Familial and Social Stressors Among Jordanian Midwives Amid the COVID-19 Crisis

To explore Jordanian midwives’ experiences at their homes and in the community during the COVID-19 pandemic crisis. The global crisis of COVID-19 disturbs the daily lives of all people including healthcare professionals. Previous studies examined stressors facing healthcare professionals while working with patients. However, studies exploring the consequences of the COVID-19 crisis on the personal lives of midwives are lacking. A descriptive qualitative design. Data were collected using telephone semi-structured interviews from March to April 2020. Twenty (20) midwives from two hospitals were recruited using purposive and snowballing sampling strategies. Data were analyzed using thematic content analysis. Three major themes emerged including “the Pandemic Shaking Our Lives” with the sub-themes of “Fear to be a “reservoir” of the virus” and “Daily Life Activities Disturbances.” The other two major themes were “Social Stigma” and “Midwives’ Response to the crisis.” Jordanian midwives felt overwhelmed and experienced stressful experiences in their homes and communities during the national lockdown. More focus on midwives’ psychological status and factors influencing them during the crisis is needed rather than focusing on work stressors to avoid any familial-work conflicts and maintain the best level of care provided.


Introduction
The COVID-19 outbreak emerged in December 2019 in China and caused many complications among the Chinese people ranging from asymptomatic to very critical attacks (World Health Organization [WHO], 2020a).Then, it has become a major health crisis globally and in Jordan and needed governmental response to protect people from this pandemic outbreak.The response included quarantine and curfew for people, closing childcare, schools and universities, closing the majority of shops, and preventing gatherings (Jfra News, 2020;Shanafelt et al., 2020).However, these actions resulted in daily life interruption and adverse effects on the physical and psychological state of people (Li et al., 2020;Mo et al., 2020;Sun et al., 2020).In contrast to most men, women often take on many roles (such as caring duties and housework), which makes it hard for them to ''have it all'' and interferes with their capacity to attain work-family balance (Gr€ unberg & Matei, 2020).The stresses working women have experienced because of their increased home workload are highlighted by Adisa et al. (2021).Compared to the time before COVID-19, women carried out more domestic tasks while the country is under lockdown.If their husbands or partners had been helpful by providing enough assistance with household activities, the increase in obligations may have been achievable (Adisa et al., 2021).These findings have consequences for family care policies being developed, particularly those supporting single parents with kids ł 17 years old.These results also imply that single parents with small children ought to be the target of initiatives to lower family-related stressors and raise levels of family well-being in times of crisis (Rudolph & Zacher, 2021).
It is expected that frontline workers as healthcare providers (HCPs) are at high risk of being affected during the pandemic outbreak (WHO, 2020b).Limited studies show that female HCPs face extensive physical and psychological pressure because of their caring role, not only at work but at home too.Because of working in hospitals or primary care centers, midwives may become worried about the safety of their families and the growing risk of being infected.Many HCPs face stigma from the community because of the risk that they may be infected with the Corona virus (Furuta, 2020;Lai et al., 2020;Sun et al., 2020).In general, stigma is a sign of shame that separates a person apart from others (Pescosolido, 2013) whereas social stigma (e.g., being discriminated against and undervalued) may have different negative consequences such as shame and embarrassment (Corrigan et al., 2016).
Midwives are healthcare professionals and they are a valuable human resource that needs to be protected from pressures while providing care to patients infected by the Corona virus.Hence, providing them with sufficient personal protective equipment (PPE) and a safe work environment while offering maternal and newborn reproductive care may help protect them from infection.As such, they should not face violence, stigma, and being discriminated against (International Congress of Midwives [ICM], 2020).Despite the pandemic, women are still becoming pregnant and babies are still being born.Hence, it is important to identify the challenges of our midwives, offer support, and train them in the best way possible to continue their good work of bringing new life into the world (Furuta, 2020).Sustaining a healthy workforce guarantees a continuous good quality of care that saves the lives of women and their newborns (Furuta, 2020).

