1 | INTRODUCTION
The coronavirus (COVID-19) spread out from China in December 2019, and the WHO declared this novel disease a global pandemic on 11 March 2020.1 COVID-19 has caused more than 160 million sickness and 3 million deaths by May 2021 all over the world.2 In response to the pandemic, governments have implemented social restrictions and lockdowns in many countries to prevent disease transmission.3 The first confirmed case in Turkey was reported on 11 March 2020, and the Turkish government has taken immediate actions like social restrictions (closures of schools, the transition to online education, lockdown at the weekend).4 The pandemic and restrictions continue in 2021 in Turkey. The COVID-19 pandemic has negatively affected healthcare system all over the world.5,6 This situation has deeply affected the pregnant women receiving regular health care and services.1,7
Changes in daily life routines during the COVID-19, fear of virus transmission, uncertainty about the impact of the virus on her own and foetus health, and the birth mode preference, and inability to benefit from antenatal services adequately compared to before the pandemic (reduction in the number of pregnant outpatient clinics, giving priority to pregnant women at risk, cancellation/delay of appointments, etc.)8-11, lack of social support11, not being aware of reliable and easily accessible information sources or having difficulties in accessing or using these sources elevate the distress of the pregnant women.6,8,12 Research indicate that the distress of pregnant women has increased more during the pandemic than the pre-pandemic period.5,13,14
In such cases, pregnant women may engage in more “health-seeking behaviour” to alleviate their concerns.7,11 Social isolation and lockdown in the pandemic have increased pregnant women’s search for tele counselling and online health.11,15However, during the health-seeking process, inadequate access to information sources and using either unsafe, inaccurate, and inconsistent information sources or excessive information overload may lead to distress in pregnant women.6,11,16 Pregnancy distress causes obstetric complications such as perinatal depression, miscarriage, preterm birth, intrauterine growth retardation, etc.5,14,17 Therefore, it is pivotal for pregnant women to access correct, timely, and sufficient information.
Insufficient scientific evidence regarding the impacts of COVID-19 infection on pregnancy-foetus and birth mode1, inadequate knowledge about the unit where the birth will take place and the preventive measures taken by health professionals who assist the birth and fear of virus transmission may influence the pregnant woman’s preference of a mode of birth.1,5,8,10,11,18 The distress of the pregnant woman that cannot be prevented/treated can lead to increased birth fears, decreased birth self-efficacy, optional caesarean section preference, and traumatic births.14,19 The WHO (2020) emphasizes that even the COVID-19 positive pregnant woman is not necessarily a caesarean indication, and the mode of birth should be determined according to the obstetric condition and preference of the woman.20
Some studies in the literature have separately examined the impacts of the COVID-19 pandemic on anxiety, depression, and distress of pregnant women.7,10,18,19,21 However, no study to our knowledge has investigated the health-seeking behaviour and mode of birth preferences on pregnancy distress during the COVID-19 pandemic. This study aims to explore the effects of health-seeking behaviour and mode of birth preferences on the distress of pregnant women in the COVID-19 pandemic. It is believed that the study will fill the gap in literature and shed light on future studies.