Taraneh Shirazian, MD, an obstetrician-gynecologist and director of global women’s health at New York University’s College of Global Public Health, is careful to remind people that postpartum depression (PPD) is a clinical diagnosis intrinsic to a person’s genetic makeup. But the conditions we’re living in could certainly exacerbate the symptoms of PPD and present barriers to its treatment. This nine-month marker is uniquely significant to the pregnant women about to deliver their babies after an entire pregnancy under such restrictions. Postpartum depression is a reality for one in eight new mothers, and the pandemic might exacerbate this risk.
Depression, Anxiety, and COVID-19
Even under the best circumstances, the postpartum period is delicate. However, we’re now approaching a time in which women will give birth after experiencing an entire pregnancy under COVID-19 restrictions. Understandably, the risk of PPD is high. It’s safe to say most people are feeling increased anxiety as we navigate a pandemic and its restrictions. Normally, between 10% and 25% of women will experience anxiety or depression during pregnancy, which can increase the risk of postpartum depression (PPD). Now, for new and expecting parents, tacked onto this are the added stressors of changes in birthing plan, a lack of support, and concern for their newborns’ health. “You may not have people around you at all that can help you identify what’s going on,” Shirazian says. “It means that PPD happens and then it goes undiagnosed for longer. People don’t get the care and treatment they need, and they’re very, very alone. That’s why it needs to be discussed.” While isolating lessens the risk of contracting the virus, it doesn’t necessarily benefit mental health. Loneliness in combination with general anxiety, uncertainty and increased vigilance around our actions has been a struggle for many, expectant parents included. Pregnant people in Canada reported substantially elevated symptoms of anxiety and depression compared to pre-pandemic, with 37% feeling more depressed and 57% feeling more anxious. And these findings were mirrored across the globe. Research from a COVID-19 “hotspot” in Italy showed that concerns about risk of exposure combined with safety measures adopted during the pandemic were worsening depressive symptoms in new mothers. Meanwhile, a study conducted in Hong Kong found postpartum women also reported feeling more depressed. It’s completely normal to feel anxiety in the wake of giving birth, and not having been able to fully enjoy pregnancy due to a global pandemic only complicates things. But for women who experience anxiety under normal circumstances, reproductive and perinatal psychiatrist Carly Snyder, MD, says they might have an easier time navigating the current conditions. “Some patients, interestingly, feel like they’re doing better because they know what it feels like to be anxious,” Snyder says. “It’s not a novel experience for them, whereas for a lot of people feeling this sense of vulnerability and loss of control is really new.” As of yet, the risk of COVID-19 on pregnancy is still largely unknown. According to the Centers for Disease Control and Prevention, infections causing COVID-19 in newborns born to mothers who tested positive are uncommon. And most newborns that did test positive had mild or no symptoms and recovered. “They’re really going down a terrible rabbit hole, because we have very mixed data,” Snyder says
Coping in the Virtual World
The current circumstances could make dealing with postpartum depression even more difficult. Many of the coping strategies you might utilize under regular circumstances may be more difficult, or even impossible, in the middle of a pandemic. But with the right tools and strategies, you don’t have to go it alone. A potential benefit of our collective struggles in 2020 is the push to destigmatize talking about our mental health. Online therapy, for example, has risen in popularity since last winter, with therapists switching to video sessions while services like BetterHelp and Talkspace provide accessible therapy through your mobile device. It’s easier than ever to get in touch with a qualified therapist. And while you may not be able to see your friends and family in person, there is no shortage of ways to visit them virtually. Just make sure that you take the right approach and understand the limitations of whatever communication methods you choose, whether you are a new mom or a loved one. It can be tough to read body language or visual cues through FaceTime or Zoom (and impossible via text), so take the opportunity to think about your feelings and honestly express what you’re going through in order to provide the other party with the info they need to support you in your time of need. Amy Morin, LCSW, psychotherapist and author, suggests that text-based communication can sometimes be a better option. “You can take your time to carefully craft a response. It also might feel easier to tackle uncomfortable subjects when you’re not looking at someone face-to-face,” she says.
Before You Give Birth
In a time where so much is uncertain, focus on the things you can control. If you’re preparing to give birth, there are actions you can take to fortify your mental health.