Background
In Jordan, there are only 3319 registered midwives (RMs) working in the public and private sectors.This number reflects the shortage of Jordanian midwives which shows an average of 3.22 midwives per 10000 population (Ministry of Health, Jordan [MOH], 2018).Jordanian midwives deliver different aspects of care for pregnant and childbearing women throughout their journey with pregnancy in and outside hospitals.Further, they provide other services including family planning, breastfeeding education, newborn, and child health and immunization (MOH, 2018).Although childbirth services in Jordan are highly medicalized, Jordanian women prefer to receive antenatal and postpartum care from midwives as they are of the same gender (Jordanian Nursing Council [JNC], 2016; Shaban et al., 2012).Despite their valuable role, midwives are not well invested in Jordan and midwifery is not recognized as a separate profession.The confusion with a medically controlled healthcare system created a lack of wellrecognized identity and image for midwives and, therefore, midwives are not able to fully practice their role and scope (Shaban et al., 2012).Many barriers were documented that prevent Jordanian midwives from undertaking this role.The major barriers were lack of professional recognition, medical domination of health services, poor societal image, high levels of stress and workload, and problems with the quality of midwifery education (Shaban et al., 2012).
In Jordan, trained health personnel including obstetricians and midwives attend 98% of births (Department of Statistic/Jordan, 2018).Midwives primarily help obstetricians, perform procedures such as vaginal examinations and episiotomies and care for low-risk women.Hence, decision-making is primarily made by obstetricians (Shaban et al., 2012).According to Alnuaimi et al. (2020), midwives were satisfied with their job and work environment.Yet, in their study, Alnuaimi et al. recommends that to enhance midwives' job satisfaction further, stakeholders (i.e., policymakers and managers) should include external rewards (i.e., salary, vacation, and benefits packages).Furthermore, to improve midwives' professional development, they should be involved more with research activities, publications, and collaboration with academic staff.Hence, Jordanian midwives should be encouraged and supported by their managers to be more actively involved in hospital affairs (Alnuaimi et al., 2020).In Jordan, nursing as a profession is perceived as higher than midwifery and this is seen in the different salary scales, incentives, and benefits are available for nurses but not for midwives.Midwifery managers also have been downgraded and nurses are responsible for the management of midwives.Such challenges need to be worked on to improve the midwifery profession (The Higher Health Council, 2015).
The first confirmed diagnosis of COVID-19 in Jordan was reported by the WHO on the second of March 2020 in the city of Irbid (International Association of Medical Assistance to Travelers [IAMAT], 2020).As a result, to reduce the risk of spreading the infection, the MOH started working with a minimized number of HCPs including midwives (Jfra News, 2020).This resulted in working under pressure with a minimal number of midwives who were already facing work overload before the crisis (Alnuaimi et al., 2019).Hence, to know what kind of life experiences midwives might live during this crisis, it is better to ask using an appropriate approach (Shanafelt et al., 2020).
Up to the researchers' knowledge, midwives' lived experiences during the COVID-19 crisis are underresearched.The majority of available studies examine the psychological and mental status of HCPs while working with clients, especially, nurses using quantitative approaches (Li et al., 2020;Mo et al., 2020).Very little information about midwives is available from the WHO and ICM documents and these are letters/comments to editors rather than research studies.Hence, the current study is the first that was conducted in Jordan to explore midwives' personal experiences at homes and in the community amid the COVID-19 crisis using a descriptive qualitative approach.This study is of great significance because there is a need for more research studies to examine factors negatively influencing the quality of care provided by midwives to special groups.Also, the study is important as midwives are rarely included in previous research studies conducted in Jordan since most of these studies are conducted to examine the effect of the COVID-19 crisis on HCPs in general but not on midwives.This paper is a part of a larger project, the first paper has been published (Alnuaimi, 2021).

