Pallango P/ Enfermería Investiga Vol. 8 No. 4 2024 (December - January)

PERCEPTION OF THE PREGNANT PATIENT ON THE ATTENDANCE TO PRENATAL CHECKS DURING THE COVID-19

PANDEMIC

Paola Estefanía Pallango Plasencia1https://orcid.org/0000-0002-5565-3207, Eulalia Isabel Analuisa Jiménez2https://orcid.org/0000-

0002-7906-7640

1Nursing Career, Faculty of Health Sciences. Technical University of Ambato. Ambato, Ecuador

2Professor of the Nursing Career, Faculty of Health Sciences. Technical University of Ambato. Ambato, Ecuador.

Creative Commons License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: July 1, 2023

Accepted: September 30, 2023

ABSTRACT

Introduction: In times of the COVID-19 pandemic, attendance

at prenatal check-ups by pregnant patients has been a matter of

concern, which is why it is necessary to know their perception in

order to attend health establishments or not. Objective: To

describe the perception of the pregnant patient about attendance

at prenatal check-ups during the COVID-19 Pandemic. Method:

Qualitative, phenomenological, descriptive, cross-sectional field

study, conducting semi-structured interviews taking into account

the perspective of pregnant women in the community of Salcedo

- Ecuador, maintaining the principles of autonomy, respect and

confidentiality of information, analyzing the results through the

methodology of Demaziére D. and Dubar C. Results: It was

evidenced that there is a significant non-compliance with prenatal

check-ups since the beginning of the pandemic, due to fear and

concern about being infected at the time of attendance. Likewise,

there are different opinions about the care provided by health

professionals, both public and private, highlighting the feminine

nature of care by blood relatives, such as sisters or

grandmothers, taking preventive behaviors to avoid getting

infected and being available to care for the pregnant for others.

Conclusions: The pregnant women expressed different

emotions, feelings and thoughts, such as: fear, trepidation,

concern, frustration, stress, depression, among others, which

have influenced, in a representative way the decision, to attend

or not to prenatal check-ups, assuming the risk of contagion and

complications in pregnancy. Non-attendance at prenatal check-

ups since the beginning of the COVID-19 pandemic has become

more regular as time has passed.

Keywords: perception, prenatal control, pandemic.

Corresponding author: Lic Mg. Eulalia Isabel Analuisa Jiménez. Email: ei.analuisa@uta.edu.ec

INTRODUCTION

In Spain, years before the pandemic, it has been estimated at

least 410,583 pregnancies per year, increasing over time. In the

case of pregnant women who have contracted COVID-19

throughout the months of confinement, an exact number of 47

pregnant women hospitalized with confirmed COVID-19 has

been identified; also stating that the majority suffer from

additional chronic diseases such as diabetes, overweight, high

blood pressure, among others (1, 2).

On the other hand, in Mexico the existence of 5,574 pregnant

and postpartum women infected with COVID-19 has been

reported nationwide, especially in states such as Tabasco,

Sonora, Nuevo León, Veracruz, Guanajuato including Mexico

City, showing that the majority of cases present pregnant women

with mild or severe symptoms of various pathologies, generating

a mortality of at least 458 pregnant women during the months of

confinement in the world (2 , 3).

In Ecuador, there have been 6,574 cases of pregnant women

with COVID-19 to date, of which 849 have died, due to acute

respiratory complications, such as the attack of infections in

conjunction with serious pathologies, such as: high blood

pressure, obesity, heart disease, and even pre-existing lung

diseases; although there have also been cases of asymptomatic

pregnant women who have developed serious complications (2,

4).

Pallango P/ Enfermería Investiga Vol. 8 No. 4 2024 (December - January)

Clarifying the above, COVID-19 is a type of pathology caused by

the severe chronic respiratory syndrome type II virus, known as

SARS-CoV-2, which generates two large pathological groups.

The first is the coronavirus acquired in the community and the

second is the zoonotic coronavirus. The latter being the one that

affects humans. Among the clinical manifestations of the virus,

the existence of asymptomatic infections and chronic pneumonia

is identified, where the application of assisted ventilation is

necessary, even though it has been verified that, in the majority

of chronic cases, the outcome ends in the death of the person

(5).

In this case, it is highlighted that pregnancy is a physiological

state that disposes the pregnant woman to develop respiratory

complications due to purely viral causes, either due to changes

in the respiratory system or due to variations in the immune

system. It is established that the high levels of progesterone,

when working in the respiratory system, together with the

continuous increase in the diaphragmatic domes, generate a

reduction of the entire respiratory reserve volume; reducing, in

turn, the functional residual capacity, increasing the need for

oxygen due to slight hyperventilation, leading to hypocapnia and

an increase in the level of bicarbonate excretion with respiratory

alkalosis by the kidneys (6).

