Dr.Nicole Amoyal Pensak: What a Clinical Psychologist Thinks You Should Know about Postpartum During a Pandemic

As if having a newborn is not challenging enough. Typically, approximately 10-20% of women will experience postpartum depression and/or anxiety (PPD/A). These statistics are representative of cases NOT DURING A PANDEMIC. Now in a pandemic and this is an insult to injury type of stress that is unprecedented.

As a scientist, if I were to create a well-designed, tightly controlled experiment in order to induce symptoms of postpartum depression and anxiety, the COVID-19 Pandemic would be the independent variable. My hypothesis would read something like this: “If COVID-19 Pandemic is introduced to mothers within the first month of birth, postpartum anxiety and depression would be significantly greater compared to the control group without COVID-19 Pandemic.” My guess would be that the COVID-19 Pandemic would account for a significant amount of variance above and beyond typical childbirth and newborn phase experiences. Unfortunately, in reality, there is no control group.

The global trauma that is occurring due to the COVID-19 Pandemic is unprecedented. We are just starting to see residual effects, but I believe the worst is yet to come. We do not yet know the statistics of mothers experiencing postpartum anxiety and/or depression because we are STILL living it. But, if I were going to base my prediction on science, which I always do, I would say that given the known factors that increase depression and anxiety including isolation, loneliness, stressors (financial, health, caregiving), lack of sleep, lack of control, feelings of helplessness, change in routine or role, uncertainty about the future, and the relentless nature of this pandemic (no end in clear sight), I would say PPD/A is going to increase at an exponential rate.

The COVID-19 Pandemic is introducing extraordinary challenges for new mothers. Some of the challenges include:

Ø Not allowing partners to join mothers during delivery

Ø Not allowing other supportive persons in the hospital during delivery (e.g., doulas, family members)

Ø No visitations from friends or family members during their stay

Ø In some cases, hospitals are separating newborns from their mothers to prevent potential transmission of COVID

Ø Mothers must wear masks while in the hospital during labor and delivery (Try breathing without a mask during labor. That’s challenging enough!)

Besides the overt challenges the COVID-19 is providing, the pandemic is providing a whole new world of worries during the newborn phase. 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 due to potential exposure. OBGYN’s provide care that is definitely not socially distant. Of course, providers are taking all the necessary precautions and gearing up in full PPE, but you can’t deliver a baby from 6 feet away.

There are other realities, such as OBGYN’s are delivering other babies as well as maintaining office visits because maternal and baby health does not stop during a pandemic. Nurses, physicians, hospital staff are all considered essential and rightfully so. As a new mom, did you ever think you would wonder about your support staff and how many people they come into contact with or what their off hour interactions are like? Of course not. The medical and support staff is meant to do exactly that, care for you medically and support you before, during and after birth.

Beyond the hospital stay, there are additional first-time challenges that new moms have to work through. Having help and support at home can potentially be a life or death decision. Grandparents that may have agreed to help before the pandemic, are now the most vulnerable population. Any other types of support such as baby nurses, nannies, daycare and school for other siblings, friends and non-immediate family members are not available. Essentially, NO BREAKS.

Amongst the other things to worry about include what if a complication occurs and the mother or baby has to go back to the hospital. I can hear mothers of young children everywhere collectively yelling- “no one in this house get injured or sick! Stop climbing on the couch! Get away from the stairs!” Not to mention if your newborn spikes a fever before 12 weeks of age- you just won an automatic admission to the hospital (aka. the COVID petri dish). During the newborn phase of motherhood, you’re recovering from childbirth, doing around the clock feeds, taking care of yourself and potentially other dependents, all while maintaining your sanity. Sounds like a walk in the park.

In America, typical maternity leave is 6 weeks for vaginal birth and 8 weeks for cesarean. That’s right, either 6 OR 8 weeks to bounce back from your body being put through the ringer during pregnancy and childbirth, all while your baby is feeding around the clock. This is too short a leave WITHOUT A PANDEMIC. Other countries provide maternity leave up to one or two years. Sleep? Who needs sleep? I’ll tell you who needs sleep most of all- NEW MOTHERS.

I did not even discuss the hormonal shifts associated with giving birth (e.g., baby blues), breastfeeding, and your body trying to figure out when to restart its monthly cycle. But, I digress. Back to the maternity leave situation in America, so again you are expected to go back to work at 6 or 8 weeks. In preparation, you probably lined up daycare, nanny, or a grandparent (if you are fortunate to have any of those options). However, in light of the pandemic, this is now impossible. You probably thought that your other child or children would be in daycare or school or somewhere other than asking you to make 24 snacks a day while having a newborn hanging off your breast.

If you have a partner, they are likely working from home- which you think may be helpful. However, they still have to work so that your family continues to have a paycheck (kind of important). So basically, you’re home with a ghost while you tend to the child(ren). If you are a single parent, you have always been my hero, but right now you are a SUPERHERO. As a mother, you may also have to keep up work for your own job.

In the pandemic, now you may have to take on the additional responsibilities of homeschooling, cleaning, cooking, and maintaining a home (e.g., plumbing problems can still happen in a pandemic). Does this sound overwhelming yet? We are currently on month FIVE of the pandemic. MONTH FIVE and still quarantining and/or social distancing.

Maternal mental health is ALWAYS important. Before the pandemic, there needed to be more awareness, less stigma, and more resources for new moms. Now that need has skyrocketed. We are just beginning to get a glimpse of fallout from the pandemic, but I believe the worst is yet to come. We do not yet know the statistics of mothers experiencing postpartum anxiety and/or depression because we are still living it. If I were going to base my prediction on science, which I always do, I would say that introducing additional and seemingly relentless stressors to new moms, PPD/A is going to increase at an exponential rate.

Here is some good news. Fortunately, because PPD/A is so common, in general, we have effective evidence-based treatments that work. THEY WILL STILL WORK DURING A PANDEMIC. Cognitive Behavioral Therapy with Behavioral Activation (CBT-BA) is one of the most effective behavioral therapies we have for PPD/A. Another piece of good news is that because of the pandemic, most therapists and mental health providers are conducting telehealth visits. What that means is that you can engage in therapy from home (while you have an infant in your arms, are eating, while also making sure your toddler doesn’t get hurt).

There are virtual support groups. In addition, there are very effective medications for PPD/A that work. As a psychologist, I always recommend if you are taking medication for anxiety or depression, you should also engage in therapy. Therapy and medication work extremely well together, especially in the short-term, but therapy outperforms medication in the long-run. This is because in therapy, you are learning the skills you need to manage PPD/A.

There are many self-care activities that will also be helpful, in addition to treatment.

These include EXERCISE; it’s nature’s mood stabilizer. During the groundhog days of caring for an infant, it’s important to get outside, reset your day, and get some vitamin D. You can also try relaxation exercises.

A brief meditation that I teach to my patients is: close your eyes and listen for the most distant sound you can hear. You can do this ANYWHERE, even for just a minute (or longer). This mindfulness exercise brings you into the present moment. They say that depression and anxiety are disorders of time; depression you think about the past, anxiety you think about the future.

Bring yourself into the present and there is no anxiety or depression. Also, make sure that you eat regularly. If you have anxiety, you should be eating 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 these free relaxation exercises here.

In sum, we already needed to increase the discussion of PPD/A before and reduce the 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 any type of support we can during this time.