Maternal mental health amid the pandemic

Social distancing guidelines arising from the ongoing pandemic can inevitably lead to heightened stress among pregnant and postpartum women. Physical distance is a burden for these individuals in a time that already feels lonely and disconnected, as they rely on support from their partners and loved ones. A Baylor College of Medicine expert explains the role COVID-19 plays on pregnant and postpartum women.
 
“Pregnancy and childbirth really introduce to women a sort of dependence, and they need people with them to feel safe,” said Dr. Karen Horst, assistant professor of obstetrics and gynecology at Baylor and staff psychiatrist at Texas Children’s Hospital. “What we have seen that is the most jarring for patients amid the pandemic is the changing policies and the uncertainty.”
 
Many women are facing the fear of being alone throughout appointments and childbirth. The lack of physical presence of a loved one – someone who can reassure them that they are safe and the baby is safe – creates a sense of danger for pregnant women.
 
The stressors of the pandemic also have created worsening symptoms of postpartum depression, anxiety and OCD. Even pre-pandemic, one in seven pregnancies resulted in significant depression or anxiety. Women also have higher rates of OCD in the postpartum period, and now they have a reason to be more concerned around contamination issues. Common symptoms of postpartum depression include:

• A sense of inadequacy and failure
• Overwhelming feelings that you cannot handle anything
• Anxiety around the baby's wellbeing
• Lack of sleep due to constantly checking on the baby

“Prevent postpartum depression by getting educated ahead of time on how best to harness support. Make a plan for sleep, know there’s a whole range of outcomes of how delivery may take place, know how comfortable your baby is and know how breastfeeding works. Have a realistic, not pessimistic, but not sugar-coated idea of how it’s going to be in the postpartum period,” Horst said. “Part of that prevention is also knowing who to call when you’re struggling.”

Social isolation is making it harder for women to find time to take care of themselves, to communicate with fellow moms about motherhood and to get a break from the work of childbearing. Horst offers coping strategies to those suffering from loneliness in the perinatal or postpartum period: 

• Identify people in your 'bubble' who will keep themselves unexposed to COVID-19 so they may come into your home to help you
• Prioritize connecting with someone virtually through phone or video calls
• Join virtual support groups for new moms

Individuals who are comforting new mothers should listen, empathize and not try to fix things. Avoid taking them out of their feelings by using phrases such as “You should be happy you have a healthy baby.” Express support for them while figuring out ways to decrease the sense of isolation. Give space for hard feelings to be present.
 
The perinatal period is a vulnerable time for women who have preexisting mental health issues. Horst suggests speaking with a therapist educated on perinatal mental health. Cognitive behavioral therapy (CBT) is a practical approach for therapy. CBT is implemented to treat depressive and anxiety symptoms, teaching individuals how to identify, challenge and overcome anxiety-ridden behaviors including excessive worry, fears of separating from loved ones and sadness.
 
Clinicians should educate perinatal and postpartum women on anxiety and depression during this time, while stressing that it is treatable. If the postpartum disorder is severe, medication and therapy are very effective. Mild to moderate cases will benefit from social and psychological support. Offer adequate resources on where to get help and explain why certain policies are being implemented at hospitals as the medical community tries to navigate pandemic safety.
 
“Be one step ahead of the patient and be useful, while still expressing that there’s a common humanity to the suffering around COVID. We will get through this through science, through being thoughtful to each other and acknowledging added stress of pregnancy during the pandemic. We need to name it and not sugar coat it.”