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The COVID-19 pandemic has been causing a rising concern in the area of mental health. Mental Health America shares that the number of people looking for help with anxiety and depression skyrocketed in 2020. In addition, the Kaiser Family Foundation highlights that the effects of the pandemic have created new barriers for that may complicate an individual’s ability to foster mental wellness. The Centers for Disease Control and Prevention (CDC) acknowledges that this causes some individuals to be more at-risk. For example, younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers are at an increased risk for substance abuse and suicidal ideation.
Another population that warrants additional attention is those who are pregnant. The stressors of pregnancy already create mental health concerns, and these are likely amplified by the present pandemic. In order to maintain mental wellness while pregnant in a pandemic it is essential to be aware of the scope of the concern, acknowledge risk factors, and be actively engaged in fostering mental wellness in the perinatal period (i.e., the time spanning from before and after birth).
Mental Health in Pregnancy
Pandemic aside, pregnancy itself can be taxing. At a minimum, about 3 in 4 women will experience the baby blues, which commonly includes short post-partum symptoms such as mood swings, reduced concentration, and difficulty sleeping. Baby blues often begin a few days following delivery and can last for up to two weeks.
This is not to be confused with a pregnancy-related mental health disorder that could arise beyond this time frame, last longer, and be more severe. According to the CDC, one in eight women experience post-partum depression, and this number is as high as one in five in some states.
While there is a focus on maternal mental health post-birth, stressors can be endured prior to labor and delivery symptoms may arise before this time as well. There are a variety of additional mental health concerns that can be prompted by the stresses of pregnancy (e.g., birth-related post-traumatic stress disorder, postpartum psychosis) or can be exacerbated by pregnancy (e.g., generalized anxiety disorder, obsessive compulsive disorder). While it may not be possible to prevent these disorders altogether, being aware that these problems may arise and taking proactive care can help to foster wellness in pregnancy that benefits mom and baby.
Key Areas That Affect Mental Health in Pregnancy
In addition to knowing the concerns that can affect a pregnant person’s mental well-being, it can be helpful to take a closer look into the factors that can exacerbate a presenting mental health problem in order to proactively moderate such symptoms. Let’s take a look at some key areas in which mental health may be affected in the perinatal period. One factor that will likely have an influence on pregnant women is hormonal changes. In pregnancy levels of estrogen and progesterone surge, however, soon after childbirth, these levels drop to pre-pregnancy levels. Experts believe that this sudden drop can cause changes in mood.
Sleep is a foundational human need, and getting quality rest is a cornerstone of mental wellness. However, there are times that proper rest may be hard to come by, and parenthood is one of those times. Especially as one adjusts to having an infant, factors such as being stressed from changes in routine, having a lack of free time, and being overwhelmed with infant care can cause a lack of sleep.
During the post-partum period, the focus tends to from the individual and/or the relationship to the newborn. However, this transition is not always easy. Parents may experience grief and loss about who they were before the baby. In addition, healthy body image may be affected by the changes endured during and after pregnancy (e.g., weight gain, nursing).
While the transition from focusing on oneself and one’s partner is to be expected, perpetually caring for another without caring for oneself comes with mental health consequences as well. While support for the new mother helps to ease this adjustment, unfortunately, many women do not feel supported by their partners, and worse, experience domestic violence during and after pregnancy. On top of this, due to cultural, societal, familial, and personal expectations, new parents often feel the pressure to gracefully adjust to this new phase of life.
Risk Factors for Mental Health Concerns in Pregnancy
Common risk factors for developing a mental health concern during or after pregnancy include:
- A personal or family history of a mental health diagnosis
- Financial instability
- Substance misuse or abuse
- Being younger than 20
- Delivering preterm
- Experiencing labor complications
- Having difficulty breastfeeding
- Having a child with special needs
Although risk factors exist, it’s important to recognize that there is no particular combination of variables that makes one immune to developing perinatal mental health concerns. Dr. Ashley Blount, Assistant Professor of Counseling at the University of Omaha, highlights that women of color disproportionately experience mental health concerns in pregnancy.