Study Design
A descriptive qualitative study was used.Qualitative methods offer an in-depth understanding of the world views of midwives (Fourtune et al., 2013).Data were collected using telephone semi-structured interviews.Due to the curfew and quarantine in Jordan at the time, telephone interviews were seen to be the best data collection method as it protects participants' privacy, preserves anonymity, and minimizes disturbance for the researcher and participants' self-consciousness while talking during the interviews (Drabble et al., 2016;Lechuga, 2012).However, it has been reported that missing body language and being shorter than face-to-face interviews are disadvantages of this method (Barret, 2019).Nonetheless, midwives in this study talked for at least 30 minutes showing their interest in the area under investigation.

Settings and Participants
The study sample was recruited from the largest maternity hospital and a peripheral hospital in Irbid.To achieve data saturation, we started by using a purposive sampling strategy to recruit 13 midwives and then followed by a snowball sampling method .The final sample included 20 midwives.Jordanian midwives working at maternity wards in the selected settings during the period of the COVID-19 pandemic and who lived with their families were recruited.

Data Collection
Upon permission, contact numbers for all midwives were collected and detailed information about the study was sent to them via the instant messaging application WhatsApp or text messages.Initially, verbal consent was obtained over the phone and then all participants were requested to send the signed consent form via WhatsApp or as a text message.Next, an appropriate time to conduct the interviews was agreed upon with each participant either from her home or during break time at her work.
The first author, using Arabic language during the period from April to May 2020, conducted all interviews.All interviews were digitally recorded upon receiving verbal permission from all participants.The interviews commenced by asking participants the following question: How do you describe your familial and social experiences during this crisis (COVID-19 pandemic)?Further probing questions were used such as ''Did you have any challenges in this period other than what experienced before the crisis at your home or community?'',''How are your relationships with your family?'', and ''How is your relationship with your neighbors, friends, and people in the community?''.For further clarifications about unclear points, the researcher encouraged midwives to speak further using questions such as ''Could you please tell me more about your experience?''and ''Can you explain that further?''Interviews lasted for 30 to 45 minutes and the first author transcribed all interviews verbatim.

Ethical Considerations
All ethical approvals were obtained from the first author University (Ref: X) prior to data collection.Then, the primary researcher contacted the manager midwives to explain the purpose of the study to them and to the midwives in the selected settings.All midwives were reassured that participation was voluntary and that they have the right to withdraw at any time without consequences.Further, reassurance was given with regard to the anonymity and confidentiality of collected information.To ensure that midwives cannot be identified different codes were used.For example, M1 was used for the first interviewed midwife when reporting direct quotes to support the study themes.A password-protected computer was used to store raw data and transcripts.

Data Analysis
Data analysis commenced using a manual Thematic Content Analysis Tool (TCAT; Berg & Lune, 2011).TCAT facilitated the identification of common themes in the text of the interview transcripts for further analysis (Anderson, 2007).All transcripts were analyzed and coded by each researcher independently to ensure the accuracy of the analysis in the current study.First, all transcripts were read and re-read several times by both authors to gain a sense of the content in general.Next, major statements relevant to midwives' experiences were extracted and marked on the transcripts and were written on a diary using exact page and line numbers.Then, data from the interviews were compiled to formulate the meanings of these significant statements.Different steps were also used to ensure that both authors agreed upon the final themes.For instance, coding, recording and organizing the codes into meaningful components was undertaken.The continued analysis helped identify major themes.All relevant themes were compiled together and when a new theme appeared, transcripts were re-read to examine if it has been identified across them.To ensure the trustworthiness of the study, different strategies were used (credibility, transferability, and conformability; Lincoln & Guba, 1985).For example, credibility was assured using a member-checking approach where the findings were discussed with five respondents to identify whether the data collected, and their interpretations reflect participants' experiences.Transferability (or fittingness) and ''thick description'' was assured by presenting a comprehensive report of the research process, and settings and providing a rich mix of participants' quotes.Finally, the full analysis approach was cross-checked by an expert in qualitative research.

