1 Introduction

Evidence of systemic racism and discrimination are gradually receiving more attention in the medical field and specifically in maternal health (Kamal, et al., 2019). This recognition brings to light the fact that the infant mortality rate (number of infant deaths per 1,000 live births) is not only the highest in the United States among comparable countries but also significantly higher for Black populations in America (Kamal, et al., 2019). Notably, Black mothers are disproportionately affected by adverse maternal health conditions and are dying from preventable complications at a rate that is between 3 and 4 times that of white mothers (Taylor, el al., 2019). These national trends are also evident in data collected specifically within the city of Pittsburgh, Pennsylvania; in fact, the 2019 report “Pittsburgh’s Inequality across Gender and Race” spotlights that Black women living in Pittsburgh have a higher maternal mortality rate than Black women living in 97% of similar cities (Howell, et al. 2019). Looking at the data at both a national and local scale, it is imperative that work is done to address this discrimination found in maternal health care.

Furthermore, the COVID-19 pandemic has placed a strain on the United States’ healthcare infrastructure, which has further exacerbated the discrimination faced by Black women. With these additional strains, now more than ever, Black women have shown immense concern over being able to receive adequate prenatal care and an overall positive birthing experience (Erickson, 2020; Minkoff, 2020; Gur, et al., 2020). As students approaching careers in healthcare following the outbreak of one of the deadliest pandemics in modern history, we were acutely and personally aware of the wave of effects that COVID-19 was having on life in the United States. The pandemic not only revealed vulnerabilities within our healthcare infrastructure but also laid bare the stark disparities that exist, particularly within maternal care. It was our shared conviction that understanding the repercussions of COVID-19 on maternal health, specifically in a racially diverse community like Pittsburgh, could serve as a microcosm of the larger healthcare challenges faced worldwide. We embarked on this research project with a deep sense of responsibility to shed light on the unfiltered experiences of mothers and to explore the potential role of the pandemic in exacerbating maternal stressors, as well as pre-existing racial divides in maternal care. We hope that through this study, and future studies, anecdotes from a diverse group of people can be collected and shared in a way that will be sustainable and accessible to all, ultimately allowing mothers of all backgrounds to feel heard while also providing a starting point for further exploration of the effects of COVID-19 on maternal health inequity.

2 Methods

3 Results

The CMHE survey was divided into four sections: demographic questionnaire, stress level identification, anecdote collection, and vaccine experience questionnaire. Each section addressed a different major research question and therefore all data from separate survey sections required unique, deliberate approaches to analysis.

4 Discussion

Although the CMHE survey aimed to reach a diverse group of mothers residing in the United States, the demographic composition of participants revealed a certain degree of homogeneity that prevented analysis of potential racial disparities. Specifically, our sample was overwhelmingly female (115 out of 119), not differently abled (102 out of 119), married (103 out of 119), white (103 out of 119), having received a bachelor’s degree or higher (84 out of 119), belonging approximately to the upper-middle to upper class based on household income (78 out of 119), and residing to Pennsylvania (83 out of 119). This homogeneity in participant demographics may be attributed to the limitations of our recruitment methods and the challenges associated with achieving a truly representative sample of the United States (or even of a city as diverse as Pittsburgh, Pennsylvania).

Limitations that may have influenced participant demographics were numerous. Notably, the CMHE survey was released while the COVID-19 pandemic caused capacity to be limited in certain public spaces, and many people (especially pregnant people) avoided these spaces to reduce their risk of contracting the disease; therefore, in-person flyering was difficult and perhaps somewhat ineffective at recruiting participants. Advertising of the CMHE survey was resultingly mainly online and, in conjunction with a survey that itself was online, limited the population to being people with access to a device with internet accessibility. As previously mentioned, the CMHE survey was originally intended to be restricted to only participants residing in Pittsburgh, Pennsylvania; however, with minimal resources to help boost recruitment efforts, we quickly realized that would yield a low number of participants and therefore decided to expand our scope to the entire United States. Furthermore, we expect that even potential participants who came into contact with flyers and/or online advertisements may have decided against completing the survey due to lack of trust in the research community, especially considering the personal nature of many of the CMHE survey questions. Future research efforts should consider more targeted recruitment strategies and greater outreach to ensure a more diverse participant pool.

Lack of diversity in participants was immediately evident in responses to the portion of the CMHE survey which asked participants to report their stress levels in relation to a list of topics. Again, certain topics seemed to evoke, on average, more heightened levels of stress from nearly all participants regardless of personal demographic information, such as the likelihood of contracting COVID-19. Concerns of childcare were also universally quite high, as the widespread closure of schools and daycare centers combined with returning to the office after many months of remote work were expected to introduce a complex new set of challenges for parents of various socioeconomic backgrounds.

