Affective-Semiotic Dynamics of the Transition to Motherhood in the Context of the COVID-19 Pandemic

In 2020, the world experienced an unexpected historical moment imposed by the rise of the new coronavirus pandemic (SARS-CoV-2 or COVID-19). The circumstances, marked by deaths without borders due to an invisible enemy of which little was known (Santos, 2020), produced an atmosphere of fear and concern. This surprising event brought about a radical and unanticipated rupture in everyday life, causing significant change in the personal and collective spheres: mobility restrictions, social distancing, work from home, homeschooling, the adoption of hygiene measures and protocols to avoid contamination, and the feeling of lurking chaos. The new coronavirus has had many subjective repercussions, such as increased uncertainties regarding the future, fear of sickness, distancing from loved ones, along with post-traumatic stress symptoms, confusion, and anger, among other negative psychological impacts (Brooks et al., 2020), such as feelings of helplessness and abandonment (Ornell, 2020).

However, the experience of the pandemic is more difficult for some social groups than for others due to pre-existing vulnerabilities. This is the case for women, who have historically endured sexual discrimination and been held responsible for care within and outside the family. With the pandemic, they have experienced work overload, stress, and violence (Santos, 2020). For women who became pregnant and gave birth during the pandemic, we can expect that this historical moment has had a significant impact on how the transition to motherhood is experienced. After all, pregnancy, delivery, and puerperium are critical moments in the course of life and require the restructuring and adaptation of women to the different physical–psychological and social dimensions related to the development of the self (Pontes, 2019).

Together with the demands of such an important developmental transition, the pandemic burdened women with yet other complex personal-collective issues, which vary significantly according to socioeconomic factors, in that maternal deaths seem to be more frequent in low- and middle-income countries, as the result of serious failures of the health system combined with the social determinants of the health-disease process (Lumbreras-Marquez et al., 2020). In Brazil, chronic problems related to women's healthcare, such as low-quality prenatal care, few available hospital beds, insufficient resources for emergency care and critical cases (e.g., lack of ventilatory assistance and difficulty of access to an intensive care unit), racial disparities in access to health services, and obstetric violence, are additional barriers in the context of the pandemic (Takemoto et al., 2020). Regarding the impact of structural racism on maternal deaths by COVID-19 in Brazil, the study by Santos et al. (2020) showed that Black women were hospitalized in conditions of worse severity, such as higher prevalence of dyspnea and lower oxygen saturation, as well as higher rate of admission to the intensive care unit and assisted mechanical ventilation, and also observed a risk of death almost twice as high in Black women compared to White women.

Thus, according to the data analyzed by the Brazilian Obstetric Observatory COVID-19, the number of COVID-19 deaths of pregnant and postpartum women more than doubled in 2021 compared to the weekly average in 2020. Moreover, the increase in deaths in this group was far above that recorded in the general population. According to the survey, an average of 10.5 pregnant and postpartum women died per week in 2020, reaching a total of 453 deaths in 2020 in 43 epidemiological weeks. In 2021, the average number of deaths per week reached, until April 10, 25.8 in this group, totaling 362 deaths this year during 14 epidemiological weeks. According to the survey, there was an increase of 145.4% in the weekly average of 2021 when compared with last year's weekly average of deaths. Meanwhile, in the general population, the increase in the weekly death rate in 2021 compared to the previous year was 61.6% (Rodrigues et al., 2021). As Souza and Amorim (2021) warn, this rate may be even higher due to factors such as underreporting, difficulties in performing laboratory tests, and possible false-negative results.

In this scenario in which women's healthcare has been affected by the pandemic, some pregnant women are afraid to seek health services due to uncertainties and fear of leaving home, increasing the frequency of anxiety and depression symptoms (Souza & Amorim, 2021). There are still few studies in the literature that address the subjective experience of the transition to motherhood in the Brazilian pandemic context. Brazilian studies that refer to motherhood during the pandemic emphasized the burden of women with domestic work (Andrade et al., 2020; Macêdo, 2020). In general, studies that address the theme of pregnancy and the puerperium during the pandemic focus on biomedical aspects.

It is relevant to investigate this complex and significant period of human development, the transition to motherhood, as it has important repercussions for the personal and transgenerational course of a family system. In the context of a pandemic, this transition can be even more challenging for women, due to the unexpected break from daily life, new family and professional demands, and the condition of vulnerability that precedes the quarantine and worsens with it.

