Pandemic Lessons for Equitable Maternity Care: Cross-Cultural Perspectives from Immigrant Mothers in Spain

Abstract

Background: The COVID-19 pandemic exacerbated pre-existing inequities in maternity care, particularly among culturally diverse and migrant women. Although data were collected during the early pandemic phase, revisiting these experiences offers valuable insights for strengthening equity, cultural safety, and system preparedness in maternal healthcare. Methods: A qualitative phenomenological–hermeneutic study was conducted in a tertiary maternity hospital in Spain. Semi-structured interviews were carried out with six women from diverse cultural backgrounds. Data were analysed inductively through thematic analysis, followed by a secondary interpretive review in 2024 to identify enduring implications for culturally safe, equitable, and crisis-resilient maternity care. Results: Four main themes emerged: (1) heightened fear and uncertainty surrounding hospital care; (2) emotional distress linked to restrictions on companionship and support; (3) disruption of culturally embedded postpartum practices, resulting in isolation; and (4) health literacy barriers and dependence on informal information sources. Despite these challenges, participants demonstrated notable adaptability and resilience. Conclusions: COVID-19 amplified structural inequities in maternity care for culturally diverse mothers. The findings highlight the need to reinforce cultural safety, health literacy support, language mediation, family-centred care, and emotional wellbeing. These insights may inform efforts to strengthen resilient and equitable maternal health systems and improve preparedness for future public health emergencies.

1. Introduction

The COVID-19 pandemic created unprecedented disruptions in maternal healthcare worldwide, intensifying pre-existing inequities and exposing systemic vulnerabilities, particularly among culturally diverse and migrant women. Emerging evidence demonstrates that women from minority ethnic groups experienced higher levels of fear, social isolation, reduced autonomy in childbirth, and barriers to accessing clear and culturally appropriate health information during the pandemic [1,2,3,4]. These inequities did not dissipate with the acute crisis; rather, they remain embedded in maternal health systems, underscoring the need to critically examine pandemic experiences to inform more equitable and resilient models of care in the post-pandemic era [5,6]. Spain, like many European countries, has experienced a steady increase in cultural and linguistic diversity among childbearing women. Although the Spanish maternity care model is grounded in universal coverage, immigrant women often face structural and communication barriers that limit access to culturally safe and health-literate care [7,8,9]. These vulnerabilities were amplified during COVID-19 through restricted companionship, reduced face-to-face support, and limited access to interpreters and prenatal education, creating challenges in navigating both healthcare systems and cultural adaptation processes.

International frameworks, including the WHO’s roadmap for maternal health equity, emphasise respectful, inclusive, and culturally safe maternity care—particularly for migrant and minority women [10]. Cultural safety theory positions safe care as care defined as such by the recipient, recognising power imbalances, social determinants, and the role of healthcare systems in perpetuating inequities [11]. Complementarily, the universal health literacy precautions approach calls for standardised communication strategies to ensure comprehension for all service users, regardless of language or sociocultural background [12]. Within transcultural nursing, Leininger’s model underscores the need to adapt care to people’s beliefs, values, and lifeways to promote wellbeing and equity, a principle directly relevant to perinatal contexts where biomedical routines may conflict with customary practices [13]. Moreover, the pandemic disrupted evidence-based, relationship-centred practices that are foundational to humane care—such as companionship and early skin-to-skin contact—with known benefits for bonding and maternal mental health; restrictions on these practices heightened vulnerability and accentuated inequities for culturally diverse women [14,15,16]. While extensive research has documented pregnant women’s stress and anxiety during the pandemic, fewer studies have adopted a transcultural and post-pandemic reflective lens, examining how cross-cultural perspectives can inform the redesign of maternal services moving forward. Understanding immigrant women’s lived experiences during a health emergency offers unique insight into how health systems may better prepare for future crises while advancing long-term equity, inclusion, and personalised care [17,18].

