Anxiety

Postpartum During a Pandemic

New challenges for new mothers.

Posted Jun 22, 2020

Jenna Norman/ Unsplash
PPD/A Treatment is available during pandemic
Source: Jenna Norman/ Unsplash

As if having a newborn is not challenging enough, approximately 10-20% of women will experience postpartum depression and/or anxiety(PPD/A). These statistics are representative of cases not during a pandemic. Pandemic is an unprecedented "insult to injury" type of stress.

As a scientist, if I were to create a well-designed, tightly controlled experiment in order to induce symptoms of PPD/A, pandemic would be the independent variable. My hypothesis would read: “If COVID-19 pandemic is occurring within the first month of mothers giving birth, PPD/A would be significantly greater compared to control condition without pandemic.” My guess would be that pandemic would account for a significant amount of variance above and beyond typical childbirth/newborn phase experiences... and wait, there’s no control group.

Global trauma occurring due to the pandemic is unparalleled. We are beginning to see residual effects, but in terms of mental health, the worst is yet to come. We do not yet know the statistics of PPD/A because we are still living it. If I were going to base my prediction on science, I would say that given known factors that increase PPD/A: isolation, loneliness, stressors (e.g. financial/health/caregiving), lack of sleep, feelings of helplessness, change in routine/role, uncertainty about future, and relentless nature of pandemic (no end in sight), PPD/A will likely increase at an exponential rate.

The pandemic is introducing extraordinary challenges for new mothers:

  1. Not allowing partners/other supportive persons to join during delivery (e.g., midwives, doulas, family members)
  2. No visitations from friends/family members during stay
  3. Sometimes hospitals are separating newborns from mothers to prevent transmission of COVID
  4. Mothers must wear masks during labor/delivery (Try breathing without a mask during labor. That’s challenging enough!)

The pandemic is providing a whole new world of worries. Side note: There was never a shortage of things to worry about with a newborn. Mothers are now worried about the safety of attending maternal health appointments. Maternal and baby health do not stop during a pandemic. As a new mom, did you ever think you would wonder how who medical staff comes into contact with, what off-hour interactions are like, or who’s in the waiting room? Of course not. 

Having help at home is now potentially a life-or-death decision. Grandparents, baby nurses, nannies, daycare, school, friends/non-immediate family members are not available (aka no breaks). And what if the mother/baby/partner/dependent has to go to the hospital? I can hear mothers of toddlers everywhere collectively yelling, “No one in this house get injured or sick! Stop climbing! Get away from the stairs!"

FYI: If your newborn spikes a fever before 12 weeks, you just won an automatic hospital admission (aka COVID petri dish). During the newborn phase, you're recovering from childbirth, doing 24/7 feeds, taking care of yourself and your dependents, all while maintaining your sanity.

Sleep? Who needs sleep? I'll tell you who needs sleep — new mothers. Not to mention hormonal shifts related to mood (e.g., baby blues), breastfeeding, and restarting the monthly cycle. All of this during a pandemic.

In America, maternity leave is six weeks for vaginal birth and eight weeks for cesarean. That's right: Six or eight weeks to bounce back! This is absurd and too short a leave without a pandemic. Other countries provide leave for up to two years.

In preparation, you probably lined up daycare, nanny, or grandparent (if you are fortunate to have options). You probably thought that your other child/children would be in daycare/school or be somewhere other than requesting 24 snacks a day while having a newborn hanging off your breast. You may have a partner working from home (great support!). However, they still have to work for a paycheck (kind of important) and you're home with a ghost.

If you’re a single parent, you have always been my hero, but right now you are a superhero. For moms, additional responsibilities of their own jobs, homeschooling, cleaning, cooking, and maintaining a home (e.g., plumbing problems still happen in a pandemic) occur. Does this sound overwhelming? It’s month five of pandemic and we're still restricted.

Maternal mental health is always important. Before pandemic, there needed to be greater awareness, resources, and less stigma for new moms. Now that need has skyrocketed. 

Some good news. Fortunately, because PPD/A is so common, we have effective evidence-based treatments. Treatments for PPD/A will still work during a pandemic. Cognitive Behavioral Therapy with Behavioral Activation (CBT-BA) is one of the most effective behavioral therapies for PPD/A.

Also, due to pandemic, most therapists are conducting telehealth visits. Now you can engage in therapy or virtual support groups from home (with an infant in your arms, eating, while making sure your toddler isn’t getting hurt).

There are effective medications for PPD/A. As a psychologist, I always recommend if you are taking medication for PPD/A, you should also engage in therapy because they work extremely well together, especially if you need relief now or yesterday. Therapy outperforms medication in the long-run because you learn the skills you need to manage PPD/A.

Self-care activities are helpful, in addition to treatment. These include exercise, nature's mood stabilizer. During these groundhog days, it's important to get outside, reset, and get vitamin D. Try relaxation exercises.

A brief meditation that I teach to patients: Close your eyes and listen for the most distant sound you can hear. You can do this anywhere, even for just a minute.

Mindfulness exercises bring you into present. They say that depression and anxiety are disorders of time; with depression, you think about past, and with anxiety, you think about the future. Bring yourself into the present and anxiety or depression cease.

Eat regularly (every four hours). Drops in blood sugar can mimic anxiety. Sleep when you can. Remember, you are just one good night's sleep away from feeling more stable. Some resources I recommend the Calm app or free relaxation exercises here.

We already needed to increase discussion of PPD/A and reduce stigma before the pandemic, but now even more so. The pandemic has presented unparalleled stressors for new moms. We need to talk about PPD/A and increase support.

#through #postpartumandpandemic #postpartum #postpartumdepression #postpartumanxiety #ppda 

@dr.nicoleamoyalpensak

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