 So without further ado, I'd like to introduce Dr. Helene and during her session today, she's going to be covering experiences, concerns and needs of the pregnant and postpartum women during the COVID-19 pandemic in Cyprus. This is a cross sectional study. I request that you give her all your time and attention. Please note. Oh, we have someone from Istanbul. Welcome. Please note that you will can use the chat feature to ask your questions. This is the public chat and I will read them out to Eleni as the session continues. You have the hand raised feature. Please also make use of that. And without further ado, Eleni, take it away. Thank you. Thank you all for your presence. I would like to express my gratitude to scientific and organizing committee. And my study is very interesting because we all know that COVID cause a lot of problem to the humanity. Eleni, you can take the presenter. That's why. Okay, sorry. That's okay. Can you make me because something is wrong? I cannot take it. That's okay. Jane, please assist making Eleni a presenter. Okay, I found it now. Fantastic. That's very good. I think we can talk amongst ourselves for a minute. Frida, I think Eleni's sound has gone out. Oh, she's dropped off. Yeah, she'll be back. I think sometimes she's in Crete. So let's chat. Frida, do you want to tell us any specific things that happened to you in your country with the COVID? Well, right now, like I said, in our country it is morning time. It is 9 a.m. in the morning. I could see a couple of people. I think I've seen two people who've joined us from Nairobi, Kenya. Jane, what time is it where you are right now? I'm at 7.12 a.m. and I'm currently at Eleni. Yeah, the COVID had a big impact. I usually live in Florida, USA, and it's had a huge impact. We lost quite a few moms and babies to the pandemic. It's very sad in France, so yeah, it's been hard. Okay, Nairobi was also really badly hit or I'd call it Nairobi or Kenya in general. Eleni, I see you're back. Yes, I'm happy with my internet. Sorry for that. That's okay. No, no, no, that's okay. We totally understand. Okay, now I must take, okay. Thank you. Thank you. Yeah, you're good now. Thank you and sorry for that. That's okay. This is an interesting study. It's about COVID-19 and we all know that the COVID-19 pandemic and the associated state-imposed measures for the minimization of risk and management of those affected by the virus have resulted in unprecedented changes in our life and especially in mothers and pregnant women life. Pregnant and postpartum women are a less research population. It appears to be more vulnerable to pandemic-related stressors compared to the general population. Since the prenatal period is generally, as we know as midwives, is a time of high vulnerability to mental health problems. Studies today show an increase in the prevalence of depression and anxiety symptoms in prenatal women. The data for this study comes from an international study. The best of our knowledge, this is the first study that examines pregnant and postpartum women's experiences during COVID-19 in my country. The aim was to examine the impact of the COVID-19 pandemic and the associated governmental-imposed measures on the experiences, concerns and needs of pregnant and postpartum women in Cyprus. And you can see here the mother. How sad she is. The method was cross-sectional study and conducted in July 2020 and January 2021. Our sample consisted of 355 other pregnant women and 340 postpartum women with an infant up to six months. All of them was in Cyprus. The collection took place through Facebook, Instagram and through local organizations and maternity units in both public and private sector, as well as through personal networks of colleagues and data collection implemented through Qualtrics. Now, about the results, the most important thing. As you can see here, the age of our participant was around 26 to 35. This is the normal age for women in Cyprus to be pregnant and be mothers. The country of origin, as you can see, most of them were from Cyprus and also for the mothers. About the education, it's something that happened in my country. Most of the women get educated with master degree and PhD degree. And let's see now what happened with the COVID-19 exposure. 1% of the women were diagnosed with COVID-19 infection. 7% reported having or had symptoms such as cough, fever, freezing difficulties or other symptoms compatible with COVID-19. 4% of the participants had been in contact with someone who had been diagnosed. Almost 2% had someone close to them die, can you imagine. The great majority of the participants, 81%, interpreted the impact of the pandemic on life as a negative. Some of the negative was 32%, moderately negative 28%, extremely negative 22%. Why 12% interpreted the impact of the pandemic as positive? Slightly positive 6.4%, moderate positive for 8% and extremely positive 0.9%. I am sure now that you wonder why this is happening. Because in my country, we have the custom when the women give birth, all relatives come to see them. And that most of the time create problem to women. That's why they said that now they have no visitors. Now let's see what about the single critical source of stress related to the COVID-19 outbreak. Both for pregnant women and for postpartum women, the main problem was the impact on child. And we all know that when we become mothers, the first our biggest worries are our children. 23% for pregnant women, 24% for postpartum women. About health concerns, we all live that. 70.5% pregnant women, 22.9% for postpartum women. Financial concerns, 90%, 62.7% for mothers. Impact on family members and especially the elderly parents. And we all know that those are more vulnerable. 