Although several qualitative studies in Spain have examined women’s experiences of childbirth during the COVID-19 pandemic, the specific perspectives of migrant and culturally diverse mothers have received limited attention. Current research has rarely focused on how the pandemic interacted with cultural practices, language barriers, or health-literacy challenges for these mothers. This study contributes to addressing this gap by offering a phenomenological–hermeneutic sub-analysis centred on culturally diverse participants and interpreted in light of post-pandemic lessons for culturally safe maternity care.

This study aimed to explore childbirth and postpartum experiences among culturally diverse women who gave birth during the COVID-19 pandemic in Spain, and to consider how these experiences might offer insights relevant for culturally safe maternity care. By drawing on a phenomenological–hermeneutic approach and conducting a secondary interpretive analysis in 2024, this research contributes practice-oriented knowledge relevant for clinicians, health administrators, and policymakers seeking to strengthen maternal care for migrant populations and enhance preparedness for future health system disruptions.

2. Materials and Methods

We conducted a phenomenological–hermeneutic qualitative study at the Hospital Universitario Marqués de Valdecilla (HUMV), Santander, Spain. The study followed COREQ reporting standards, including disclosure of interviewer characteristics (the first author, a female healthcare professional with experience in maternal care), absence of a prior relationship with participants, interviews conducted in private settings chosen by the women, and no presence of non-participants during the interviews. Participants (n = 6) represented Spanish, Senegalese, Colombian, Moroccan, and Chinese backgrounds. Semi-structured interviews were performed between March and December 2020, using a brief guide that covered key areas including memories of labour and birth during COVID-19; fear of infection for themselves or their newborn; feelings of isolation or calm associated with social restrictions; perceived healthcare and social support; postpartum adjustment; breastfeeding experiences and changes in work or employment. Interviews were transcribed verbatim and analysed inductively. Data were revisited and re-analysed in 2024 to extract cross-cutting lessons applicable to post-pandemic care frameworks. The study was carried out at the HUMV, the reference centre in Cantabria, an autonomous community in northern Spain. This centre attended an average of 2857 births per year during the pandemic years (data provided by the hospital’s admissions service). HUMV is the main provider of maternal care services in the region, especially during the period between March 2020 and June 2021, when it was the only public hospital to deliver babies in the community. In addition, from March 2020 until the end of the pandemic, it was the only hospital in Cantabria, both public and private, that performed deliveries in patients with a positive PCR test for COVID-19 on the day of delivery.

2.1. Target Population

The study focused on women of different nationalities and countries of origin who gave birth at the HUMV during the COVID-19 pandemic, specifically between March and December 2020. To participate, women had to be able to communicate in Spanish sufficiently to participate in a semi-structured interview and voluntarily sign an informed consent form. Women with significant communication difficulties, mothers of children with congenital diseases or who had developed a serious illness prior to sample selection, and mothers of extremely premature or very premature babies (born before 32 weeks’ gestation) were excluded.

2.2. Sampling

This study is part of a broader qualitative project that included 17 in-depth interviews. In the original qualitative project, which involved 17 women, participants were selected through a non-probability quota sampling strategy to ensure variability in key sociodemographic and perinatal characteristics, including maternal nationality. During the analysis of these 17 interviews, it was identified that a subset contained particularly relevant information regarding cultural diversity (postpartum practices, linguistic barriers, low health literacy). Within this framework, the informants analysed in the present study correspond to the multicultural quota (women of Chinese, Senegalese, Colombian and Moroccan origin). For this reason, the research team decided to conduct a specific phenomenological–hermeneutic subanalysis of this group, based on the criterion of information power. In this case, the six interviews provided sufficient depth and variation to develop the central themes of the analysis, without the emergence of new relevant content in the later stages of the process. The aim of this sub-analysis is not to systematically compare cultures, but to explore in depth how the pandemic interacted with cultural diversity in the experience of childbirth and the postpartum period. No additional selection criteria were applied for this sub-analysis. All informants in this study were contacted by telephone by the principal investigator. Only one eligible participant declined due to lack of availability.