It has been shown that the lethality of COVID-19 in pregnant

women is at least 25%, although there are no studies and

research that support that pregnant women are more likely to

contract this type of infections. However, it is necessary that any

type of risk or complication during pregnancy be identified and

treated immediately, taking into account additional maternal

pathologies, because if a pregnant woman presents Covid-19

coupled with any serious illness, the mortality levels and lethality

are totally increased, putting maternal and fetal life at risk (2).

The most latent concern in the event that a pregnant woman

contracts COVID-19 focuses on the risks of maternal and/or fetal

death; or, the possible negative effects that may develop in the

fetus, and in any case in the newborn. However, given the lack

of information due to the few studies carried out on the subject to

date, by taking samples from the umbilical cord, placenta,

amniotic fluid and even breast milk, it is highlighted that in none

of the cases presented there has been transmission of the virus,

much less vertical transmission; but variants may exist as the

virus continues to advance in the world (7).

It is important to mention that COVID-19 does not cause a risk of

abortions or early pregnancy losses, although intrauterine

transmission is not ruled out without causing malformations or

congenital damage. Diagnosis of the virus in pregnant women

must be carried out during prenatal check-ups, as there are

cases of pregnant women who do not present symptoms of the

infection. However, the follow-up and treatment should be the

same, as it does not exempt the risk of complications or death

(8).

Prenatal check-ups are considered a public health service,

whose performance is focused on supply, so that pregnant

women use it responsibly. Among the influential factors for the

use of prenatal controls are the need of the pregnant woman,

maternal/fetal health care, responsibility for gestational care,

prevention or early detection of diseases; in addition to

conceiving a safe, risk-free birth (9).

On the other hand, it is established that prenatal controls are

preventive measures against maternal-fetal morbidity and

mortality, which is why they must begin during the first months of

the gestational period, continuing until the moment of delivery, in

order to continually evaluate the development of the fetus,

normal placental/uterine functioning, and even to confirm or rule

out any anomaly or malformation of the fetus; without leaving

aside the possibility of diagnosing any condition of the pregnant

woman that could affect the health and normal progress of the

pregnancy (10).

Therefore, the data available so far suggests that pregnant

women are at greater risk of developing a severe form of COVID-

19 and, in some cases, could progress to death, elements that

are warned by the global epidemiological alert of the World

Health Organization (WHO). In this sense, the Pan American

Health Organization (PAHO) recommends that countries

address the specific risks and vulnerabilities faced by this

population, ensuring the continuity of prenatal care services, as

well as timely attention to serious signs and symptoms. by

COVID-19 in pregnant women (11).

For this reason, every pregnant woman who does not present

symptoms and, above all, who does not maintain any suspicion

of infection, should routinely undergo prenatal check-ups, taking

the necessary care measures. However, in the event that the

pregnant woman presents symptoms or suspicions of COVID-19,

all medical appointments must be postponed until the isolation

period ends. Nevertheless, throughout this period she will have

telephone medical attention due to possible risks or need for

urgent medical assistance. (12).

The present study aims to obtain important data that helps inform

people who are interested, so that the recommendations

published by public health agencies are taken into account, and

in this way, evaluate the emotional exhaustion of women in

pregnancy during the isolation period seeking to avoid the

community spread of COVID-19. At the same time, it is meant to

describe the way in which the problem was faced and what was

the perception of such a situation in order to have a pregnancy

in good conditions, from the beginning until the quarantine

measures are less rigid, being able to carry out more activities

related to pregnancy, living with other people and/or outside the

home. Therefore, the approach is aimed at identifying the

phenomenological aspects that pregnant women, during the

pandemic, presented to comply with prenatal check-ups.

This research project is of great importance since it will allow the

collection of relevant information to contribute to the study, given

that the COVID-19 pandemic related to pregnancy is a new topic

in the world of research. For this purpose, the study objective was

to describe the perception of the pregnant patient regarding

attendance at prenatal check-ups during the COVID-19

pandemic.

METHODS

A qualitative, descriptive, phenomenological research was

carried out, since it answers questions about why people do what

they do. It seeks to understand the meaning of the experience or

explore a phenomenon from the point of view of another (13).