Sample Demographics
Participants' ages ranged from 32 to 46 years; the (M = 37 years).The majority of midwives had a diploma degree (n = 13), four midwives had a bachelor's degree, and three had a master's degree.Working experience ranged from 10 to 25 years; the average was 15.2 years (Table 1).

Main Themes
The interviews explored the perceived experience of participants at their homes with families and in the community during the COVID-19 pandemic crisis.Also, they identified participants' life changes, feelings, emotions and thoughts about themselves, their families, and other people during this crisis.Three major themes emerged.The first was ''Pandemic Shaking Our Lives'' with the sub-themes of ''Fear to be a ''reservoir'' of the virus'';''Daily Life Activities Disturbances'' and the other two major themes were ''Social Stigma'' and ''Midwives' Response to the crisis'' (Table 2).

Pandemic Shaking Our Lives
All midwives stated the sudden interruption of their normal life because of the pandemic and agreed on many changes that influenced their lives negatively.
Fear to be a ''Reservoir'' of the Virus All midwives revealed that they had inadequate knowledge about the new virus and its negative consequences at the time of data collection.They reported fear and high levels of stress in case they transmit the virus to their families and beloved ones.They perceived that they are mobile persons who interact with many people and suspected patients due to the nature of their work as midwives while their families are staying at home during the quarantine.Midwives who had elderly parents or/and infant or very young children were more worried, especially, breastfeeding mothers.Some midwives felt that they were a ''reservoir'' of the virus because the affected person might have no symptoms and could have accidentally spread the infection, as captured in the following statements: ''My fear of this virus increases at home.I was scared that my children might become infected more than I might.I felt myself a danger to them''M16 ''I felt myself as reservoir because I am the person who goes outside the home and interacts with many clients and people, then I come back home to my husband and children''M5 A single midwife said ''I live with my old parents and that makes me very worried when I go back home.I stay for a long time as much as I can in my private room.When I arrive home, I have a shower then greet them from a good distance'' M1.

Daily Life Activities Disturbances
Many midwives were shocked when they heard that all nurseries and daycare centers were closed.These midwives had very young children and infants who need special care.Few midwives reported the difficulty of managing this problem as their babies did not accept bottle-feeding and they had to go back home during their work time two or three times to breastfeed their babies.This problem intensified the stress level among those mothers who already had stress at work as they were thinking of their babies and this may have affected their productivity negatively.
''The most difficult moment that I had in this crisis was when they told me that the nursery will be closed at my work area because my daughter is 5 months old, and she is breastfeeding..She refused bottle-feeding, so I had to go home three times during my shift and each time I had a shower before feeding her.From the beginning of the crisis, most midwives did not visit their parents, sisters, brothers, and mothers and fathers-in-law.They made phone calls instead of face-toface meetings.There were no gatherings or picnics in this spring season as they used to do every year.Some midwives visited their old parents; however, they did not kiss or hug them due to their fear of the virus.They wear masks and gloves and sit on a plastic chair so it can be cleaned after leaving their parents' house.Even at their houses, midwives minimize contact with their kids to protect them and followed different precautions.All these were emotional and psychologically stressful changes for midwives.
''I'm getting scared from the changes in our life.this is the first year we did not go outside to enjoy the spring season and make barbecue parties.I miss my parents and family''M19 ''Before the crisis, my daughter used to sleep with me on the same bed as my husband lives in another country, but when the crisis becomes serious, I asked her to sleep in her room'' M4 ''Even in my house I asked my children to keep a good distance .nokissing or hugs when I arrive from work.but really when I see my 3 years old son coming to me and how I avoid him, I feel sorry for that'' M15 Table 2. Meaning units, sub-themes and themes.

Meaning units Subthemes Themes
My fear from this virus increases at home.Fear to be a ''reservoir'' of the virus Pandemic shaking our lives I felt myself as reservoir.I live with my old parents and that makes me very worried when I go back home.I feel myself as a virus resource.The most difficult moment that I have in this crisis when they told me that the nursery will be closed at my work area.