2.3. Data Collection

The interviews were individual and semi-structured, allowing an in-depth exploration of the participants’ experiences and perceptions. The interviews were conducted face-to-face, with a total meeting time of approximately 45–60 min, of which the interview itself lasted around 30 min. Participants were offered the choice of conducting the interview either in their own home or in a workroom at the hospital, depending on what was most convenient for them. This flexibility was particularly important given that many were caring for young children or working, and the research team travelled across the province when home-based interviews were preferred.

2.4. Subjects

We interviewed six women: one Senegalese, one Colombian, one Moroccan, one Chinese and two Spanish. These nationalities were chosen for the diversity and cultural representativeness they bring to the study. In addition to nationality, we collected basic sociodemographic characteristics including age at childbirth, educational level, area of residence, COVID-19 exposure during pregnancy or postpartum, infant feeding practices during the first six months, and employment status (

Table 1. Demographic and Socioeconomic Characteristics of Women at Childbirth.

Mother’s Age	Nationality	Education	Number of Children	Delivery	Population	Type of Job	Childbirth
39	Spanish	High School	2	Eutocic	Rural	Restaurant and retail services	27 March 2020
31	Spanish	Vocational Training (VT)	1	Eutocic	Rural	Restaurant and retail services	23 July 2020
38	Moroccan	Primary Education	2	Eutocic	Urban	Inactive/Unemployed	4 June 2020
38	Colombian	High School	1	Eutocic	Urban	Teaching professionals	17 November 2020
37	Senegalese	Primary Education	2	Eutocic	Semiurban	Student	6 June 2020
39	Chinese	Primary Education	1	Eutocic	Urban	Unskilled service workers (excluding transport)	17 September 2020

). Employment status was classified following the Spanish National Classification of Occupations (CNO-2011, Instituto Nacional de Estadística). The qualitative methodology of semi-structured interviews allowed us to explore in depth their personal experiences and identify possible patterns and differences related to their cultural backgrounds.

2.5. Procedure

Data analysis was carried out using a phenomenological–hermeneutic approach. Each interview was transcribed independently by the principal investigator and a second researcher, and both versions were compared to ensure accuracy. Participants were also given the opportunity to review and confirm the accuracy of their transcripts, which contributed to ensuring the fidelity of the data. The interviewer used clarifying questions and paraphrasing techniques when needed to ensure accurate understanding, particularly with non-native Spanish speakers. The analytic process included repeated readings, identification of meaning units, inductive coding and the grouping of codes into categories and subcategories through iterative discussions.

Hermeneutic interpretation was operationalised through an iterative movement between excerpts, full interviews and the dataset as a whole, together with reflexive dialogue between the researchers. Based on this process, an additional interpretive analysis focusing on cultural dimensions was conducted, which allowed the identification of the four themes that structure the findings of this study. A brief reflexive stance was maintained throughout the study, acknowledging that both researchers were Spanish healthcare professionals, and potential pre-understandings were addressed through independent transcription and iterative peer discussion.

2.6. Ethical Considerations

The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all participants, who were informed of the aims of the study, the confidentiality of their data and their right to withdraw at any time. All participants are referred to by informant number to ensure confidentiality. Approval was obtained from the Ethics Committee of the Cantabrian Health Service.

3. Results

The women interviewed gave birth between March and November 2020, during the first and second waves of the COVID-19 pandemic. The interviews were conducted within the first six months after delivery. The sample included four women from non-European countries representing different cultures: a Senegalese, a Colombian, a Chinese and a Moroccan woman. Two women of Spanish origin were also interviewed. Details of the characteristics of the participants are given in Table 1. All participants were married or living with a husband of the same nationality.

From interviews with women who gave birth during the COVID-19 pandemic, several key categories emerged that reflect their experiences and perceptions. These categories capture both the emotions and challenges they faced and the cultural differences that influenced their experience of motherhood in this unique context.