This research was considered field research, since its purpose

was to collect and record in an orderly manner the data related

to the topic chosen as the object of study. In view of the above,

observation and questioning are the main techniques used in the

study (14). That is, pregnant women from the community of

Salcedo – Ecuador, were interviewed according to their interest

Pallango P/ Enfermería Investiga Vol. 8 No. 4 2024 (December - January)

in participating. Eight semi-structured interviews were carried

out, which consisted of having a conversation with one person or

several people to extract data about what is being held in the

conversation. Through this, research is promoted on a topic

related to the problem to be treated and which involves obtaining

reliable data (15) It is taken into account what is indicated in the

criterion of information saturation, where if the information

collected by the participants is repeated the data collection

process must be terminated (16).

Each of the interviews carried out had been transcribed. The

information was triangulated, which included the use of several

strategies when studying the same phenomenon (17), following

the methodology of Demaziére D. and Dubar C, resulting in a

detailed description, with exhaustive analysis to understand the

meaning of the narrative of the observed participants (18).

RESULTS

The perspective of patients during pregnancy, going through the

situation of the COVID-19 pandemic, has been worrying, making

it necessary to propose strategies that provide confidence to

pregnant women, with the hope that they comply with prenatal

check-ups.

Category 1. Emotions, Feelings and Thoughts

The key informants agreed when reporting what they felt when

the COVID-19 pandemic began, having to attend prenatal check-

ups, aspects that are transcribed in summary form, taking into

account the relevance of their contributions. In this sense, Liseth

related the following: “…Actually, I did worry a lot because it was

the fear of suddenly becoming infected, of having what I know,

days or weeks, of my defenses being low; Yes… I was very

afraid, for me and my baby…” Similarly, Paola expressed: “…It

generated concern and fear in me, because in these moments

one has to take more care of oneself, both for one's health and

the baby’s, so until now, my greatest fear is "May something

happen to my baby because of this pandemic...?" Likewise,

Estefanía mentioned: “…I was too afraid, too afraid, to the point

of also reaching frustration, thinking about the idea I could get

infected, and in such a way, that would affect my pregnancy, also

yes… I went into depression…”

On the other hand, Katherine commented the following: “…My

perception was very calm, I thought it was a simple illness, that

in one or two months it was going to pass, and everything was

going to be normal as before, but actually, when it already came

it lasted more than 2 months, so there... it was a little more

worrying, because you as a young person can be exposed, but if

you already have a life inside you, it is super more

complicated...".

Category 2. Attendance to Prenatal Controls

The participants mentioned that the COVID-19 pandemic has a

significant impact when making the decision to attend prenatal

check-ups or not. As Doris stated: “…at the beginning of March,

when the pandemic had already begun, I no longer went,

because I found out that they were already infected, there were

quite a few of them, that is, more than anything. It was my fear of

leaving and get infected in a clinic or a hospital, because I knew

that those who were infected with COVID were going there, so I

missed 2 months of check-ups…” In the same way, Mirian

commented: “…well I am a person who suffered from

Preeclampsia, and yes…. I was afraid, because I had to attend

often, sometimes almost once a week, that's how they called me,

every week the doctors called me, because my blood pressure

was going up, I... but well, the pandemic thing already started

and I already I stopped going to the hospital…”

Category 3. Perception of birth options: Public hospital or

private clinic

The interviewed participants had different perceptions regarding

this aspect, as Jéssica expressed it: “…at first we were quite

hesitant… then not, because also due to the economic situation,

that you obviously have to pay at a clinic, it is always expensive,

but I mean, the mission was to have my baby here in the hospital,

but I had a risk of premature birth a month or so ago, so from

then on, I have a huge fear and the truth is we chose to give birth

in the clinic where I am being checked at…”. Likewise, Katherine

related: “…as I mentioned, I am having the checkup in a clinic in

the city of Latacunga and yes…, we have decided that my

delivery will be right there, we have to see what situation we are

in right now, I don't want to expose myself, my family, or

anyone..."