Attend Appointments
It’s crucial that you attend all health care appointments if you are able. Shirazian notes that virtual visits don’t convey visual cues in the same way an in-person appointment can. Visiting your doctor while wearing a mask and sanitizing frequently not only keeps you and your baby healthy, it can also provide some much-needed peace of mind. If in-person visits feel unsafe, attend regular telemedicine appointments with your doctor and be as transparent as possible about what you’re experiencing at that point in your pregnancy.
Make a Plan for Care and Recovery
Peace of mind might be harder to come by after you’ve brought your baby home, so experts highly recommend making a plan well before heading to the hospital. “I tell women all the time, before delivery, because we never know what we’re going to face until we face it, make sure you have some kind of recovery plan in place,” Shirazian says. “Your recovery plan should be about you.” The important thing to keep in mind is that we currently have no hard evidence that the virus has any health or developmental effects on newborns. Snyder warns women against indulging in rampant Google searches on the subject, which only acts as fuel for anxiety. With the isolation of COVID-19 restrictions, you’ll likely be relying more on your partner than outside sources of support. What do you want this to look like? How will you divide care responsibilities, such as nighttime feedings? How can your partner help in constructive ways? Answering these questions in advance will smooth the transition of coming home with a newborn.
Make a Plan for Meals
Another question to answer is, how will you nourish yourselves? Snyder recommends asking for support ahead of time in the form of setting up a meal train with friends or neighbors. If you’re hesitant to receive homemade meals at this time, opt for food delivery gift cards or subscribe to a meal kit delivery service. And stocking the house with healthy snacks can help in moments between meals. “It’s very rare that a woman will nourish her body well in the postpartum period,” Snyder says. “This can be very depleting.”
Coming Home With Baby
During the pandemic, new parents are typically being discharged within 24 hours of giving birth. So you’ll have to hit the ground running, but the plans you made in advance should alleviate some of the stress. The early days of new parenthood will certainly look different amid COVID-19 restrictions, but there are steps to take to help yourself.
Share the Experience Virtually
“Zoom fatigue” is real, but winter might prevent you from gathering outdoors for a socially distant meet-up. And sharing in the excitement of early parenthood with family and friends is not something you want to miss. You may not be able to commune with loved ones in person yet, but video chatting on a weekly basis provides another outlet of support and stress relief. “Distance doesn’t mean separation, necessarily,” Snyder says. “But if you don’t plan it, it won’t happen. It’s allowing people into your life and into your home, without being in person.” Choose a day that works for you and your partner and let people know they can “pop in” virtually over FaceTime. You can also schedule Zoom chats in advance for a chance to connect.
Ask for Help
“The only thing working in some ways to women’s advantage is that their partners are often working from home,” Snyder says. “But this is not universal. And let’s be honest, even if they’re home, they’re working and are not inherently available. Then that in itself can be a whole different issue.” This is where the care plan made in advance comes in handy. But if you’re in need, it’s crucial that you feel comfortable asking your partner for help even while they’re working. The fact that they’re at their desk doesn’t mean they can’t take 10 minutes to help with the baby. You’ll never know if they’re “too busy” unless you ask. While sharing baby responsibilities is necessary, you should also feel comfortable taking time for yourself. Asking for help so that you can care of your mind and body, such as practicing yoga or meditation, will ease stress and eliminate unnecessary tension. “The first thing is always support, because you can’t really do anything for yourself when you have a screaming baby,” Shirazian says.
Move Your Body
A study published in the journal Frontiers observed women both pregnant and in their first year after delivery during the early months of pandemic shutdowns. With the majority reporting reduced physical activity in isolation, 72% of the women were experiencing moderate to high anxiety. However, an important finding showed that women engaging in 150 minutes of physical activity each week during the pandemic experienced significantly lower levels of both anxiety and depression. Finding ways to move your body, like taking a walk or practicing yoga, can ease stress levels.
Be Kind to Yourself
Being gentle with yourself is one of the easiest things to forget as a new parent. Snyder says women are too quick to think they’re not doing enough, and letting go of the pressure of household chores can ease stress. It’s OK if both you and your partner are too busy to do the laundry. “No one is judging you,” Snyder says. “And it’s imperative that you don’t judge yourself.” Another act of self-care can be avoiding stress triggers like spending too much time watching the news or indulging in social media—unless it’s for support. Facebook is home to countless online support groups that offer another outlet for support and allow you to “meet” other parents that can relate to your experience, especially if you’re feeling down. “You do not need to wait it out,” Snyder says. “You deserve to feel well, and you deserve to enjoy motherhood. It can happen if you ask for help.” The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.