That said, the objective of this article is to analyze the affective-semiotic dynamics of women who experienced the transition to motherhood in the Brazilian context of the COVID-19 pandemic from the perspective of Cultural Semiotic Psychology. This theoretical perspective focuses on how people develop amid the social direction present in sociocultural contexts – which are conceived not only in their physical or geographical sense, but as systems of meanings and sociocultural practices that enable some ways of thinking about the lived world and acting in it. It is important to emphasize, however, the active character of the person in the reconstruction of social messages as they appropriate them, giving them their own and personal meaning. Through the incessant construction of meanings, people seek a coherent organization of their experience in the world (e.g., getting pregnant, giving birth, and caring for a baby). In the flow of experience, unexpected events, such as the emergence of a pandemic and the intensification of uncertainties related to the next, unprecedented moment of experience, can arouse feelings of tension and ambivalence. To create stability, from a psychological point of view, people create semiotic devices – fields of meaning – that will temporarily stabilize the inevitable uncertainties of experience. So, for example, collectively shared and personally internalized meanings about risk management in a pandemic – such as staying home, keeping social distance, and wearing masks – can guide people's actions and regulate their feelings, giving them some sense of security. In this sense, the social regulation of affect occurs through the person's participation in a myriad of sociocultural practices, throughout their psychological development, that lead to the internalization of affective-semiotic fields. These fields of meaning with affective quality operate as values – conceived as beliefs imbued with affection and social and subjective significance (Branco, 2006) – such as those related to motherhood and family – which regulate all concrete behaviors and create the conditions for the dynamic development of the self system (Valsiner et al., 2007/2012).

Method

We performed a qualitative multiple case study (Stake, 2006). As described in Table 1, eight women participated in the study, all of whom experienced the transition to motherhood in the context of the COVID-19 pandemic in the city of Salvador, Bahia, Brazil. To interview the participants, we used the “snowball” technique, a form of nonprobability sampling that uses reference chains (Vinuto, 2014). We interviewed women with different family income and different professional qualifications to explore the socioeconomic aspects involved in the focused experience. Data were collected from two narrative interviews done with each participant by videoconference, with an approximately 2-month interval between interviews. This interval was established to obtain a deeper understanding of the narratives and to follow the experiences of the participants over time, including changes in the transition to motherhood and the situation of the pandemic in their social contexts. Saturation was used as a criterion for establishing the number of participants, especially related to the heterogeneity of the participants, the volume, and richness of the data collected (Minayo, 2017).

Table 1 Participant description

Name	Age	Approximate family monthly income (Real/Dollar)	Professional occupation	Civil status	Condition during first interview	Condition during second interview
Elaine	36	R$2,700/$530	Public servant	Single	5 months postpartum	7 months postpartum
Gabriela	25	R$10,000/$1,970	Student	Single	2 months postpartum	4 months postpartum
Isadora	22	R$800/$160	Architect	Married	Pregnant	Postpartum
Karla	28	R$3,600/$710	Makeup artist	Married	Pregnant	2 months postpartum
Letícia	34	R$10,000/$1,970	Psychologist	Married	Pregnant	Pregnant
Marcela	27	R$10,000/$1,970	Journalist	Married	4 months postpartum	6 months postpartum
Sandra	27	Could not inform	Philosopher	Married	1 month postpartum	3 months postpartum
Silvana	23	R$1,500/$295	Telemarketing	Single	Pregnant	Pregnant

Table 1 Participant description

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The narrative interview is a nonstructured and in-depth method that promotes a reflective process (Moura & Nacarato, 2017). We used the following starting question: How is it for you to become a mother (or mother once again) during a pandemic? The interviews were audio-recorded. The research was approved by the Committee of Ethics on Research with Human Beings (Opinion No. 4.255.261).

All participants were Brazilian, except Sandra, who is from Mozambique and temporarily in Brazil. All the interviews were conducted in Portuguese. Isadora did not participate in the second interview because she had recently given birth. Data were evaluated using Consensual Qualitative Research (CQR), a method of consensual qualitative analysis that studies, in depth, the unique experiences of the person, seeking to minimize researcher bias. CQR has, in its basic components, the use of open-ended questions for data collection, use of multiple points of view (judges), consensus decisions, auditor to check consensus, valuing personal narratives, importance of context, use of small samples, ethical care, and continuous return to the raw data to check the veracity of understandings (Hill, 2012). The data analysis was carried out by the authors of this article: All are women, and two have experienced the transition to motherhood (the first and third authors), while the second author works assisting women in childbirth. These aspects probably contributed to the participants being receptive and cooperative in sharing their personal experiences, while the researchers were familiar with the subject matter of the narratives. However, although the researchers were immersed in the same sociocultural context as the participants, they had differences related to socioeconomic status and racial belonging when compared to some interviewees, which may offer a limited field of insight and interpretation. The first stage of data analysis was to define the thematic axes, establishing general terms that encompassed the main aspects to be evaluated in the interview. In the second step, the central ideas of each speech were highlighted in the interview to fill in the thematic axes. For this, the first and second authors individually coded each interview, agreed on each central idea, and sent it to the auditor, the third author of the article. The function of the external audit is to assess the consistency of the findings, minimizing inferences by the researcher (Hill, 2012). In the third step, the duo who coded the interview created categories uniting the central ideas on the same theme and sent them again for audit.