Table 2. Emerging categories and subcategories.

Category	Subcategory
Fear of hospital care	Fear of childbirth during COVID-19
	Fear of hospital admission
	Fear of going to hospital
Perceptions of healthcare	Positive experiences
	Challenges in care
Social and cultural impact of the pandemic	Feelings of loneliness and isolation
	Adapting to a different cultural environment
Access to and use of prenatal information	Reliance on informal sources
	Lack of adequate preparation

presents the categories and subcategories in a structured way. These categories and subcategories reflect interpretive patterns identified through a phenomenological–hermeneutic approach; they are therefore not quantified, as meaning rather than frequency guides the analysis.

A more detailed description of the analysis follows:

• Fear related to hospital care during the pandemic.

• Definition: Feelings of fear and anxiety experienced by women when interacting with hospital environments perceived as dangerous due to the pandemic.
• Subcategories:

  ○

  Fear of going to the hospital: Fear of exposure to a source of infection when visiting the hospital, influenced by images of chaos and hospital overcrowding seen in the media.

  ▪

  Example: “Oh my goodness, really. It was like going to war, no better way to say it.”—Informant 2 (Spanish).

  ○

  Fear of giving birth during COVID-19: Anxiety related to hospital restrictions, such as the possibility of being without family support or the risk of separation from the newborn.

  ▪

  Example: “The anxiety caused by the thought of being separated if I tested positive for COVID during delivery.”—Informant 5 (Spanish).

  ○

  Fear during hospital stay: Concerns about the risk of infection for themselves and their babies during hospitalisation, leading to extreme precautionary measures.

  ▪

  Example: “I kept my mask on the whole time, even though it was uncomfortable, to protect myself from the virus.”—Informant 17 (Chinese).

• This theme appeared across both migrant and Spanish participants. Among migrant women, fear was occasionally compounded by distance from family networks or challenges related to understanding information and navigating the health system.

2.

Perception of healthcare.

• Definition: Evaluations of the quality of care received, including interactions with medical staff and perceived support.
• Subcategories:

  ○

  Positive experiences: Appreciation for the care and accessibility of healthcare staff despite restrictions.

  ▪

  Example: “My primary care pediatrician was more like a friend than a doctor.”—Informant 10 (Moroccan).

  ○

  Challenges in healthcare: Difficulties arising from safety measures and restrictions on accompanying visitors.

  ▪

  Example: “I couldn’t have anyone accompany me to my appointments, and that made me feel very alone and vulnerable.”—Informant 5 (Spanish).

• Emotional distress appeared across the whole sample. For some migrant participants, this distress was linked not only to the pandemic context but also to feelings of isolation, more limited support networks and, in some cases, communication challenges.

3.

Social and Cultural Impact of the Pandemic.

• Definition: Changes in traditions and family dynamics due to health restrictions and social isolation.
• Subcategories:

  ○

  Feelings of loneliness and isolation: Loss of postpartum support traditions and limitations on family interactions.

  ▪

  Example: “In my country, it’s a tradition to host a welcome party for the newborn, but they waited until lockdown measures were lifted.”—Informant 14 (Senegalese).

  ○

  Adapting to a different cultural environment: Challenges faced by immigrant women in navigating an unfamiliar healthcare system and the absence of cultural family support.

  ▪

  Example: “My first child was born in Senegal. I had my mother’s support. She helped me a lot… But here, I only had my husband, and he had no experience.”—Informant 14 (Senegalese).

• This theme predominantly emerged among migrant women, who described culturally meaningful postpartum practices that could not be carried out during the pandemic. Spanish informants did not usually refer to structured cultural rituals in the postpartum period.

4.

Access and use of prenatal information.

• Definition: Access to adequate information and difficulties encountered due to the lack of in-person resources during the pandemic.
• Subcategories:

  ○

  Reliance on informal sources: Use of social media and online platforms to seek information about childbirth and motherhood.