On the other hand, Estefanía commented the following: “…yes, I

have been talking with my family, to see the possibility of giving

birth in the clinic, but the situation we are currently going through

is very difficult, where we do not have the necessary economic

resource to be able to pay and sustain private medical care; So,

I'm still in that controversy, because I know that they will also treat

me well in a hospital, obviously with the risk of contracting the

disease…” Similarly, Mayra expressed: “…we are still with the

idea of giving birth in the hospital, because I think that there are

more doctors there, that is, professionals who can do something,

maybe for my baby or for me too, so I think about who are more

qualified in anything…”

Category 4. Care received from Health Professionals

In relation to the attention received from health professionals,

there is a different perception on the part of the participants, as

mentioned by Doris: “…Well, I can't complain about the health

staff, because they were up to date, they gave me their

indications, the prevention rules, they took care of me very

well…”. Likewise, Mayra related: “…I went to the health center,

they were very friendly, they had all the protections, they used a

visor, gloves, when I entered the guard took my temperature and

gave me the gel so I could wash my hands, so yes, yes, it was

very good…” In the same order of ideas, Paola expressed: “…In

the clinic, it is very good, because everyone takes safety

measures, they are very friendly, they give a correct explanation

about the process of my pregnancy…”

On the contrary, Jéssica told her experience: “…At the Social

Insurance Hospital, the truth is, if I'm honest, I had a problem

there, both with the licensed nurses and with the gynecologist-

obstetrician, of who was going to examine me, what can I say?

In other words, they sent me, they sent me out of the hospital, so

the truth is, I got a very bad opinion from the Social Insurance

Hospital …”

Category 5. Family accompaniment

Pregnancy is a stage of happiness, both for the woman and her

family, where currently with the pandemic, family support has

been limited in order to avoid the risk of contagion and crowding

in health facilities, as Katherine commented: “…yes,… it was a

little sad, because as I am a first-time mother, it was like I needed

my mother or my husband to be next to me, seeing the new being

Pallango P/ Enfermería Investiga Vol. 8 No. 4 2024 (December - January)

that was being formed in my womb, but it was not possible…”.

Mirian commented in the same way: “…Yes, it was something or

something sad too, because the first check-ups he always

accompanied me and I always even went in there with the doctor

and everything and the doctor explained even to him…”.

DISCUSSION

Pregnancy is a very special period full of emotion and

anticipation. However, for expectant mothers facing the

coronavirus disease (COVID-19) outbreak, fear, anxiety and

uncertainty are clouding what should otherwise be a happy time

(19). According to the aforementioned, the participants agreed

on the different feelings, adding the worry, stress, and depression

that affected them, to maintain a pregnancy in adequate

conditions and circumstances.

Regarding this, Awad et al (20) argue that pregnant women who

perceive they have access to health care receive clear and

coherent action protocols to avoid the risks of contagion, feeling

satisfied with the care and follow-up carried out by gynecological-

obstetric professionals, in turn presenting lower levels of anxiety.

On the contrary, among the study participants, since the

beginning of the pandemic they have felt that the lack of

information, as well as the difficulty in accessing prenatal check-

ups, which has been the most important concern for them,

translating into additional reasons for uncertainty.

Prenatal care requires in-person evaluation, particularly to

evaluate clinical semiology that is essential for timely diagnosis

of pregnancy complications. Such care is essential to detect

pregnancy complications such as preeclampsia, gestational

diabetes and asymptomatic urinary infection, among others (21).

However, one of the participants mentioned that she suffered

from Preeclampsia, for which the doctors told her to attend the

hospital every week, but due to fear of contagion, and something

happening to her or her baby, she stopped attending.

Today, reducing the public health burden of COVID-19 should be

the priority. As obstetricians and gynecologists, we must help

achieve this, implementing measures as simple as spreading

awareness in the community, mostly among pregnant women,

spreading the safe hand hygiene practices, cough etiquette,

social distancing, staying home when sick, and disinfecting

contaminated surfaces (22). According to the interviews carried

out, all the participants mentioned that the professionals who

attended the prenatal check-ups mentioned the biosafety

measures that they should take into account to avoid the spread

of COVID-19.

In this sense, in case of risk of preterm birth and COVID-19

infection, the clinical benefits of antenatal corticosteroid could

outweigh the risks of potential harm to the mother. Faced with

this situation, the balance between benefits and harms, both for

the woman and the premature newborn, must be discussed with

the woman to guarantee an informed decision (23). However, the

majority of the participants mentioned that no health professional

gave them instructions on how to cope with the situation if they

had COVID-19 infection. That is, they are completely unaware of

the actions they should take if that were the case.

It is recommended that the pregnant woman contact the place

where she receives health care by telephone, which must

guarantee the conditions of necessary social distancing, to avoid

crowding of women in routine prenatal care (24). Thus, according

to the interviews carried out, all participants confirmed that, in this

sense, the health establishments where they went for their

prenatal check-ups maintained the conditions of social distancing

between patients, also complying with biosafety regulations.

