Late last year, a collaboration of organizations focused on maternal health made the declaration that 2020 would be the “Year of the Mother.” While this announcement was already timely in many ways, it is unlikely that anyone anticipated what was to come in 2020, and how a global pandemic would impact pregnant and postpartum women.

Perinatal women face unique challenges in the context of COVID-19. As our understanding of the novel coronavirus expands daily, perinatal women are anxious about contracting the virus, potentially passing the virus to their baby, and the safety of healthcare visits or a hospital delivery. Social distancing guidelines have impacted nearly every facet of life, including the ability to identify and engage parenting supports. Hospitals have had to make difficult decisions to limit the number of support persons during and after labor in order to reduce risk, as well as to preserve personal protective equipment.

BEING A WORKING MOTHER DURING A PANDEMIC

The experience of this pandemic has deepened inequalities and exposed vulnerabilities in our society. For working partnered mothers, the closing of schools and rapid shift to working from home have forced challenging conversations among couples about the division of childcare responsibilities. For single mothers, especially those with very young children, the juggling act of caring for children and managing a career may now be impossible. Women who are essential workers may not have the option of working from home and face an elevated risk of transmission, producing amplified anxieties not only about finding childcare for work responsibilities, but also the anticipation of childcare needs in the event of illness.

As a reproductive psychiatrist, I care for women with mental health conditions or concerns at times of reproductive transition, including menses, pregnancy, postpartum and menopause. I chose this field because I believe that women should have access to informed mental health care at all stages of life. I also appreciate the impact that a healthy mother can have on a family and a community. Mothers who are burdened by active mental health conditions often don’t have the bandwidth to remain as emotionally accessible and responsive to their children as they would like, and this can have effects across generations. So, while the COVID-19 pandemic and necessary responses create stress for all of us, the impact on maternal mental health is of particular concern not just in the immediate-term, but in the long-term as well.

PERINATAL DEPRESSION

Perinatal depression is a common complication of childbirth affecting approximately to one in seven pregnant or postpartum women. There are likely multiple contributors to its onset including hormonal fluctuation, accumulated sleep deprivation, and the level of stress inherent to both a major role transition and demanding caregiving responsibilities. Unfortunately, if left untreated, perinatal depression can have adverse consequences for both mother and child, in addition to causing a great deal of distress. Even years after the fact, women will describe to me the experience of perinatal depression as having an enduring role on their identity, their relationship with their child or on their partnership with their spouse.

Thankfully, awareness about perinatal depression has grown over the past several decades, and major advocacy efforts have resulted in increased detection and access to care. However, in the time of COVID-19, the identification and treatment of perinatal depression is facing new challenges. Rapid conversion to telehealth has brought logistical challenges to the more routine elements of pregnancy, postpartum and pediatric care, including screening for perinatal depression. Also, the typical prevention advice we give to women simply misses the mark in the context of COVID-19. Asking women to enroll the support of their community in order to engage in self-care, get some sleep, connect with a partner, or simply have a moment to do something reminiscent of their pre-baby life is no longer feasible. Empowering women’s collaboration in their birth experience via delivery plans doesn’t look the same in the time of new restrictions and unpredictable illness. All of these factors, in combination with the added layer of stress and anxiety related to the virus, make it likely that we are in a time of heightened risk for perinatal depression.

HELP IS HERE

The good news is that specialized treatment for perinatal depression and other mental health disorders during pregnancy and postpartum is available and can be effectively delivered via telehealth. The CU Department of Psychiatry’s Perinatal Mental Health Services offer a multitude of virtual treatment options including psychotherapy, group therapy and medication management. In addition, while navigating pregnancy or early motherhood may feel overwhelming during this pandemic, there are strategies that are likely to help reduce stress and increase well-being:

Set expectations around social distancing early and clearly. Not everyone interprets these guidelines the same way, and conversations with family members and friends around when and how they are able to visit the baby can potentially be awkward. Making your boundaries clear in a proactive manner can help you feel more in control of your family’s safety.

Stay in touch with your healthcare providers. Ask them for updates on labor and delivery policies or protocols for outpatient visits. Think ahead of time about who you want to be with you during your visits or delivery, and have a backup person in mind.

Stay connected from a distance. Video interaction with loved ones is a safe way to socialize, introduce your new baby, and give updates about the successes and challenges of your life. Consider joining a virtual group for pregnant or postpartum women (like the new pregnancy and postpartum groups hosted by the CU Department of Psychiatry).

Stay connected with your baby. Document memories of this time in a journal or scrapbook. Consider writing a letter to your baby describing how you got through a pandemic together!

Sarah Nagle-Yang, MD
Visiting Associate Professor, Department of Psychiatry
University of Colorado Anschutz Medical Campus

Listen to Dr. Neill Epperson and Dr. Sarah Nagle-Yang

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