Daily life activities disturbances
This is the first year we did not go outside to enjoy the spring season.Distance learning adds a new task on my previous ones.The most important change was the extra time at the kitchen in preparing food and sweets.My sister's husband refused to hold my mobile.
Social stigma Once I meet my relative, I notice that he keeps a distance between me and him more than usual.When I visited my brother in law, he cleans my place with sterilizer.When I arrive home, I take off my shoes outside, have a bath.
Midwives' response to the crisis Then, I isolated myself at my own house for 1 week.I refused to become in contact with my children and closed my room door for 5 hours.
Because of the closure of day-care facilities, schools, universities, and the quarantine, all midwives reported being physically tired due to the huge demands at home and at work because of this crisis.Extra efforts were undertaken by midwives to teach their children during the quarantine such as providing distance learning to their kids, which was a new experience and required more efforts from students and their families.Many midwives reported the long time that their children spent on smartphones and computers to accomplish their homework.Further, due to the long-time staying at home, all midwives had to prepare food and cook more than before and this made them more tired.The majority reported this noticeable change in eating routines and the number of usual meals.More frequent meals, in particular, more sweets were prepared and eaten by family members.Most midwives were mothers who are responsible for preparing and offering food.For some, the fear of the Corona virus contamination made them prepare everything at home, even bread.
''There are many changes that happened due to this crisis in my life and the most important one is the extra time in the kitchen in preparing food and sweets.mychildren did not stop eating all the time and gained weight in these few weeks''M14 ''It is unbelievable how many times my children go to the kitchen asking for food, snacks, and sweets.. I'm getting tired.but,you know, nothing we can do''M7 The majority of midwives also reported that their sleeping time was interrupted because their children stayed awake for late time at night and slept throughout the next day.Therefore, midwives did not take enough sleep and did not communicate with their children very well.On the other hand, the majority did not allow their children to play with others and if they played in the garden or go outside for a walk, they bathed them before going to bed.This resulted in children spending most of their time watching TV, playing electronic games, and using smartphones.For some midwives, children fighting with each other and being hyperactive were also major problems.All midwives had similar extra housework and tasks due to the COVID-19 pandemic.Like all Jordanian mothers, midwives were obsessive in cleaning and sterilizing every shopping item from outside by themselves.All shopping items were cleaned and sprayed with water to be disinfected.Some midwives left shopping items in a separate area for days before using them.All midwives cleaned stuff by themselves with the help of their husbands to protect their children, in addition to the extra clothes washing, extra food preparation, dishwashing, extra surfaces and house cleaning.This made participants more exhausted and were very tired when they go to work.
''The most person who is treated unfairly in this crisis is the mother.allthe time cleaning, cooking, bathing, and cleaning all shopping stuff..''M5

Social Stigma
While all midwives isolated themselves as they can to protect others' health, some midwives experienced the social stigma of being HCPs and feel distressed about that.
Relatives and neighbors kept a social distance and were cautious while talking to midwives.Some people told them clearly that they were scared to contact them because they are working at hospitals.Some midwives noticed the changes in the behaviors of their neighbor's that indicated their fear to take anything from them, something that was unlikely before the crisis.Midwives reported seeing worrying expressions on others' faces when interacting with them as they took extra precaution practices: ''My sister's husband refused to hold my mobile when I asked him to see a message on my mobile.He was very scared of me as my sister told me about the high level of fear he experienced because I am a health worker''M4 ''Once I meet my relative, I notice that he keeps a distance between me and him more than usual and he was worried and tried to finish his talk very quickly.it is his right to protect himself but the situation is not easy to me and make me more stressful'' M7 ''When I visited my brother-in-law to take some necessary things from his home, he cleans my place with sterilizer when I leave.I feel with them.butsometimes I think they exaggerate the situation''M2

