The New York Times
By Pooja Lakshmin
May 29, 2020
New and expecting moms are facing pandemic-related fears on top of social isolation.
After going through a harrowing bout of postpartum depression with her first child, my patient, Emily, had done everything possible to prepare for the postpartum period with her second. She stayed in treatment with me, her perinatal psychiatrist, and together we made the decision for her to continue Zoloft during her pregnancy. With the combination of medication, psychotherapy and a significant amount of planning, she was feeling confident about her delivery in April. And then, the coronavirus hit.
Emily, whose name has been changed for privacy reasons, called me in late-March because she was having trouble sleeping. She was up half the night ruminating about whether she’d be able to have her husband with her for delivery and how to manage taking care of a toddler and a newborn without help. The cloud that we staved off for so long was returning, and Emily felt powerless to stop it.
Postpartum depression and the larger group of maternal mental health conditions called perinatal mood and anxiety disorders are caused by neurobiological factors and environmental stressors. Pregnancy and the postpartum period are already vulnerable times for women due in part to the hormonal fluctuations accompanying pregnancy and delivery, as well as the sleep deprivation of the early postpartum period. Now, fears about the health of an unborn child or an infant and the consequences of preventive measures, like social distancing, have added more stress.
As a psychiatrist who specializes in taking care of pregnant and postpartum women, I’ve seen an increase in intrusive worry, obsessions, compulsions, feelings of hopelessness and insomnia in my patients during the coronavirus pandemic. And I’m not alone in my observations: Worldwide, mental health professionals are concerned. A special editorial in a Scandinavian gynecological journal called attention to the psychological distress that pregnant women and new mothers will experience in a prolonged global pandemic. A report from Zhejiang University in China detailed the case of a woman who contracted Covid-19 late in her pregnancyand developed depressive symptoms. In the United States, maternal mental health experts have also described an increase in patients with clinical anxiety.
In non-pandemic times, as many as 14 percent of women will suffer from pregnancy-related anxiety, which refers to fears that women have about their own health and their baby’s over the course of pregnancy and delivery, and up to 20 percent of women will experience postpartum depression.
Samantha Meltzer-Brody, M.D., M.P.H., who is the chair of the department of psychiatry at the University of North Carolina at Chapel Hill and the director of the Center for Women’s Mood Disorders, said, “The natural vulnerability of this major life transition is exacerbated when you just have sort of global anxiety, and things like going to the grocery store to pick up diapers suddenly become a much more anxiety-producing event than it ever was before.”
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Dr. Meltzer-Brody explained that the higher levels of stress in perinatal women increase their risk for developing a clinical disorder, such as perinatal depression or anxiety.
In my clinical practice and in a Covid-19 maternal well-being groupI co-founded, women have voiced their fears about a number of possible distressing scenarios: delivering without a support person; being one of the 15 percent of pregnant women who is asymptomatic for Covid-19 and facing possible infant separation; and recovering during a postpartum period without the help of family or friends to provide support. There’s also grief about the loss of a hopeful time that was meant to be celebrated with loved ones.
Pregnant women and new mothers must also deal with the constant low-grade panic that comes with making decisions that have no specific medical guidelines, such as: What should I do if I have other kids at home and the only person who can help me is a grandparent who is at high risk? What kind of precautions should I take if my partner is a health care worker? Is it OK to send my kid back to day care? Without clear right answers, the mental load of these decisions defaults to mothers.