There have been multiple studies over last year showing increased anxiety and depression in certain populations as a result of the COVID-19 pandemic. It is clear that some members of the population may be more susceptible to psychological distress than others with recent studies demonstrating that pregnant and postpartum women experience increased levels of stress, anxiety, and depression.
Long before the pandemic, Sharon Dekel, PhD and her research team has been interested in understanding trauma related to pregnancy and childbirth. Her research indicates that childbirth-related post-traumatic stress disorder (CB-PTSD) is common and clearly under-recognized. In the wake of the pandemic, Dr. Dekel became interested in measuring the impact of the pandemic on maternal mental health. In this setting, expectant and new mothers suddenly had to grapple with uncertainty and anxiety related to the impact of the virus on their own health and their pregnancies, while at the same time dealing with disruptions in medical care, lockdowns, social distancing, and vanishing supports and resources.
Several recent studies from Gus Mayopoulos and members of the Dekel Lab demonstrate that giving birth early in the pandemic has had a significant impact on maternal mental health.
Trauma Symptoms, Worse Bonding in Women Giving Birth During the Pandemic
In the first study, a sample of 1611 primarily American women who gave birth during the first wave of the COVID-19 pandemic completed an Internet survey detailing their childbirth experiences, and their responses were compared to a group of 640 matched controls, women who gave birth before the pandemic.
Birth-related traumatic stress was assessed using the Peritraumatic Distress Inventory; and PTSD-checklist. Maternal bonding was assessed using the Maternal Attachment Inventory and the Mother-to-Infant Bonding Scale).
Mothers in COVID-19-exposed communities were more likely to report clinically significant acute stress response symptoms to childbirth than matched controls (OR= 1.38). In addition, higher acute stress response symptoms at the time of childbirth were associated with more childbirth-related PTSD symptoms and less bonding with the infant, including a higher prevalence of breastfeeding problems.
Being COVID-Positive: More Trauma Symptoms, Worse Pregnancy Outcomes
The second study surveyed women who gave birth during the first wave of the pandemic, comparing responses in women with confirmed or suspected COVID-19 infection during pregnancy or childbirth (n = 68) to a matched group of women reporting COVID-19 negativity (n = 2,276).
Nearly 50% of COVID-positive women endorsed clinically significant acute traumatic stress symptoms in response to childbirth. Compared to COVID- negative women, COVID-positive women were more than twice as likely to endorse acute stress (OR 2.64).
COVID-positive mothers were more likely to have no visitors during maternity hospitalization and were also less likely to room-in with their newborns (OR?=?0.37). In addition, COVID-positive women reported higher levels of pain during delivery, lower newborn birth weights, and more infant admissions to the neonatal intensive care unit (OR?=?2.03).
Protecting the Mental Health of New Moms During the Pandemic
The pandemic has been with us for nearly two years. Unlike many other stressors, the pandemic is not a single traumatic event but instead has been a prolonged traumatic experience punctuated by periods of more acute stress. In dealing with a novel, highly contagious and virulent virus, pregnant and postpartum women have had to navigate uncertainty and anxiety. In addition to concerns about the impact of COVID-19 on their own health, the pregnancy, and their families, there have been many other significant stressors.
In an effort to decrease the spread of COVID-19, public health officials have recommended that we minimize close physical contact with others and furthermore require those with either suspected or confirmed COVID-19 infection to be under quarantine. Most hospitals now require that all women admitted for obstetrical care be screened for COVID-19, so that COVID-positive women can be separated from the general population.
These guidelines are scientifically sound and absolutely appropriate, except when it comes to taking care of a newborn. Everything we typically recommend to the new mother to promote bonding and to optimize newborn care — skin-to-skin contact with the baby, exclusive breastfeeding, and rooming in with the infant — run counter to the guidelines we should follow for preventing the spread of COVID-19. In addition, many of the social supports new mothers rely on — friends, family, community — are no longer available as a result of social distancing.
The findings of these studies indicate that COVID-19 affected populations are at increased risk for traumatic childbirth, which may negatively affect bonding and may contribute to increased risk for psychiatric morbidity. It is important to note that acute stress symptoms related to childbirth were the most prominent in COVID-positive women; however, increased acute stress was evident in healthy COVID-negative women. Thoughtful attention to the emotional well-being of women giving birth during the pandemic is warranted, and as we move forward, we must ensure that the trauma sustained during the current pandemic is identified and addressed.
Ruta Nonacs, MD PhD
Mayopoulos GA, Ein-Dor T, Dishy GA, Nandru R, Chan SJ, Hanley LE, Kaimal AJ, Dekel S. COVID-19 is associated with traumatic childbirth and subsequent mother-infant bonding problems. J Affect Disord. 2021 Mar 1; 282:122-125.
Mayopoulos GA, Ein-Dor T, Li KG, Chan SJ, Dekel S. COVID-19 positivity associated with traumatic stress response to childbirth and no visitors and infant separation in the hospital. Sci Rep. 2021 Jun 29;11(1):13535. Free article.
The Mothers Who Can’t Escape the Trauma of Childbirth (The Atlantic) – Includes interview with Dr. Sharon Dekel on postpartum PTSD
Exploring the Mental Health Impact of COVID-19 on New Mothers (MGH Research Institute)
Other Researchers Involved in this Project: Gus Mayopoulos, Tsachi Ein-Dor PhD, Gabriella Dishy, Rasvitha Nandru, Sabrina Chan, Lauren Hanley MD, Anjali Kaimal MD