Interestingly, certain prompts given to participants yielded results indicative of low to average stress. Comparing these results to the average demographic information of survey respondents further raised our suspicion of the potential influence of homogeneity among the sample, particularly homogeneity that on average was very white and likely would fall within the category of upper-middle to upper class according to the Social Security Administration’s 2022 wage data (National Average Wage Index, 2022). For example, average reported stress levels related to risk of job loss and the possibility of working under dangerous conditions were, on average, not significantly high for the CMHE survey participants. It is possible that the economic stability and job security typically associated with our sample demographics may have contributed to the relatively modest stress rank for this category. Similarly, financial worries, such as job loss, reduced income, and economic uncertainty, were expected to contribute to the overall self-reported increase in stress levels; however, the economic stress experienced by our participants, while notably present, did not reportedly exceed their pre-pandemic financial concerns to a significant degree. It is essential to consider that our sample, which primarily comprises upper-middle to upper-class mothers, may have had more financial stability and resources to cope with the economic impact of the pandemic, which could account for the relatively modest heightening of financial stress levels.

While concerns about receiving proper prenatal care during the pandemic were evident in our sample, including worries about the accessibility of healthcare services, potential disruptions in prenatal care, and the safety of healthcare environments, these concerns did not result in above-average stress levels for a few potential reasons. It is possible that the relatively high socioeconomic status of our sample allowed respondents to navigate these concerns with a greater degree of resilience and confidence. We also predict that, as many survey participants had reported already having experience with pregnancy and/or maternal healthcare from prior to the onset of the pandemic, those whom were the mother of multiple children had been able to mitigate the overall impact of COVID-19 on their level of stress simply by being familiar with the birthing process and potentially by having connections to a trusted birth team. The final category of note was related to stress surrounding having a positive birthing experience; although this category showed responses most similar to that of the aforementioned “high stress” categories, again, it is possible that the financial and healthcare resources available to our sample provided a level of comfort and security that contributed to an overall modest level of stress related to birthing experiences in the midst of the pandemic. Regardless, worries about labor and delivery procedures, access to support persons during childbirth, and the health and well-being of the newborn, among other universal yet naturally urgent concerns, potentially contributed greatly to the stress reported by many survey respondents.

While our data and sample made it impossible for us to definitively answer the initial research question, new questions and observations emerged during data collection and analysis. By enabling the sharing of personal anecdotes, the CMHE survey offered an opportunity for survey participants to express themselves. Because of its anonymity, many participants felt comfortable with describing their frustrations, fears, disappointments, and more in regards to the COVID-19 pandemic and their maternal health experiences. Therefore, despite our inability to make direct comparisons and draw conclusions regarding the pandemic’s impact on maternal health (due to low survey participation and undiverse sample demographics), we uncovered a rich tapestry of maternal experiences, shedding light on the challenges and concerns faced by mothers during this extraordinary period.

The original hypothesis that the COVID-19 pandemic may exacerbate the racial divide seen in maternal care in Pittsburgh remains a critical question. Although we could not provide a conclusive answer in this study, our findings indicate the importance of continuing this exploration. The narratives shared by our participants underscore the complex interplay of systemic inequities and personal experiences, highlighting the need for a more in-depth investigation into the intersection of race, maternal health, and the pandemic. Future research efforts should delve deeper into this critical issue, employing a larger and more diverse sample to capture the nuanced differences in experiences among mothers of color and white mothers.

One notable aspect of our research approach was the inclusion of open-ended questions that encouraged participants to share their personal anecdotes in an intentionally unfiltered manner. Personal anecdotes, in many cases, transcended quantitative data in capturing the true essence of the maternal experience in this unprecedented time. This approach should be further implemented in future research as a means to capture the multifaceted nature of maternal health and its intersection with social and healthcare systems.

5 Conclusion

While our study faced some limitations, such as a homogenous participant demographic and questions left unanswered, it nonetheless offered invaluable insights into the experiences of mothers during the COVID-19 pandemic. Our study underscores the need for continued research on the racial disparities in maternal care and the potential exacerbating impact of the pandemic. Furthermore, the qualitative narratives shared by our participants reveal the power of personal anecdotes in gaining a deeper understanding of the complexities of maternal health during times of crisis. These findings lay the foundation for future research in the realm of maternal health and healthcare equity.