70% for pregnant women, 12% for postpartum women. Generic well-being due to social distancing and quarantine. 10% for pregnant women, 9.5% for postpartum women. Now, the overall levels of stress as you can see here was the same between pregnant women and postpartum women. For example, all COVID-19 related symptoms of potential illnesses was around for both of them, both categories. COVID-19 related symptoms of potential illnesses in pregnant family, 4.92% for pregnant women, 4.99% for postpartum women. Employment and financial impact, 5.5% and for postpartum women, 5.38% almost the same. And disruption to social support again almost the same for around 4.24%. Now, pregnant women's concern, support and involvement of family and friends was a big concern. Most of the women regarded changes in the support and involvement of family and friends was that they could not have their partner or a member of their family with them during labor and birth was a big problem. It is understandable and expected that the visit will be limited. But at least I would like to ensure that my husband will be present. And I don't even want to think about the possibility of giving birth entirely alone. And believe me at the beginning of the pandemic, the women give birth alone. The concern or disappointment of women about the presence of other family members or their children and parents during birth or immediately at the birth was also a major thing in the women's resources. It is hard not to have the last ones next to you. And especially my other children to be able to visit us. Women's concerns about their child's health revolved mainly around the idea of infection of the fetus or the body either because of the mother, baby, because of the mother or others. Especially during the first days, I will be very afraid to go out with the baby and I wouldn't. I want friends and family members to kiss it. Many mothers were concerned about the overall quality of care that they would receive due to the novelty of virus. If there is a complication due to COVID that is new to the doctors and again is new and doctors don't know how to react. One women were mainly concerned about the effects of government imposed measures on the psychosocial development of the baby, both in the short term and the long term. I am concerned about the limitation in socialization and development activities, stimulation from nature, playgrounds and etc. 63% reported that their stress levels worsened as a result of the pandemic. Worse than the significance around 14%, worsened moderately around 50%. Why one third reported no change? Pregnant and postpartum women have particular concerns and needs as a result of current pandemic. And this is an important message for us. To develop plans for the improvement of perinatal care during periods of crisis, as well as to inform policymaking and future decisions on government imposed restrictions and measures for the management of public health threats. Community midwifery would be a vital source for the improvement of care offered to women and postpartum women, as well as for the prevention of persistent stress related issues and vulnerability during the challenging times of COVID-19 pandemic. Thank you all for your presence. I have more to say if you wish. I am here for you. Thank you so much Eleni for that. If you do have more to say, you actually do have another 10 minutes. You can share some more insights onto this topic. Please go ahead. Actually, after that study, we did a qualitative study. Why? Because we wish to see in depth what happened to the women. And we found that the women, they have a lot of stress because they worry about the long consequences of the COVID-19 on their child health. And believe me, they are right because we don't know what will happen after the COVID-19. And we already know that people that they survived from the COVID-19, they had some problems. For example, many they said that they have problems with memory. But we don't know what we happen with children. So this is new. And we shall have new research around the impact of the Neonioids. And not only that, the women, they said to us that they found their selves to be more relaxed during quarantine because they stay at home. They took care about their children. Their husband was next to them. So some of them, they said that the relation between the family was become stronger. But unfortunately, we have the other thing that some women, they had problem for violence. Some husband become, let's say, more aggressive because of the stress and things around the financial problems. Of course, they have no excuse for that. But yes, it is an interesting study to see. And maybe in the future, I will present the qualitative results also. And we have a question. It's a comment from Catherine and she says, Eleni, you were right to say at the start of a presentation was interesting. Indeed, it was very interesting and educative. Just another question or another comment from Caroline, it was a great presentation. Such an eye-opener. Jen says that this was incredible, so much insight. Mine is more, mine is a question. Seeing that now we are approaching the post end quote unquote of the COVID-19 pandemic. What other key lessons learned and how are those going to be implemented, especially in the midwifery going on forward? How is that going to be done? First of all, we must have in mind that women in a period of crisis, they need more support. They need midwives to sit next to them, to listen to them. We all know how important it is for the women during labor to have someone next to them to be there for them. I mean, not to discuss, for example, some women said that the women was there, but they are discussing about the COVID. Can you imagine to be in labor instead of having the people around you to give