Likewise, health services must be safe, of quality and warmth,

guaranteeing informed consent, access and reliability of

information related to patients. Therefore, state public health

services must be universal and free at all levels of care, including

the necessary diagnosis, treatment, medication and

rehabilitation procedures (25). Regarding this aspect, one of the

participants mentioned that the care received from health

professionals was bad, having a bad experience when attending

the Social Insurance Hospital, which is recognized as an

excellent public health establishment. However, she stated that

due to the perceived mishap, she made the decision to attend a

private clinic, where the care was totally different, leaving

exposed the question of why the same care is not provided if both

public and private professionals receive their monthly

remuneration.

At this point, as Chávez et al (26) state, the COVID-19 pandemic

scenario forced women to seek care and prevention strategies to

overcome the health crisis, where they came to understand that

care experiences based on social interactions they had to be

perceived beyond clinical recommendations. That is, adding

socio-emotional expressions, where they, on their own, are

determined to create interactions aimed at emotional survival, to

establish preventive actions against COVID-19 during

pregnancy.

On the other hand, as stated by Domínguez et al (27), the impact

produced by the lack of social support perceived by pregnant

women on the development of depressive and anxious

symptoms during pregnancy creates the necessary impact

towards the emphasis to implement programs that offer

additional support during the confinement period, which could be

beneficial in reducing anxiety and depressive symptoms in

pregnant women.

Faced with this, the studies currently being developed indicate

that pregnant women with COVID-19 require special attention,

as they are subjects of high obstetric risk, with an increase in

prematurity, birth complications and neonates with an increase

in admission to nursing units and neonatal intensive therapy (28).

Therefore, the breadth of preventive strategies and practices

adopted by health operators are understood as part of the self-

care model, highlighting in particular the relational dimension in

group care. From the gender studies defended by Viera and Evia

(29), the feminine nature of care is highlighted, where it is sisters,

future grandmothers, other relatives, who take preventive

behaviors to avoid contracting COVID-19 and thus be available

to care for the future mother as well as the newborns, thus

reinforcing the central role of primary social networks (especially

women) in the health-illness-care processes for health care,

mutual help and self-care actions.

Taking into account the above, according to the Epidemiological

Gazette of Maternal Death (30) corresponding to the month of

November 2020, the data related to the main causes of maternal

deaths until EW 48 were taken as reference, being: a) the

hypertensive disorders with 33.33% (51MM); b) obstetric

hemorrhages with 18.95% (29MM); and c) indirect causes with

33.33% (51MM). In addition to this, the same source indicates

that indirect causes have increased due to the pandemic, with

Pallango P/ Enfermería Investiga Vol. 8 No. 4 2024 (December - January) 
33 
 
24MM  indirect  causes  due  to  COVID-19  (30).  Consequently, 
uncertainty  persists  regarding  the  increase  in  maternal  deaths 
from COVID-19, given that, according to the interviews carried 
out, health personnel maintain biosafety measures, both in public 
and private establishments, providing appropriate  education to 
avoid the contagion of the virus at the time of attending prenatal 
check-ups, even considering that these circumstances are due 
to external causes. 
CONCLUSIONS 
The  research  participants  expressed  the  perception  they  had, 
from the moment the COVID-19 pandemic began, about the care 
received  and  in  the  way  it  influenced  when  attending  prenatal 
check-ups.  These  are  considered  important  and  necessary  to 
maintain  a  healthy  pregnancy  in  optimal  conditions,  while 
avoiding complications. 
 
In this sense, the emotions, feelings and thoughts perceived in 
the  research  participants  were:  fear,  trepidation,  worry, 
frustration,  stress,  depression,  others;  which  have  had  a 
representative  influence  when  making  the  decision  to  attend 
prenatal  check-ups  or  not,  including  assuming  the  risk  of 
contagion and complications in pregnancy. 
 
Likewise,  the  phenomenological  factors  identified  by  the 
participants have directly influenced decision-making, given the 
evidence found through the interviews, where non-attendance at 
prenatal  check-ups  since  the  beginning  of  the  COVID-19 
pandemic has been regularized. As time has passed, risk factors 
have  been  minimized.  In  turn,  the  care  provided  by  health 
professionals in the prenatal check-ups of the participants has 
been characterized as good, being in very few and rare cases 
considered  a  bad  experience,  differentiating  the  care  between 
professionals in the public sphere with the care of a private health 
facility. 
 
FINANCING: There were no sources of financing 
 
CONFLICT OF INTERESTS: The authors declare that they have 
no conflicts of interest. 
 
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