Skip to main content


Main Content
Lisette Saleh, Ph.D., headshot
Lisette Saleh, Ph.D., and assistant professor of nursing at TCU is conducting a study on women’s childbirth experiences during COVID-19.

Harris College spoke with assistant professor of Nursing Lisette Saleh, Ph.D. who looked at women’s childbirth experiences during COVID-19 and how they impacted birth, postpartum and motherhood.

Giving birth is one of the top reasons women are admitted to the hospital. During the pandemic, only one person was allowed during the birth of a child due to COVID-19 restrictions. The reality was, “women were making changes in what they were going to experience, and they may have had a plan but that wasn’t going to be able to happen,” explained Saleh.

COVID-19 impacted giving birth and being a parent in a powerful way, from not getting baby showers to not having family around at all to provide support. “Women were scared to get child care, women felt exceptionally isolated and a lot of them still have lingering effects mentally,” Saleh said. Many of those women were willing to tell their stories.

The Study

During the pandemic, Intensive Care Units (ICU) became COVID-19 units causing elective surgeries, and even those one wouldn’t consider elective, to be banned – but giving birth was still happening.

With the help of TCU Nursing faculty, staff and students, efforts were made on Facebook to recruit women who’d be willing to participate in a qualitative study that investigated the effects COVID-19 had on childbirth. Within 24 hours, there were over 90 women who wanted to share their experiences.

“When women are coming in and giving birth, it should be a happy experience and it didn’t feel that way,” said Saleh. “They felt very robbed, and it continued affecting them even a year later; it was traumatizing.”

As part of the longitudinal study, postpartum depression and perinatal anxiety were the focus. To begin, they randomly selected women who’d given birth after March 13, 2020, the day COVID-19 was declared a national crisis, to interview. To those who were not interviewed, an open-ended survey was sent to gather similar data. A second survey was sent a year later to reflect on their childbirth experience and how it affected their family planning, postpartum depression, parenting style and whether COVID-19 still affected their life.

The study aimed to identify what providers can do better or differently if there is another pandemic. Saleh stressed that there is a need for mental health support infrastructure and the ability to teach those coping mechanisms already in place for parents.

A Mother’s Experience

Many women said their childbirth experiences impacted how they parent, and some don’t know if they want other children. One woman said she didn’t learn how to work a baby stroller until the baby was six months of age because they were so afraid and didn’t go anywhere. One woman said she was going to have another baby to replace the experience that she didn’t get. Another woman felt empowered stating if she had a baby during the pandemic, she could do anything.

Data shows that parenting has also been impacted. “Toddlers now know what hand sanitizer is when that was not the norm for children and parenting before the pandemic,” said Saleh. “Negotiating who their child can be friends with and whether those children’s parents have the same COVID-19 philosophy or germ philosophy.” COVID-19 caused a lot of conflict within family units and many women said they added COVID-19 to the list of things they don’t talk about at the dinner table.

Saleh and her team learned there was also not enough postpartum support. After giving birth, women usually visit with a provider once within six to eight weeks. However, during the pandemic, providers were not allowing babies to attend the visit with mothers, causing mothers to try to find child care. This was very difficult to do, so many mothers simply did not go.

Additionally, giving birth during the pandemic could have put women back decades Saleh states. Many women quit jobs that required them to be around a lot of people for the safety of their children and in doing so lost that human connection. The obstetrician on the team said her telehealth sessions turned into counseling sessions.

“The maternal mental health system is already fractured and this just strained it more,” said Saleh. “We need to do better in how we care for mothers in the hospital and what we do for them, and make sure it’s science-based, but also recognize there are needs when they are sent home.” Saleh suggests these could be using telehealth better for follow-ups and creating communities for new mothers to feel supported.

What’s Next?

The study team is now conducting a secondary analysis of data. Every hospital system had different methods for distributing COVID-19 information. The providers often were not in the rooms for fear of exposing other patients, so the nurses took on more. The role of a nurse is to support, encourage and educate.

“Nurses on units did the best they could; they did their best with what they knew,” said Saleh.

Saleh hopes this study will tell a story about what the nurses needed and what they get. “We want to be able to inform and don’t want to wait until something happens; we want to be proactive,” said Saleh. “We need to learn what patient experience and health care provider experience can provide policy change or at least create a framework for what needs to be in place.” Saleh explains that these include proper access to information, understanding how telehealth can be utilized, what works and what doesn’t work in hospital policies and adequate guidance for health care providers to have tough conversations.

Another goal of the study is to analyze the one-year data to highlight the need for more mental health for maternity. Saleh hopes these findings will help work toward changing legislation that impacts the amount of time off during maternity leave a woman can have and supporting breastfeeding resources. To do this, Saleh says they will look at health care systems and policies in areas with good postpartum support and work on replicating them.

Aspects of Women’s Health Course

“Our students have a real desire to have more experiences in women’s health, specifically, global issues and image issues and expand their horizon for women in a variety of situations and experiences,” said Saleh.

Because of that, associate professors of professional practice Lynette Howington, DNP, Susan Fife, DNP, and Saleh established a women’s health elective three years ago that is offered each fall that explores the various issues facing women today. The course examines the local and global perspective of women-centric topics such as childbirth, breast cancer, social image, substance use and abuse, body image and many other complex topics. The course is offered to students in all levels of the program and reaches full capacity each fall.

“Students are interested in learning more about topics that impact them and their families,” said Howington. “Toward the end of the class, they realize this also shapes how they relate to and care for their patients. They recognize that exploring topics that impact women is important in all areas of patient care.”

Students interested in becoming involved in this research can reach out to Dr. Saleh directly. For more details about the study, read the published study in the Journal of Perinatal & Neonatal Nursing