you calm and explain to you what happened to yourself at that time, to talk about the COVID and to talk about the things that doesn't happen and to say that the government can do more and not only that, many women complained that they didn't support them to give birth naturally. Most of the women give birth by caesarean section because most of the obstetrician, they found it easier for them. Why? Because we must ask obstetrician now, but the women said that obstetrician said, instead of having a woman to give birth for 10 hours, I can take the baby out and have an hour. So the exposure of health professionals, it will be less to the COVID. So as you can see and I'm glad that my students here all that is that we must be very careful and not only about the protocols. In my country, we create protocols that believe me, for example, to say that the fathers cannot see the baby. They must stay outside, outside of the hospital. Can you imagine? But the fathers are fathers. They participate for this baby. They must be with the baby. And we must always think the best and the worst for each occasion. What was and they have that you cause. And now we have many women that give birth by caesarean section. That will cause a lot of problems to them in the future. Family planning and a lot of problems to the financial problems. They may have more. We all know that the kids that comes from elective caesarean, because most of them were elective, they have more problems. That from the babies that comes through a caesarean and they have the ability to have some pressure on their chest. We all know that through elective caesarean, the babies come out without preparation and that creates problems to them. So we have a lot to discuss, a lot, a lot to research. And I'm glad that we have with us. I'm sure we already found that we have researchers. And it will be nice to see globally what can we do in the future. I hope to stop the pandemic. Mine is now my last question, as I can see the chat feature. Catherine is typing something on the chat feature as I wait for her. She says, what are the women's reactions to having a caesarean section? It's something that I'm dealing in now. Now we shall do a project about respectful maternity care. In Cyprus, we have problems. I don't know if you know, but we are the first country in Europe with rates of caesarean section. And we must do something about that. We already did a campaign about caesarean section. We have a non-governmental organization in Cyprus. You can see, you can find all this information that I told you through internet now. It's birth for world. And we work together to do a project. I hope to get funding because funding is very important. And we shall educate obstetricians and midwives not to make so many interventions. And to humanize childbirth. Because if we convince the health professionals how important it is for the women to have the proper support, to have the proper preparation, we can minimize this caesarean section. Okay, that's a fantastic answer. Thank you so much, Catherine, for that question. I guess as we wrap up my final question is looking at it from an educational and from a research perspective, what do you feel that is going to be implemented? Do you feel like we need to have more courses from a master's standpoint, from a PhD standpoint? Do you feel like we need to now start honing more university courses when it comes to the specialization of postpartum in a pandemic? I think we must do something now first of all to help women that they have post-traumatic stress syndrome from all these that happen to them. Yeah. So I try with a colleague of mine that is a perinatal psychiatrist to create some workshop to help women to talk about their experience. Because we must have healthy mothers in order to have healthy children. So now we must work. This is something that I plan to do for women in Cyprus. To help them to survive, let's say, to lower their stress that because most of them, they go under obstetric violence. To have you and send to you. You have no choice. You have COVID. You must as a parent for your children. You must be in this room alone. Can you imagine? You cannot see anyone. You can communicate only through vibe. Yes. So all of these, we must talk with the women and we must help them to realize that life is going on. And they must see what happened with the pressure. We must see how many women are depressed now because we are not only so strong to say okay and we don't know what's happened in their houses. Okay. Now we have one last question. The final question as we close, this is from Catherine again. And she asked what happens to the women who could not afford to have as they say in section because of cost. In Cyprus, we have a national health system. And there is no cost. Oh, fantastic. And this is another problem. It's another problem. Because it's so readily available. Yes. No problem. Do as you like. Yes. No cost. And the women said okay. And we all know that if a doctor said to a woman, listen, it's better if we go ahead with a cesarean section for you and for your babies the best. All the women said okay. Okay. You know better than me. Yeah. Oh well. I think I'll give. There's Caroline Moringa is typing. Caroline, I'm going to give you about 20 seconds to wrap up so that if it's a question or comment, I can read it to Dr. Eleni. And in the meantime, as we wait for Caroline's question, I really hope we hear more voices from other countries on the effect of COVID on women. Caroline, I do request that you stay on the entire conference. It's a full day and we are covering various countries and the various effects on this session. Dr. Eleni, thank you so, so much for your presentation. And now I will turn off the record element of the...