Results

The main themes that emerged in the narrative interviews were as follows: (1) The perception of personal vulnerability and of the future as uncertain gave rise to the emergence of an affective field characterized by intense fear and anxiety; (2) I–other relations marked by intense ambivalence between the need for social support and the risk of contagion; and (3) from this scenario of deep uncertainty and ambivalence, the perspective and experience of childbirth were marked by a strong feeling of insecurity in the relationship with the health contexts, with negative repercussions on the puerperium experience.

The emergence of the COVID-19 pandemic in the Brazilian context was perceived by the participants as an unexpected and significant rupture of personal-collective expectations about the transition to motherhood. This event was described as something that interrupted the possibility of a certain predictability of events from pregnancy to childbirth and amplified uncertainty about the future. According to the narrative of the participants, this event was depicted as something that “threw everything down the drain” (Karla), was “a very big scare” (Letícia), “a reason to pause everything […] to change our routine,” “something that turned our lives upside down” (Isadora), “caught us off guard” (Karla), leaving them “disoriented” (Silvana), “not sure of anything” (Isadora), and “not having control, not knowing what to do” (Karla). Sandra's account illustrates the great challenge faced by women dealing with such a surprising event taking place at the same time as their transition to motherhood:

For the participants, in general, the pandemic made personal and family planning difficult or even impossible – leaving the future on hold. This included, for example, organizing oneself professionally prior to the baby's birth, buying the basic baby products, or performing cultural rites such as baby showers. In this sense, the common concerns of women during the transition to motherhood – like the moment of birth and the changes in the family system – were relegated to a second plan due to other concerns related to the pandemic:

Immersed in this scenario of uncertainty, the feelings most described by the participants were fear of contagion, their own or their babies' deaths, and anxiety:

These feelings, most of the time, were accompanied by physical symptoms, as described by Gabriela: “I started having anxiety crises. I didn't sleep, I had arrhythmia, I had trouble breathing.” The emergence of this affective-semiotic field, marked by a perceived vulnerability, was intensified by the socially constructed and personally internalized notion that pregnant women were part of the risk group. This view was corroborated by mass media with news on deaths of pregnant women in Brazil. As a result, the notion of protection in terms of how pregnant and puerperal women may protect their babies has changed. Under such circumstances, they could not isolate their babies from themselves. There was an intense fear of being a source of contamination:

In order to mitigate the feeling of vulnerability and fear of contagion, the participants followed government measures adopted to control the pandemic, focused on social distancing strategies, which brought about significant changes in the I-other relations, especially with regards to the perceived support <> lack of support from the most important members of each woman's social network: “It's just me and her [baby] […]inside the house just me and her, so all the care inside the house just me.” (Elaine)

For women who had partners, these were signaled as someone who helps in domestic and childrearing activities. However, the other sources of support mentioned – even if not activated due to social distancing requirements – were women, such as the mother, mother-in-law, or friends. Housework overload, including the almost exclusive responsibility for childcare, had important physical-mental implications: “[…] I developed tendinitis in both wrists […] The child's weight […] repetitive effort […] I got used to the pain […] there's no one to help me […] I can't share the weight with other people.” (Gabriela)

It is important to highlight that the transition to motherhood brings with it significant transgenerational bonds that reach back to the previous generations and the continuity of the family in the future, especially in the Brazilian context where the family has a fundamental value. In this sense, the Ministry of Health's suggestion to extend the period of social distancing was a significant obstacle to the shared experiences of motherhood:

In general, the I–other relations were described by the participants as marked by the emergence of intense ambivalence. On the one hand, given that the other can be a potential transmitter of the virus, the risk of contagion requires strict social distancing. On the other hand, the supposed protection that social distancing offers to the woman and her baby can lead to a devastating experience of helplessness:

The experience of giving birth in a pandemic context was described by Sandra as “a challenge”, especially due to the need to go through this moment with no family member to support her, because her husband had to take care of their two other children. In addition, maternity hospitals do not accept the presence of companions during the pandemic:

The emergence of the pandemic – perceived by the participants as an abrupt rupture in the ongoing developmental trajectory – interrupts a certain predictability of events and raises ambivalence in the relationship with others, amplifying uncertainty about the future. In this sense, for the women who were pregnant, one of the main concerns was to imagine and plan the moment of birth in the context of the pandemic, especially due to the perceived risk of contagion. After all, they feared that during the critical moments of the experience of childbirth, they might fail to take some protective measures properly such as using masks or constantly sanitizing their hands:

