, they removed the feeling of selfishness:\u003c/p\u003e\n\u003cp\u003e\u0026quot;Our skills and competencies have allowed us to take care of corona patients. I know that the women of my country need this knowledge and skills. Therefore, it was not just me, my colleagues or my family. We were involved in a war and we must go beyond ourselves.\u0026quot; (Midwife/29 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026quot;These mothers had no support but us. No hospital except university hospitals would accept them. The pain of childbirth was enough for them at that moment, adding the pain of rejection was too much for them. It was our duty to admit them here. And we would do everything we could for them.\u0026quot; (Midwife/12 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 4- Looking forward to a better future\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBirth attendants, while referring to the many hardships, high workload and job stress that they suffered during the Corona period, to their needs and expectations regarding \u0026quot;improvement of working environment conditions\u0026quot;, \u0026quot;enhancement of career field\u0026quot; and \u0026quot;improvement of employment conditions\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme 4-1 Improvement of working environment conditions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome of the birth attendants complained about the high workload and lack of personnel:\u003c/p\u003e\n\u003cp\u003e\u0026quot;At one time, the patient load was very high, especially during peak periods, there were many patients, our work shifts were long, but the number of staff in the shift did not change. The lack of staff was annoying at times like this. We needed more staff.\u0026quot; (Midwife/15 years of work experiences)\u003c/p\u003e\n\u003cp\u003eThe lack of proper knowledge of midwives or obstetricians in taking PCR samples to confirm the Covid-19 is considered a challenge for them and requires them to practice or get help from experts in this field:\u003c/p\u003e\n\u003cp\u003e\u0026quot;We had a lot of difficulty in taking PCR samples. We didn\u0026rsquo;t train for this. We didn\u0026apos;t know if the sample we were taking was correct or not. We couldn\u0026apos;t trust the results of our samples. We needed someone who knew how to get PCRs samples, so that we didn\u0026rsquo;t do it without training and in a stressful way.\u0026rdquo; (Midwife/12 years of work experiences)\u003c/p\u003e\n\u003cp\u003eAccording to some participants, one of the prerequisites for getting ready to provide services in pandemic conditions is access to clear instructions and updates on how to deal with patients, especially mothers infected with Covid-19, in order to protect them from confusion and ambiguity:\u003c/p\u003e\n\u003cp\u003e\u0026quot;At first, everyone said whatever they wanted. Treatments was performed based on the interests. The training unit posted the information in the group, and we would act based on that. They should have issued instructions or a protocol much earlier. This way, both mothers and infants were in danger.\u0026quot; (Midwife/4 years of work experiences)\u003c/p\u003e\n\u003cp\u003eTeam cooperation in the care and midwifery processes of pregnant women with covid-19 is one of the other requirements of the medical staff based in the maternity hospital:\u003c/p\u003e\n\u003cp\u003e\u0026quot; The issue of giving birth and taking care of children and newborns with corona should not be done by one person. I had a problem with doing all the work alone from the beginning to end. I understand that it was for preventing the contamination of others, but in this way, the number of deaths would increase. Everyone should cooperate, because we didn\u0026rsquo;t have enough information. For example, gynecologists on one hand, neonatologists and anesthesiologists on the other hand had to do their jobs. The issue of taking care of high-risk mothers is a matter of teamwork.\u0026quot; (Midwife/15 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u0026quot;It\u0026apos;s not possible to isolate a room and hospitalize the mother with Covid-19 and do all her works there. The facilities must be enough. The issue of air conditioning is very important. Our exhaust fans are mostly weak. Every time you had a Covid-19 mother, there were many shortages in the room. Once there was no Sonicaide, once there was no NST tape. Once there was a shortage of birthing kits. No matter what you did, no one would help us. We had to take them by yourself. This also caused the infection to spread. At first, they didn\u0026rsquo;t give the masks to us. They said it\u0026rsquo;s\u0026nbsp;based on quota. For a long work shift, they gave a mask for 12 hours. There were many shortages and problems.\u0026quot; (Midwife/20 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme 4-2 Enhancement of career field\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants pointed to their organizational and job needs from the government and other government organizations, and consider solving their problems and needs at the critical time, and receiving practical support as a type of appreciation.\u003c/p\u003e\n\u003cp\u003e\u0026quot;What I am most unsatisfied about is that no one supports the midwives. We expected the Ministry of Health and the University to at least support us here, but I remember that at the beginning they didn\u0026rsquo;t provide masks for us. Midwives don\u0026rsquo;t receive any support. Their position is always threatened. This situation showed how effective our existence can be, so it\u0026apos;s time to show us our true position.