COVID is not what women expected when they were expecting

Reproductive psychiatry, also known as perinatal psychiatry or maternal mental health, focuses on mental health concerns in pregnancy (also including planning and IVF), delivery, postpartum, and parenting. As a reproductive psychiatrist, I try to imagine myself in the situation of my patient, to conceptualize the stresses she’s dealing with, who can support her at home, and, on top of any needed meds—what sort of therapy, self-care, what strategies she would benefit from. Stories patients share can be full of anguish, fear, sadness, heart-breaking trauma, or hope. Or more often, some combination of the above. I’m entrusted with so many stories, so many secrets.

We’re all expecting mental health fall-out from COVID and from the lockdowns. People’s coping strategies are being stretched (even pulled out of shape), kids have been at home all day every day, financial strain is everywhere, and there have been a lot of Facebook posts about day drinking.

It’s scary to be at the grocery store.

It’s scary when people come too close on a neighborhood walk.

It’s scary to come to the hospital if you don’t absolutely need to. People worry about ‘if I have chest pain, and go to the ER, will I be saved from a heart attack, but die from catching COVID?’

But there’s one group of patients who brave this fear to go to the hospital even when they are perfectly healthy—the pregnant women about to deliver.

COVID is not what they expected when they were expecting.

We have to socially distance to be safe. But imagine giving birth, with your partner if you’re lucky. Maybe there’s less excitement in the birth because everyone around you at the hospital has the risk of COVID somewhere in their mind. The doctors and nurses are trying to smile at you with their eyes, and encourage you. Yes, you’ve had your temperature taken, and you’ve had a COVID test on hospital admission, which may or may not have been sensitive enough to pick up a case. Around the country, in order to maintain safety at hospitals, visiting restrictions have been put in place. Which are difficult for so many people who want to visit their loved ones when they are sick. But this was supposed to be the most exciting day, your firstborn, and you’re not even sure once you go home whether your mother and best friend can come over to see the baby because of COVID.

Depending on the population, up to about one-fifth of women may develop postpartum depression. That’s in normal times. And already disadvantaged groups are more affected in normal times. Stresses increase the risk for each of us. One of the important pieces in mitigating risk is social support. No one wants babies or mothers to get sick from COVID, but we also can’t forget that new mothers and babies are out there, some struggling through without support at home. I’m often encouraging patients to reach out to family members online, wherever they are.

That’s all if your baby is perfect and healthy. It’s scary to come to the hospital to visit your critically ill baby even without COVID. There are tubes and wires and machines, and he might be too sick for you to hold when that is what you most deeply want to do. But with restrictions, it might be only you who can visit. So you feel even more guilty than you did for the baby being sick, even though you know the doctors said that the baby being sick was not at all your fault. And you have other kids at home, so you need to split your time, and your own body is still healing from a birth which might have been traumatic or emergent. Some days, even I can’t imagine how some moms keep it all together, and especially now.

That’s all if your baby is alive. Grieving a stillbirth or the loss of a baby seems unbearably difficult in COVID. Psychiatrists and therapists can help talk and process and cope. But it feels from where I’m sitting that these traumas and losses without our normal grieving rituals and coming together as humans may pervade all thought for a long time to come.

Systems have started to relax these restrictions as numbers go down locally, but we know that more restrictions may be necessary at any time.

As we continue to fight COVID, we all need to think of both taking care of our own mental health—our self-care, whether we are health professionals or patients. We need to have compassion for others, even when our own resources are running dry. From the stories I’ve been gifted by so many mothers, it is important to be aware that we never know what lies beneath the surface of the moms we see whether in clinic, the grocery store, or the sidewalk venturing out for their neighborhood walk.

Susan Hatters Friedman is a reproductive and forensic psychiatrist.

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