Even prior to the coronavirus pandemic, it was the case that “women who are depressed during pregnancy or after the birth may stop doing things for themselves that give them a sense of enjoyment or satisfaction,” note researchers at British Columbia Children’s Hospital. With the added stresses of a pandemic, it is clear that new and expectant mothers face a new range of obstacles and challenges to the health and well-being of themselves and their families. These include limitations on receiving social support as well as possible conflicts that can arise from living in “close quarters” with partners and perhaps other children.
A new mother can have concerns about her suitability for motherhood and her ability to soothe and take care of her new child, all while trying to steer her own sense of enjoyment or satisfaction. At the same time, medical specialists are inclined to be proactive, promote self-care, and alleviate stress by “screening, identifying and managing perinatal mental health disorders during the pandemic, without delay.” To this end, the Society for Maternal-Fetal Medicine (SMFM) has partnered with the Maternal Mental Health Leadership Alliance and others to request additional funding from the federal government for mental health screenings in more states during the pandemic.
In order to facilitate self-care for new and expectant mothers, mental health specialists have devised the NESTS strategy. While devised in 2011, these principles still apply now, especially in the middle of a stress-inducing pandemic. The different components of the NESTS strategy include, but are not limited to, the following:
- Am I eating three meals each day at least?
- Am I getting enough hydration during the day?
- What physical activities have I enjoyed in the past?
- Am I making time to do those now?
- How much sleep or rest do I get each night?
- Do I ask for help if I need more sleep or rest?
T—Time for Self
- How much time do I have for myself each day?
- Do I take short breaks during the day for myself?
- Are there others I can depend on when I really need help?
- Is there at least one person I can trust for advice when I have questions?
Self-care for new and expectant mothers requires sufficient answers to the questions above, to begin with. In order to facilitate overall health and well-being, mental health specialists suggest the following tips to fulfill the NESTS strategy for self-care:
- Try planning meals: Plan simple meals for three to four days in advance with someone who can help. Organize a shopping list and make plans to get the food items you need. Alternatively, ask for help from family and friends to get your groceries so you can have one less thing to worry about.
- Keep a mug or refillable water bottle with you to remind you to stay hydrated.
- Stay consistent and include shorter regular exercises (e.g., walking outdoors) rather than sporadic yet intense exercises.
- Use the five-minute initiation rule: Start with at least five minutes of activity. If you can keep moving after five minutes, go for it. If not, try again later.
- Reduce or eliminate caffeine before sleep time. This will help you fall asleep faster and stay asleep.
- For pregnant women, try using a body pillow or several smaller pillows at different positions (lower back, between the legs, etc.) to aid with comfort and facilitate sleep.
Time for Self
- Have alone time: Try sitting somewhere comfortable, like on a front step or patio, and read a magazine for five minutes alone during your favorite time of day.
- Treat yourself: Buy yourself a small treat like a scented body wash or new nail polish color. For more ideas that might apply during COVID-19, see the full NESTS strategy.
- Be direct and specific about what you need. To your partner, for example: “Could you arrange to be home from work a little earlier tonight so that I can get out for a short walk?”
- Timing of feedings: See if your partner or family member can feed one time early in the evening or early in the morning so you get a three-to-four-hour stretch of sleep and can pump milk for the baby.
Last but certainly not least, remember that it is normal to feel some postpartum ‘blues’ and emotional challenges in the immediate postpartum period, like episodes of feeling tearful, exhausted, or overwhelmed. While it can be a joyous experience to welcome a new baby, it is also very challenging to adjust to the new schedules (i.e., regular breastfeeding and less sleep). At your OB/Gyn or pediatrician offices for postpartum follow-up appointments, they should be asking you to fill out an Edinburgh Postpartum Depression Scale (EPDS). The EPDS will help determine more objectively if you are at risk for postpartum depression. If a mom has a particularly stressful childbirth experience or a baby in the NICU after delivery, these experiences may elevate the scores. Women who have a history of depression, anxiety, or other mental health conditions may be at higher risk. If a mom ever has feelings that she may want to harm the baby or herself, she should seek help immediately from her OB/Gyn physician or go to the emergency room.
Remember to not be so hard on yourself and take it one day at a time. The postpartum period will get easier as you adjust. Try as much as possible to talk to friends, family, and loved ones about your joys and struggles since this will help you through it. Your physician can also be a source of support and can refer you to a mental health specialist if you are concerned about postpartum depression. Finally, remember that 130 million babies are born each year worldwide and you, like all those mothers, can do this too.
Thapa, S. et al. 2020. Maternal Mental Health in the Time of the COVID-19 Pandemic. Acta Obstetricia et Gynecologica Scandinavica.
Haring, M. et al. 2011. Coping with depression during pregnancy and following the birth: A cognitive behavior therapy-based self-management guide for women. British Columbia Reproductive Mental Health Program.