Midwives' Response to the Crisis
As a response to the high level of fear, all midwives took too many precautions to protect their families.All midwives explained in detail the precautions that were taken by themselves when they arrived home.Taking-off their shoes outside the house, then cleaning them with a sterilizer, change all clothes and have a bath, wash all clothes in the washing machine and clean their handbags and keys with the sterilizer before entering the house to see their children and husbands.
''I have fear for my children and my husband more than myself.whenI arrive home, I take off my shoes outside, have a bath and clean my clothes in the washing machine.then I see my family''M7 A breastfeeding midwife stated ''I am afraid of the unknown future as this disease makes me very worried at home.my fear is on my kids as they cannot tolerate it, my daughter is 5 months old''M9 For some midwives who provide care to suspected cases, isolation for hours or days sometimes was the appropriate precautions precaution.The nature of their work and being HCPs increased the possibility of being infected, forcing midwives to pay more attention to people's health and avoiding any contact or social interaction.All midwives decreased their social interaction with others including neighbors, friends, colleagues, people at shops, visitors at hospitals, and relatives to a minimal level.For some midwives, closing the door and crying alone was the situation if they felt scared to be infected.

Discussion
To our knowledge, our study was among the first studies to explore midwives' daily life experiences during the COVID-19 crisis.In the current study, midwives experienced very stressful time and changes in their daily life activities that negatively influenced their psychological and physical state.Most people and HCPs face and cope with different social and familial stressors, which can be a stimulus that includes physical or emotional factors that lead to physical or mental tension and may contribute to the development of the disease during the COVID-19 crisis (Merriam-Webster, 2021).Yet, at the same time, they experience a greater risk of virus contamination, extra workloads, and working with new environments that they were not familiar with.This created huge pressure for midwives at work and home (Adams & Walls, 2020;Lai et al., 2020;Shanafelt et al., 2020).
Consistent with previous studies (Shanafelt et al., 2020;Sun et al., 2020), midwives in our study experienced the fear to take the virus home and transmit it to their family members and beloved people, especially, their children and old parents.Midwives often experience complex and inconsistent thoughts about sustaining their roles as HCPs and parents mounted their experience of feeling guilty about the potentiality of harming their families and loved ones as a result of caring for and working with patients with CORONA virus (Bradsher, 2003;Ramaci et al., 2020).This fear altered the communication and interaction between our participants and their family members to protect them.As a response, all midwives followed very strict protocols for cleaning and protecting.Adams and Walls (2020) agree that discussing some protocols with HCPs might help reduce their stress regarding their families including the separation of living spaces and bathrooms, the benefits of removing shoes, removal of and washing clothes, and immediately taking a shower before entering the house.Further, they stressed on following strict protocols such as wearing hospital-supplied scrubs while at work might also reduce the chances of contamination after returning home.
Midwives in the current study also fear transmitting the virus to people in the community.As a response, they decreased interactions with people to a minimum and followed all precautions to protect them.Social avoidance during COVID-19 by midwives in our study and other HCPs in a previous study was one action to minimize the virus spread (Usher et al., 2020).However, social interaction might be kept active using the available social media without physical contact during COVID-19 to reduce the risk of boredom and possible psychological problems that could become risky for the person or people around (Courtet et al., 2020).People have a fear to be infected by midwives as reported by our participants and by other studies (Bruns et al., 2020;Ramaci et al., 2020) that linked stigmatization to working with potentially highly infectious patients.Therefore, more efforts should be developed and tailored toward educating the community about such diseases and why quarantine is essential at times.These efforts as well as providing HCPs working in the frontline during this crisis might help to reduce stigmatization (Ramaci et al., 2020).The use of media is an effective and powerful tool for influencing public opinion (Brooks et al., 2020).
Quarantine and curfew altered midwives' daily activities and added more tasks to their shoulders.Takeuchi and Yamazaki (2010) outlined that inadequate assistance and support for female nurses while providing childcare and doing housework for a long time seems to increase workfamily conflict that might influence their performance negatively at work and home.Prolonged working hours make any additional housework, such as extra home cleaning, a significant challenge.Despite that, any kind of supportive discussions and the use of clear guidance and recommendations always aim to minimize anxiety levels and reduce misinformation (Adams & Walls, 2020).
Different organizations estimated that around 1.38 billion children were out of school or childcare and stayed at home without being involved in any activities, team sports, or playgrounds during the COVID-19 crisis (Cluver et al., 2020).Similarly, our participants' children stayed at home with limited physical activity and long time in front of electronic games and screens.Cluver et al. (2020) found that children and their parents live with fear, greater stress, and media hype during the COVID-19 crisis.Clark et al. (2020) also addressed the need to use influential approaches to encourage families to respond, care and protect the future of their children.In addition, eating habits and meals frequencies are gone in a negative direction among our sample's children as they consumed food with high calories.Pietrobelli et al. (2020) concur those adolescents practiced wrong eating habits during the COVID-19 crisis lockdown by consuming sugary drinks, potatoes, and red meat, which may affect their health negatively in the future.Thus, these points should be addressed to find appropriate strategies to minimize the adverse outcomes on children in the future and decrease stress among their parents.
All previous challenges experienced by midwives in our study increased stress levels among them and affected their concentration in their work.Family responsibilities and work stress predicted burnout that might inversely lead to noncompliance with personal protective equipment, non-compliance with safe practices, safety reporting, and communication (Smith et al., 2018).Shanafelt et al. (2020) assessed the causes of anxiety among HCPs during COVID-19 and found that three out of eight reasons were family related.
Uncertainty about the support from their organization and managers to help their families, if they become infected, and daycare access during the crisis were highlighted.Shanafelt et al. (2020) asked leaders to listen to HCPs' needs and identify stress sources and help them accordingly in this stressful crisis.