\u0026quot; (Midwife/15 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u0026quot;Some things may be very small and insignificant, but these things make us feel valued. For example, free parking, giving food packs during the work time, these kinds of things really help to make us feel better. We don\u0026rsquo;t need them, but doing these things for the staff makes them feel that their needs are respected and that they are valuable to the hospital, and this is very important. There is no need to always thank them with payment. Appreciation from authorities at the maternity hospital or the written encouragement is a great encouragement.\u0026quot; (Midwife/1.5 years of work experiences)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme 4-3 Improvement of employment conditions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026quot;It is not enough for us to get appreciation. It will even make us disappointed. They\u0026nbsp;think\u0026nbsp;this is enough for us. But we want safe working conditions and payments for our risks. They should pay attention to the needs of doctors and midwives. Our income should be fare. We risk our lives and our families\u0026rsquo; lives.\u0026quot; (Midwife/14 years of work experiences)\u003c/p\u003e\n\u003cp\u003eSome midwives defined the support plan they need in the stability of their job position:\u003c/p\u003e\n\u003cp\u003e\u0026quot;I spent the whole time at Corona Center Hospital. Hiring us is the least they can do for us. They should contract with us for a long time or hire us. There should be a quota for medical staff who are on the frontline in this situation.\u0026quot; (Midwife/1.5 years of work experiences)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of this qualitative phenomenological study was to explore the real time experience of birth attendants in caring for pregnant mothers who are suspected or infected with Covid-19, in the labor and delivery departments. The results consisted of four themes: \"lost peace\", \"spirituality\", \"pride\" and \"looking forward to a better future\". Although no study has been conducted in the field of midwives' experiences in caring for mothers with covid-19 disease, but in some similar studies, the experiences of medical staff have been investigated. The theme of \"lost peace\" includes the sub-themes: \"feeling of social isolation\", \"being separated from the family\", \"psychological tension\", \u0026ldquo;job challenges\". Similar themes were also expressed in other studies. In a study entitled \"Nurse's report of stressful situations during the COVID-19 epidemic\", the negative emotions of nurses included fatigue, discomfort and helplessness due to high-intensity work, fear and Anxiety and worry for patients and family members were among the themes. Other themes included pandemic-related limitations and feelings of inadequacy/helplessness regarding patients and their treatment, and more than half of all stress-related comments related to difficulties in responding to the pandemic at work (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In another qualitative study conducted in 2021 regarding healthcare providers' experience of service delivery during the COVID-19 pandemic, which analyzed the data, four main themes including, \"Working during the pandemic,\" \"Change In personal life and increasing negative emotions\", \u0026ldquo;experience, normalization and adapting to the epidemic\" and \"mental health considerations\" were extracted. The present results showed that the deterioration of mental illnesses is revealed through a stepwise process with the spread of the epidemic (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In another study with a phenomenological approach, the real time experience of nurses in caring for patients with covid-19 in Iran showed that nurses who worked in covid-19 wards suffered from mental and emotional distress. Mental state (subthemes including \"anxiety and stress\" and \"fear\"), emotional state (subthemes including \"suffering\" and \"expectation to die\"), and context of care (subthemes including \"confusion\" and \"lack of support and equipment\") were extracted as the main themes (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a study on the experiences and perceptions of healthcare workers during the coronavirus pandemic in Oman (2020), the main themes included \"perceptions of mental disorders as consequences of social distancing\", \"cadaver management\", \"healthcare worker fatigue\" and \"being at risk of disease\" (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). On the other hand, according to another similar study, while nurses are on the front line of fighting against the pandemic, they had problems in their personal-emotional dimension and in the maternal dimension (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). \"Difficulty in adapting to a demanding environment\" (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) is one of the experiences in dealing with new work environments. Since this pandemic is an emerging situation, the experience of people's first encounter with the disease, seeing heartbreaking scenes and social distancing, the loss of peace was not far from the mind.\u003c/p\u003e \u003cp\u003eAmong other main themes extracted from the present study was \"spirituality\". The midwives present in the study, faced with this disease, saw themselves in the field of divine test and always asked help from God. Midwifery is one of the professions that is always mixed with spirituality (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). One of the well-established values ​​of spirituality is that it helps people cope with major life stresses (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Although the present theme was a new finding in the studies, but since midwifery is a profession based on helping others, however, long working hours and their exposure to traumatic birth events affects the level of spiritual care and compassion (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). In a study about the experience of being a mother and a nurse during a pandemic, the participants' religious themes were found to be valuable in coping with the experienced chaos (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Spiritual awareness of the birth experience emerges through relationships and is influenced by the spatial environment. Spiritual midwifery is a relational approach to childbirth care that recognizes and values ​​the existential importance and meaning of childbirth (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The quality of the relationship between the midwife and the woman is widely recognized as a critical factor in pregnancy and childbirth. Some authors argue that it is the presence of a spiritual force that enables midwives to fully actualize their communicative capacity with pregnant women (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In the current study, both pregnant women as service receivers and midwives as service providers are under pressure and many challenges. In dealing with a new situation and an emerging disease, there was a spiritual management experience in all stages of service delivery.\u003c/p\u003e \u003cp\u003eThe midwives who participated in the present study were full of pride and honor and felt a sense of heroism and of self-sacrifice. In a study examining the psychology of nurses caring for COVID-19 patients, participants expressed that they experienced growth under pressure, which included increased affection and appreciation, development of professional responsibility, and self-reflection (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). In the difficult conditions caused by the epidemic and based on the beliefs that exist among health care providers in Iran (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), the emergence of such a theme was expected.\u003c/p\u003e \u003cp\u003eThe theme of \u0026ldquo;looking forward to a better future\u0026rdquo; included the need to improve the work environment, seeking to improve the field of midwifery, and looking forward to improving individual job conditions. Studies have shown that improving the working conditions of midwives contributes to the quality of maternal health care (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). The doctors who were working in the NHS center required receiving privileges such as rest spaces against mere gratitude (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). In another qualitative study on health and social care workers' experiences and views of psychosocial support during the Corona pandemic, the results showed that people's experiences and views on psychosocial support are complex. Support from frontline peers was the expectation of many people. Health care workers were ambivalent about support from organizations, the media, and the public, and while they valued mental health support services, there were large differences in provision and barriers to access (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). From the data analysis, it organizational issues and support for novice nurses were related to fear and concerns (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). In the real time experience of novice midwives, the results showed themes for describing the meaning of clinical practice for newly qualified midwives. Preparation, meeting expectations, knowledge and practice gaps, need for clinical support and guidance, and continuing professional education of midwifery educators should be addressed when reviewing and revising midwifery education programs to prepare midwifery students for workplace (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Another phenomenological study in the field of midwives' real time experience of care during childbirth in 2014, the general structure of the phenomenon of care in midwifery during childbirth included the key components of division of responsibility, active and real presence, creating a relaxed atmosphere in a mutual relationship, having clinical knowledge. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Performing any behavior in humans is in the hope of achieving some kind of benefit (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). In the present study, due to dealing with a critical situation and also the participation of some young people in the study, a better future was one of the motivations for hard work and facing the dangers of the epidemic.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eStrengths \u0026amp; limitation\u003c/h2\u003e \u003cp\u003eThe present research is valuable for providing a real insight into the causes of the covid-19 pandemic. Among other strengths of this study, we can mention the detailed analysis of qualitative data and all the measures taken to maximize the reliability and trustworthiness of the findings. However, it should be acknowledged that due to the qualitative research design and the small sample size, the generalizability of the findings is not possible. According to the time of the study, the available samples were only limited to two hospitals. In addition, it is important to mention that the meaning of the real time experience of birth attendants caring for pregnant mothers with Covid-19 may be beyond their experience only in the hospital work environment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eImplications for practice\u003c/h2\u003e \u003cp\u003eSeeking for a better and deeper understanding of the experiences and concerns of birth attendants in crises such as the Covid-19 pandemic can be helpful in better understanding their needs and developing support and protection programs for this group. More research is recommended in the field of clinical experiences of birth attendants in the context of the Covid-19 pandemic. In addition, the necessity of increasing cooperation and providing support and consulting services to the medical staff is emphasized.