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.