A participant who had the experience of childbirth during one of the critical moments of the pandemic in Brazil revealed the intense fear she felt when she was admitted to the hospital unit. Her account shows that the services provided by hospitals and maternity units – so often associated with the safety of specialized assistance – were perceived, in that context, as unsafe and threatening. The emotional repercussions of this experience of uncertainty and imminent risk were observed during puerperium, with the intensification of emotional instability commonly experienced by many mothers after childbirth:

The experience of becoming a mother was also affected by the assistance offered by health services in monitoring pregnancy, childbirth, and puerperium. With the pandemic, this factor became even more evident, especially because in this context pregnant women are a risk group, making quality assistance essential. However, it is worth mentioning that this phenomenon is determined by intersecting factors and must be understood using social markers such as gender, class, and race. To illustrate the issue of intersectionality, especially the issue of the country's existing social inequalities, we can mention the temporary closing of some public maternity hospitals in the city of Salvador during critical moments of the pandemic. This increased the perceived vulnerability of the impoverished pregnant women:

Discussion

The narratives of participants in the study describe that the event of the pandemic consisted in a non-normative rupture of their life trajectories, represented by signs¹ such as “destructuring,” “collapse,” “break,” and “end of the world.” These fields of meaning related to the emergence of the pandemic have an affective quality. The emotional flow was characterized by intense fear (of contagion, of death itself, and of losing the baby) and, in an interrelated way, by a strong anxiety (apprehensive expectation of the future). From the interactions between the intrapsychological resources of each woman and the suggestions of culture, new fields of meaning with affective quality begin to form their self systems (Valsiner, 2007/2012). From the participants' narratives, three main interdependent affective-semiotic fields were emphasized: the perception of oneself regulated by the sign of vulnerability (main tension: protection <>² lack of protection); the other regulated by the sign of a potential threat (main tension: support <> helplessness); and healthcare provision regulated by the sign of risk (main tension: security <> insecurity). The emergence of the pandemic and the socially constructed notion that pregnant women are at some risk – based on scientific studies and fostered by the mass media with news about deaths of pregnant women in Brazil – leads to subjective processes that aim to integrate new meanings of oneself and the world to preserve a sense of subjective continuity. In this sense, the first affective-semiotic field highlighted is related to the emergence of meanings of oneself regulated by the sign of vulnerability. Being pregnant in the midst of a pandemic was perceived by the participants as a special risk situation due to the greater risk of COVID-19 evolving into more severe symptoms and even death. In addition, the country is going through a situation of great economic, social, and political vulnerability. From the mediation, the sign of vulnerability, an affective field emerged dominated by fear and anxiety of leaving home – described a place of protection – and meeting others – possible transmitters of the virus. The home as a place of protection during the pandemic is also marked by various tensions due to gender inequalities at various levels, such as the housework overload on women (Andrade et al., 2020; Macêdo, 2020). Another aspect worth highlighting is the ambivalence felt during pregnancy in relation to the mother's own body: The female body, which houses the developing baby and which should protect it, can also be the transmitter of a virus that threatens its integrity (main tension: protection <> lack of protection).

Closely related to the affective-semiotic field regulated by sign of vulnerability is the I–other relationship regulated by sign of potential threat, marked by the tension between support <> helplessness. In general, Brazilian pregnant women have a family support network during the days before and after delivery. During the pandemic, the presence of a support network is not possible. The socially suggested notion that the others are potential transmitters of an invisible enemy that threatens the physical integrity of pregnant women and their babies comes to mediate women's relations with other people, including other members of the extended family. However, other central aspects of the transition to motherhood, such as the shared experience of pregnancy, childbirth, and puerperium – so important for Brazilian mothers – were blocked, leading to a deep feeling of helplessness and of disintegration of transgenerational bonds.

Finally, we highlight healthcare provision regulated by signs of risk. Here, the main tension consisted in safety <> insecurity. In general, women reported feelings of fear and anxiety when they needed to leave their homes and avoided this movement due to their vulnerable condition. The main exception was for medical reasons. However, going to the doctor or to a medical examination raised intense tension between the perception of security – permeated by meanings related to mother and child healthcare – and insecurity – being with other people who could potentially transmit COVID-19. To circumvent the intense fear and anxiety related to this highly ambivalent choice, they make use of symbolic devices of protection that work as strategies of affective regulation (Valsiner, 2007/2012), attenuating the perceived danger, such as wearing protective masks, keeping distance, and reading the Bible.

However, in the case of the Brazilian reality, access to healthcare is determined by different intersecting factors and must be understood by using social markers such as social class. Social inequalities regulate the access to health services (Takemoto et al., 2020). In the case of women who do not have health insurance or lack the financial resources to pay for visits to the doctor or examinations in the private network, public healthcare appears as the only alternative. However, Brazilian public healthcare, despite its fundamental importance for the population, is characterized by scarcity of resources and largely impermeable frontiers – as in the situation of contingent and temporary closing of maternity units during a pandemic period – leading to an experience of deep insecurity.