Geographical Isolation and Limited Healthcare: Becoming a Mother in Hawai'i during COVID

Overview: This qualitative story inquiry study evaluated the experience of becoming a mother In Hawaii during the COVID-19 pandemic to better understand maternal mental health challenges related to pandemics specific to those residing in Hawai’i.Proposal text: Background/Rationale: Currently, the leading cause of maternal death within a year after the birth of a child is suicide relating to perinatal mood disorders (PMADS) (Doe et al., 2017). A contributing factor to developing PMADS is the experiences a mother has as she becomes a mother. The becoming a mother (BAM) theory, explains the many concepts and dimensions of the transition into motherhood. This transition can be shaped by a multitude of personal and societal factors; cultural context also contributes to how women become mothers, that ultimately affects maternal mental health. In Hawai’i specifically, where there are unique cultural and geographical factors to consider, the process of BAM, as it relates to social and geographical isolation, as well as limited healthcare infrastructure, all are particularly affected in the current global pandemic.
This study asked the following research questions using the BAM theoretical framework to guide the approach: 1: What are the experiences of becoming a mother (BAM) for those who are pregnant or have given birth during the global COVID-19 pandemic crisis in Hawai’i? 2: In what ways, if any, does the unique geographical location of Hawai’i impact PMADs during COVID? And, 3: Are there differences in how mothers belonging to historically marginalized populations experienced birthing during the COVID-19 pandemic in Hawai’i?


Methods: The study used the Story Inquiry qualitative research method to understand the collective story of the experience of perinatal care during the COVID pandemic for mothers in Hawai’i. Story inquiry is a culturally appropriate method which collects stories from a community experiencing a shared health challenge. In-depth phone interviews were conducted using interview guides. Transcriptions were coded by three researchers using Story Inquiry analysis.


Results: 20 woman-identifying individuals, from diverse backgrounds, were interviewed. The three primary themes included: 1. Isolation and Birth, 2. Heightened Postpartum Anxiety, and 3) Grief of the Lost Experience of Becoming a Mother.


Conclusions: The findings of this study illuminated heightened pervasive uncertainty prompted by the pandemic, including extreme economic downfall in a state that relies heavily on tourism for jobs. In addition, the geographic location of Hawai’i exacerbated feelings of social isolation for new moms during the pandemic given strict travel restrictions to the islands. They also experienced grief from not being able to experience the transition to motherhood per cultural norms and expectations due to the pandemic restrictions as they limited elder interaction. Implications from these findings include a need for culturally informed perinatal services, including education, to address the potentially large influx of mothers experiencing PPD in the wake of the pandemic.