Limitations
As this is a qualitative study, the sample size was small.However, the interviews revealed rich findings and a good understanding of midwives' experiences.All participants in this study were midwives.Hence, exploring the experiences of other HCPs might reveal different findings.The quarantine and the use of snowballing methods limited data collection to two hospitals and, therefore, including diverse settings in future studies is recommended.All participants were experienced and, therefore, the inclusion of newly graduated midwives might reveal different findings.

Implications for Midwifery, Health, and Education Policy
This study recommends that frequent psychological assessment and discussions with midwives might help in improving their psychological statue and identify factors that may influence them.To reduce work pressure, hospital management and the administrative team are advised to accommodate working hours and tailor holidays as needed.Policymakers and the government should also develop effective strategies to control the unhealthy behaviors that increased among family members, especially, among children that included bad eating habits and the excessive usage of electronic games and internet.Further, huge efforts should be implemented to minimize social stigmatization toward HCPs by using social media and television promotion.Finally, health leaders and managers should offer more emotional and psychological support to help midwives cope with different types of stressors and maintain a high level of performance at work and at home.

Conclusions
Jordanian midwives experienced a tense and stressful time while offering care to their families, and patients, and communicating with other people.This unique study identified several psychological and physical challenges and discomforts.Midwives presented an in-depth understanding that reflects the situation for many Jordanian families during the COVID-19 crisis.

''
During this period (COVID-19 crisis), I provided care for a high-risk woman who had infected relatives and I knew that after finishing my work with her.I went back to my home and started crying .Then, I isolated myself at my own house for one week.(I left my two daughters with my mum), so I did not go to my mum's house for one week.really it was an incredible experience.I cannot sleep for a week .allnight thinking if I have this infection what will happen to my daughter''M4 ''I know that the woman whom I took care of was suspected.becauseI have young children, when I arrived my home, I refused to become in contact with my children and closed my room door for five hours''M6
''I do not allow my children to go outside.you know I try to protect them from any contamination.butreally I'm very sorry for them .theyare fed up.. all the time staying at home playing on play station''M20