  ▪

  Example: “I had to watch videos on Facebook, but it was a bit complicated because it’s not the same.”—Informant 13 (Colombian).

  ○

  Lack of adequate preparation: Lack of knowledge about childbirth and available prenatal resources in the new cultural environment.

  ▪

  Example: “I didn’t know prenatal classes existed here. No one told me.”—Informant 14 (Senegalese).

• A Senegalese participant also described interpreting the estimated due date as an exact prediction. When labour began two days earlier, she believed that something dangerous was happening. This misunderstanding illustrates how literal interpretations of clinical information can generate fear when health-literacy levels are limited.
• Difficulties in understanding recommendations or navigating the healthcare system were most salient among migrant women, whereas Spanish participants generally described fewer challenges in this area.

The following categories and specific quotes highlight the cultural differences and ethnographic richness of the shared experiences:

Informant 10 (Morocco): This Moroccan woman experienced how COVID-19 restrictions affected the postpartum support and companionship traditions that are fundamental to her culture.

“In my culture, neighbours and acquaintances come to congratulate you. But they couldn’t. I could only receive my parents and my neighbour, who lives across from me… But it’s for my own good and the baby’s and everyone else’s, of course.”

This vignette about our Moroccan participant illustrates Theme 3 (disruption of culturally meaningful postpartum practices) and represents a typical experience among migrant women who were unable to follow expected postpartum rituals during the pandemic.

Informant 13 (Colombia): Without access to in-person prenatal classes, our South American informant turned to social media for preparation, finding the experience insufficient.

“I had to watch videos on Facebook, but it was a bit complicated because it’s not the same.”

However, she appreciated the care she received at the hospital:

“Everything has been wonderful… Giving birth in Spain is amazing, everything is easy, even with COVID.”

This vignette illustrates Theme 2 (perception of care). The informant 13 expressed a very positive personal experience of the Spanish healthcare system, highlighting feelings of protection and high-quality care. Her interview provides a contrasting transcultural perspective, showing that some migrant women perceived the maternity care in Spain as exceptionally supportive, even during the pandemic.

Informant 14 (Senegal): This woman from sub-Saharan Africa experienced cultural shock giving birth without the presence of her mother, who had been so important during her first childbirth in Senegal.

“My first child was born in Senegal. I had my mother’s support. She helped me a lot… But here, I only had my husband, and he didn’t, he had no experience.”

She also described a misunderstanding of the estimated due date, which she interpreted as an exact prediction:

“The contractions started at one in the morning. My husband came back home to eat and asked, ‘What’s happening?’ I said, ‘I don’t know, I feel a bit strange.’ He told me, ‘You’re going to give birth now.’ And I said, ‘No, the midwife told me I will give birth on the 8th of June.’ It was two days early.”

The restrictions also impacted her community’s traditional celebration:

“They wanted to throw a party… but my husband said, ‘No. Now is a very… very difficult time.’”

This vignette of our Senegalese participant illustrates Theme 1 (heightened fear and vulnerability), Theme 3 (disruption of culturally meaningful practices), and Theme 4 (health literacy and communication barriers). Her account shows how the absence of family support, the literal interpretation of the estimated due date, and the inability to follow expected community celebrations all contributed to a sense of uncertainty and cultural dislocation. This reflects a common pattern among migrant women in our sample.

Informant 17 (China): This oriental woman faced social isolation compounded by a lack of understanding of the healthcare system.

“At first, I didn’t know anything, I didn’t know what was happening, and I was very worried about the baby because I couldn’t get out of bed, I couldn’t walk.”

Although she was accustomed to solitude, her primary concern was her baby’s health:

“To me, it seems normal because before, I also wasn’t with people. I don’t have many friends; I’m already used to being alone here.”