Blount emphasized that with a closer look, these risk factors can be explained by systemic problems that are important to address (e.g., accessibility, cultural competence). According to the CDC, people of color are more likely to be diagnosed, hospitalized, and experience fatalities from COVID-19. Underlying inequities can serve as key factors that may affect pregnant women of color in the pandemic such as income inequality, lack of access to culturally competent care, being essential workers, being in fields with more significant job losses, and pressures to be on the frontlines at home as well as at work.
How Mental Health Concerns Can Be Amplified in a Pandemic
Women who are pregnant in the pandemic can be affected by the key areas noted above and may also have to face additional stressors as well. One way that some of these stressors can be moderated is by raising awareness.
This can be covered in a traditional pregnancy class. Childbirth classes have been linked to reduced depressive symptoms in the postpartum period. In an effort to be precautious, expectant parents may forego such classes. On top of that, as a measure to try to reduce COVID-19 exposure, many hospitals have canceled their classes altogether. However, this is not the case for all hospitals. In addition, many providers such as Lamaze International, have adjusted to offering classes online to allow parents to continue to bridge this knowledge gap.
Separate from perinatal education, in an effort to be cautious, especially when considering being immunocompromised, individuals may be hesitant to attend prenatal appointments. However, not only do these appointments provide essential information pertaining to physical wellness for the parent and child, but they also are crucial for preventative mental healthcare. Prenatal appointments provide an opportunity for providers to assess for mental health concerns and intervene proactively if needed.
Individuals who are concerned about their safety when attending prenatal visits should inquire about COVID-19 precautions that are being implemented in the office. Another option is to ask about pursuing telehealth as an alternative as opposed to Dr. Google.
COVID-19 precautions have exacerbated our pre-existing loneliness epidemic. As noted earlier, social support plays a key role in mental wellness in pregnancy, however, suggested guidelines in the pandemic can create obstacles during this time. Therefore, even in the case that a pregnant woman has an established social system, social distancing may prompt feelings of isolation.
Due to the fact that we are still living in the COVID-19 pandemic, information on what happens when pregnancy and pandemic stress intersect is sparse, but not nonexistent. In a study published in the American Journal of Obstetrics and Gynecology, it was noted that perinatal anxiety has been heightened due to concurrently managing baby preparations and COVID-19 precautions. While we await additional studies, we can stay informed by proactive assessment and intervention of mental health concerns.
Fostering Mental Wellness While Pregnant in the Pandemic
The kicker for all of this is that pregnant women are strongly encouraged to reduce their stress levels in order to moderate adverse consequences for the baby. However, stress reduction may be easier said than done, especially when pregnant in the pandemic. Nevertheless, all hope is not lost. To be cautious, providers need to routinely screen their patients. Kaitlyn Zipoli Agudelo, a nurse practitioner and certified nurse-midwife at The Women's Center, encourages her patients to begin making a connection with a mental health professional early on in their pregnancies. While this was a practice she utilized prior to the pandemic, in her personal experience during this time, she has made sure to emphasize this practice within the last year. Dr. Ashley Blount shares that we need to empower women to be informed and engaged in regard to perinatal care. While self-care and mental wellness are always essential, they are particularly important during this unique time in our history.
This is a series dedicated to perinatal wellness in the pandemic. To learn about general perinatal mental health read this piece. The next piece in this series will provide skills for coping with pregnancy stress in the COVID-19 pandemic.
If you find yourself struggling with the stress of this time and these tips are difficult for you, it may be a sign that you could utilize help from a local mental health professional. You do not have to handle this alone, and you can find a trained clinician by reaching out to your insurance provider, local mental health organization, or searching for a provider in the Psychology Today directory.
If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States via phone at 1-800-273-8255 or chat.
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