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this article, participants experienced a wide range of emotions during the pandemic. Although they were valuable as specialists in the front line of fighting the disease, they faced challenges in different aspects such as professional, personal and emotional. Providing mental health assistance should be an essential part of services for health care providers during a pandemic. Based on the results obtained in the present study, assistance should be focused on different stages and be person-centered, because such interventions are very important to maintain the ability of midwives/gynecologists during the pandemic. This study shows the need for structural organizational policies so that midwives/gynecologists are in an equal and safe position to fulfill their profession and have a healthy relationship within the family, especially in the face of difficulties such as the Corona pandemic. Training courses increases the self-confidence of midwives in dealing with new diseases and providing better quality care. On the other hand, medical and health care organizations should provide opportunities for midwives to discuss their experience, support each other and offer suggestions for improving services at the workplace during this epidemic. Midwives/gynecologists can share their experiences for continued professional development. More research is needed to implement and evaluate the impact of different service practices in relation to midwifery care and whether this can benefit the care of women in the Covid-19 pandemic.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present research was approved by the ethics committee of Mashhad University of Medical Sciences, Iran, with code IR.MUMS.REC.1399.124. In addition, before the final selection, complete explanations were given to participants about the objectives of the study, data collection method, the confidentiality of information and the right to withdraw from the study at each stage. Also, informed consent was obtained from all the participants for engaging in the study and recording the interviews. Finally, a unique code was assigned to each participant (midwife 1, midwife 2, assistant 1, etc.) to ensure anonymity. For the sake of confidentiality, the file containing their audio interviews has been kept in a safe place.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript does not contain personal data, such as individual details, images, or videos. The authors confirm that all research participants provided informed consent for the publication of this manuscript\u003cstrong\u003e.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFinancial resources were provided by Mashhad University of Medical Sciences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;SA provided the conceptual framework and designed the study. SA conducted the interviews, performed initial data analysis, and drafted the manuscript. FSH and RLR collaborated on further data analysis, interpretation, and manuscript drafting. All authors reviewed and approved the final manuscript\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research team is sincerely grateful for the support of the Vice Chancellor for Research of Mashhad University of Medical Sciences and all the mothers who shared their experiences with the researchers.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of autoimmunity. 2020:102433.\u003c/li\u003e\n\u003cli\u003eOrganization WH. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). 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The economic approach to human behavior: University of Chicago press; 1976.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1- Demographic characteristics of Participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.300683371298405%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.369020501138955%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eJob Position\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.40091116173121%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.929384965831435%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork Experiences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.300683371298405%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.369020501138955%\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.40091116173121%\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.929384965831435%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.300683371298405%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.369020501138955%\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.40091116173121%\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.929384965831435%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.300683371298405%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.369020501138955%\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.40091116173121%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.929384965831435%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.300683371298405%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.369020501138955%\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.40091116173121%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.929384965831435%\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.300683371298405%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.369020501138955%\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.40091116173121%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.929384965831435%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.300683371298405%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.369020501138955%\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.40091116173121%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.929384965831435%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.300683371298405%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.369020501138955%\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.40091116173121%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.929384965831435%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.300683371298405%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.369020501138955%\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.40091116173121%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.929384965831435%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.300683371298405%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.369020501138955%\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.40091116173121%\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.929384965831435%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.300683371298405%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.369020501138955%\"\u003e\n \u003cp\u003eResidents of Obstetrics and Gynecology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.40091116173121%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.929384965831435%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.300683371298405%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.369020501138955%\"\u003e\n \u003cp\u003eResidents of Obstetrics and Gynecology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.40091116173121%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.929384965831435%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.300683371298405%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.369020501138955%\"\u003e\n \u003cp\u003eObstetrician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.40091116173121%\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.929384965831435%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2- The summary of Themes and Subthemes\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubthemes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eThemes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eSocial Isolation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" rowspan=\"4\"\u003e\n \u003cp\u003eLost peace\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003eFamily Separation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003ePsychological Tensions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003eOccupational Challenges\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eIn the field of divine test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" rowspan=\"2\"\u003e\n \u003cp\u003eSpirituality\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003eDemanding from God\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eA result of a hero\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" rowspan=\"2\"\u003e\n \u003cp\u003ePride\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003eA manifestation of self-sacrifice\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eImprovement of working environment conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" rowspan=\"4\"\u003e\n \u003cp\u003eLooking forward to a better future\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003eA manifestation of self-sacrifice\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003eEnhancement of career field\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003eImprovement of employment conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Phenomenology, Covid-19, Birth attendants, Midwifery","lastPublishedDoi":"10.21203/rs.3.rs-3344539/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3344539/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCovid 19 pandemic has imposed the increased workload and challenges to birth attendants while providing the required care for delivery in mothers. However, so far, no study has been performed based on the experiences and views of this group. The present study was performed with the aim of filling the existing research gap in this field by exploring the real time experiences of birth attendants in caring for suspected/infected pregnant mothers during the pandemic.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe present research is a qualitative phenomenological study that was conducted on birth attendants (midwives and doctors) of pregnant women suspected/infected with covid-19 in the delivery department of teaching hospitals located in Mashhad, Iran, from March to May 2020. The qualitative data was collected about the real time experiences of the participants and was analyzed by six methodological steps proposed by Van Menen (1990).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eInterviews were performed with 12 birth attendants working in teaching hospitals. Four final themes were obtained about the real time experience of this group for caring pregnant women suspected/infected with Covid-19 in the delivery department. These themes included: \"lost peace\", \"spirituality\", \"pride\" and \"looking forward to a better future\".\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe final results indicated that despite the fact that midwives/gynecologists played a valuable role as obstetricians in the frontline of the fight against the Covid-19 disease, they faced many challenges in various occupational, personal, and emotional dimensions. By the way, structural organizational policies are recommended to provide midwives/gynecologists an equal and safe position to fully perform their profession and a have healthy relationship within the family.\u003c/p\u003e","manuscriptTitle":"Birth attendants’ lived experiences of caring for pregnant women suspected to or diagnosed with Covid 19 in labor and delivery ward based on a phenomenological approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-10-04 06:58:25","doi":"10.21203/rs.3.rs-3344539/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5148f46a-ada3-4749-8ca7-cf30361cbb1e","owner":[],"postedDate":"October 4th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-22T03:38:19+00:00","versionOfRecord":[],"versionCreatedAt":"2023-10-04 06:58:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3344539","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3344539","identity":"rs-3344539","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}