This vignette of our participant of Chinese origin illustrates Theme 2 (emotional distress and social isolation) and Theme 4 (health literacy and communication barriers). Her experience reflects how limited familiarity with the healthcare system, combined with the absence of support networks, intensified her anxiety during the postpartum period. Her account represents a pattern seen among migrant women who faced the pandemic with minimal social and informational resources.

4. Discussion

This phenomenological–hermeneutic study shows that women’s childbirth and postpartum experiences during COVID-19 were shaped not only by fear and uncertainty but also by structural and cultural determinants that influenced perceived safety, autonomy and belonging. Although the data were collected in 2020, the lessons remain pertinent for post-pandemic maternal system redesign focused on equity, cultural safety and health literacy. These findings align with evidence that perinatal anxiety and uncertainty increase in crisis conditions and may be exacerbated among culturally diverse women who face additional barriers to information, support and navigation [1,2,3,4,5,6]. The intersection between our findings and the existing literature allowed us to identify cultural nuances that appear to be less explored in previous research.

Cultural safety and cross-cultural vulnerability.

Transculturality emerged as a central dimension of maternal experience, consistent with the cultural framework for health [9]. Participants—particularly immigrants—described linguistic barriers, difficulty understanding clinical information and the lack of cultural mediation, mirroring reports that language gaps heighten insecurity and disconnection in healthcare encounters [2,10]. Leininger’s transcultural nursing theory underscores the need for culturally congruent care when family/community scaffolds are disrupted [14]. Among participants from certain cultural backgrounds, the absence of culturally expected postpartum family involvement contributed to feelings of isolation and made it difficult to re-establish culturally meaningful practices, echoing prior observations on the protective role of family support during the perinatal period [13]. As one of the inclusion criteria of this study was that the participants should have sufficient ability to communicate in Spanish, migrant women with very limited Spanish proficiency were not represented. This may mean that the communication challenges identified here underestimate the difficulties faced by women with minimal language skills, and that the findings on culturally safe care mainly reflect the experiences of women who were able to communicate in Spanish.

Emotional and relational support as core safety needs.

Restrictions on companionship were experienced as a profound loss of emotional security and advocacy. In line with previous studies, continuous support during labour is associated with better maternal experiences and outcomes [11,15]. The suspension of partner presence and early skin-to-skin-widely reported during the pandemic [12,13] was not merely a procedural change but a relational rupture with consequences for bonding and mental wellbeing. Our analysis reinforces that policies for future emergencies must preserve humane childbirth practices wherever feasible, explicitly safeguarding the relational components of care [15].

Service disruptions, interventions and unintended consequences.

Beyond companionship, women perceived more restrictions and fewer supportive services during the peak waves of COVID-19, which may inadvertently heighten distress and undermine person-centredness [16]. Such shifts, even when safety-driven, may inadvertently heighten distress and undermine person-centredness.

Respectful practices and postpartum bonding.

The curtailment of evidence-based, relationship-centred practices, especially immediate skin-to-skin, was perceived as de-humanising and avoidable by several participants, aligning with literature stressing its importance for maternal–infant bonding and anxiety reduction [17]. Reintegrating and protecting these practices in contingency protocols is essential for humane and culturally responsive maternity care [17].

Health literacy as an equity lever.

Health literacy gaps were prominent, particularly among immigrant mothers who missed antenatal education and relied on informal digital sources. This echoes the system-level nature of health literacy [7] and women’s decision-making needs in maternity care [18]. Implementing universal health-literacy precautions, plain language, teach-back, structured interpreter use and culturally tailored materials can improve understanding and participation, both in routine and emergency care [18].

Resilience and strengths-based responses.

Despite constraints, participants demonstrated adaptability and resourcefulness, resonating with strengths-based perspectives on maternal adaptive capacity. Recognising and scaffolding these strengths—through family inclusion, emotional support and culturally meaningful practices—can enhance resilience at patient and system levels.

Post-pandemic lessons for system preparedness.

Overall, our results illuminate how global crises intensify pre-existing inequities, disproportionately affecting culturally diverse mothers. Post-pandemic maternity system resilience requires embedding cultural safety, language mediation, universal health-literacy precautions and family/partner inclusion into standard pathways, with contingency protocols that preserve the relational core of humane childbirth. These lessons align with contemporary international calls to advance equitable, respectful and culturally responsive maternity care and to integrate these principles into preparedness planning [10,11,12,13,15,16,17,18]

To clarify the origin of the implications presented, in this section we distinguish those that derive directly from the empirical findings (as summarised in the table) from those that are developed through engagement with the existing literature, including frameworks of culturally safe and transcultural care [8,9,13], respectful and woman-centred maternity care [10,16], and health-literacy models that highlight the need to strengthen understanding and clinical communication [5,6,7] (

Table 3. Themes, issues identified in participants’ accounts, and implications for practice.

Theme	Issue Identified	Practice or Policy Implication
1. Heightened fear and vulnerability	Fear of labour during the pandemic, uncertainty about warning signs, absence of family support, feeling alone.	Ensure continuous emotional support, improve clinical communication, allow safe companionship even during health crises.
2. Emotional distress and social isolation	Loneliness, restricted presence of partners or relatives, emotional strain due to limited networks.	Reinforce postpartum psychosocial support; provide culturally sensitive emotional care.
3. Disruption of culturally meaningful practices	Inability to carry out traditional rituals; absence of key female relatives; interruption of expected cultural norms.	Integrate cultural mediators and allow culturally meaningful practices when safe and feasible.
4. Health literacy and communication barriers	Literal interpretation of clinical information (e.g., due date), difficulty understanding the healthcare system, reliance on informal sources.	Provide clear, linguistically and culturally adapted explanations; verify understanding; strengthen health literacy strategies.

).

As we can see in this table, the implications derived from the 4 themes integrate not only the problems identified directly from the informants’ interviews but also the contributions from the literature, which allows us to translate the findings of this research into concrete guidelines for the future of clinical practice and the organisation of health services.

Limitations.

This study has important limitations. First, although phenomenological research does not aim for statistical generalisation, the small sample size and single-centre design may limit transferability to other settings. The transferability of the findings should also be interpreted with caution because the study was conducted in a single tertiary hospital in northern Spain which, during much of the pandemic, functioned as the only COVID-positive delivery centre in the region. This organisational particularity may have shaped some of the experiences described—particularly those related to restrictions, service reorganisations and perceived isolation—and may differ from contexts with alternative maternity care structures. Second, although participants only needed sufficient ability to communicate in Spanish, women with very limited proficiency were inevitably faced by migrant women with minimal language skills. Third, the exceptional and rapidly evolving circumstances of the early pandemic may have influenced participants’ memories and emotions. Interviews were conducted within six months postpartum, which likely reduces the risk of factual recall errors; however, meanings, interpretations and emotional evaluations of the childbirth experience may evolve over time. Therefore, the narratives may reflect both accurate recollections and later reinterpretations shaped by the broader pandemic context. Finally, the focused interpretive re-analysis conducted in 2024 represents a natural extension of the hermeneutic process. While the analysis remained grounded in the original data and was supported by reflexive dialogue between researchers, we acknowledge that interpretive depth may evolve over time. Further studies in diverse contexts would help broaden and complement these interpretive insights.

5. Conclusions

The COVID-19 pandemic magnified existing inequities in maternity care, disproportionately affecting women from culturally diverse backgrounds. Our findings highlight the need to embed cultural safety, emotional and informational support, and universal health-literacy strategies as core pillars of maternity services to ensure equity and resilience. Supporting continuous companionship, culturally meaningful practices, and clear communication pathways is essential to safeguard humane, person-centred care under both ordinary and crisis conditions. These insights provide evidence to guide maternal health systems in strengthening preparedness, enhancing inclusion, and promoting respectful and culturally responsive childbirth care for all women.