Ask The Expert
How To Cope With Giving Birth During the Covid-19 Crisis
Giving birth is stressful enough without a global pandemic. Now, with increased uncertainty and hospital protocols changing daily, the new normal is particularly trying for pregnant women. We caught up with Christin Drake, maternal mental health expert and Clinical Assistant Professor, Department of Psychiatry at NYU, on how expectant mothers can manage anxiety and prioritize their mental health.
What is your advice for helping pregnant women maintain their mental health during this difficult time?
The most impactful mental health strategies in a time as difficult as this are going to be the most basic. Doing what exercise you can safely do, keeping up social connections, eating enough and healthfully, and protecting sleep. This is a time for true conversations with loved ones. Talk about your fears, tell people how you are really doing. No putting on a good face or polishing things up. This way, you can really use the social support that you have— even if you are using it virtually. It is also incredibly important for pregnant women who may naturally be feeling hyper-alert to issues of safety to avoid consuming too much of the news. I recommend a brief daily update if that feels necessary and nothing more.
What do you say to women who are nervous and also worried that their increased anxiety will harm their baby?
We know that mothers and babies are resilient to short term stresses and it's really chronic stress that can impact health outcomes. So, there is reason to believe that every effort toward minimizing stress will do some good in this time. It can be powerful for women to know that turning inward and caring for themselves is one way to minimize the impact that this otherwise very difficult to control crisis can have on their family.
With the situation and hospital guidelines changing so rapidly, what is your advice for women who feel an utter lack of control? Any tips for dealing with uncertainty, specifically? Or how to let go of expectations or reframe expectations around the birth experience?
I am always encouraging my patients to remember that the most important thing is that they leave the hospital healthy and with a healthy baby. While the experience of the birth is important, it is much less important than the outcome.
While New York has issued an executive order allowing women one support person during labor, in many states across the country, it is still possible for a hospital to restrict visitors including a birth partner. What is your advice to women who may have to labor alone?
Hospitals in New York City are following the order with very careful limitations in place for that one visitor. I understand the efforts that hospitals must make to minimize risk to healthcare workers and to birthing mothers and their babies. There isn't a way to manage the risk perfectly, but in this case I agree that women ought to have the option of having a support in the room when they give birth. To a woman who does have to labor alone, I would recommend the option of constant contact with their support person via a device. A person who is connected to the room via a device can still advocate and provide some level of support. Again, it is so very important here to remember that the birth is just the beginning. The most important thing is that it be a safe birth and that the mother is healthy and able to care for herself and baby afterward.
And to women who are choosing whether or not they should forego having a support person in order to protect their baby’s health?
It's important to feel as comfortable with the birthing situation as possible given the circumstances and this will vary from one individual to another. Of course, if the planned support person is at all symptomatic, they must remain at home. Unfortunately, parents also have to consider the risk of exposing both parents by having them enter the hospital. If the birthing mother would feel uncomfortable with the idea that their support person might put their newborn at risk, then she would be right to weigh that against the benefit of having that support in the room.
Many women are switching doctors or hospitals very late in the game in order to deliver with their spouse or doula present. Is this something you would recommend? What are the risks women need to weigh as they are making these decisions?
This is a conversation that women should have with the obstetricians who have been caring for them throughout their pregnancies. So many women have needed to leave their homes to be close to family who can provide care for their older children and are transferring their obstetric care for that reason. For some, transferring care will be the right choice. For others with more complicated pregnancies, it may not be wise. It is also important to note that hospitals are needing to change their safety measures as the Covid crisis develops in their areas and that transfer of care certainly does not guarantee that a support will be allowed to be present.
It’s likely that women giving birth during this crisis will experience even more isolation in the postpartum period. What recommendations do you have for getting through those early days?
I think that in some ways, once a mother is home with her newborn, it may feel very natural to be staying home with immediate family. I would advise planning carefully for those in the household to help with caring for mother and baby. Partners may make the mistake of thinking that they can work from home and still be as present as they need to be. Caring for older children in close quarters will be particularly challenging. Some parents are making arrangements for family members who can come to provide help to begin isolating well in advance of the birth.
While some level of anxiety is expected and normal in a situation like this, what signs should women or their loved ones look for in terms of seeking professional help?
It is important to know that mood and anxiety difficulties can develop during pregnancy as well as after. Signs like irritability, obsessive worry, worsened difficulty sleeping and sadness that makes it difficult to enjoy things and to function at work or in your family would be reasons to seek help from a psychiatrist. You also raise the important point that loved ones can really be a help in watching for signs that ordinary worry has shifted to something that requires professional help. It is a good idea to review the signs and symptoms of peripartum mood and anxiety disorders with loved ones to ensure that they are also fully informed.
Dr. Christin Drake is a professor and psychiatrist in private practice focused on the treatment of mood and anxiety disorders and women’s mental health.
The most impactful mental health strategies in a time as difficult as this are going to be the most basic. Doing what exercise you can safely do, keeping up social connections, eating enough and healthfully, and protecting sleep. This is a time for true conversations with loved ones. Talk about your fears, tell people how you are really doing. No putting on a good face or polishing things up. This way, you can really use the social support that you have— even if you are using it virtually. It is also incredibly important for pregnant women who may naturally be feeling hyper-alert to issues of safety to avoid consuming too much of the news. I recommend a brief daily update if that feels necessary and nothing more.
What do you say to women who are nervous and also worried that their increased anxiety will harm their baby?
We know that mothers and babies are resilient to short term stresses and it's really chronic stress that can impact health outcomes. So, there is reason to believe that every effort toward minimizing stress will do some good in this time. It can be powerful for women to know that turning inward and caring for themselves is one way to minimize the impact that this otherwise very difficult to control crisis can have on their family.
With the situation and hospital guidelines changing so rapidly, what is your advice for women who feel an utter lack of control? Any tips for dealing with uncertainty, specifically? Or how to let go of expectations or reframe expectations around the birth experience?
I am always encouraging my patients to remember that the most important thing is that they leave the hospital healthy and with a healthy baby. While the experience of the birth is important, it is much less important than the outcome.
While New York has issued an executive order allowing women one support person during labor, in many states across the country, it is still possible for a hospital to restrict visitors including a birth partner. What is your advice to women who may have to labor alone?
Hospitals in New York City are following the order with very careful limitations in place for that one visitor. I understand the efforts that hospitals must make to minimize risk to healthcare workers and to birthing mothers and their babies. There isn't a way to manage the risk perfectly, but in this case I agree that women ought to have the option of having a support in the room when they give birth. To a woman who does have to labor alone, I would recommend the option of constant contact with their support person via a device. A person who is connected to the room via a device can still advocate and provide some level of support. Again, it is so very important here to remember that the birth is just the beginning. The most important thing is that it be a safe birth and that the mother is healthy and able to care for herself and baby afterward.
And to women who are choosing whether or not they should forego having a support person in order to protect their baby’s health?
It's important to feel as comfortable with the birthing situation as possible given the circumstances and this will vary from one individual to another. Of course, if the planned support person is at all symptomatic, they must remain at home. Unfortunately, parents also have to consider the risk of exposing both parents by having them enter the hospital. If the birthing mother would feel uncomfortable with the idea that their support person might put their newborn at risk, then she would be right to weigh that against the benefit of having that support in the room.
Many women are switching doctors or hospitals very late in the game in order to deliver with their spouse or doula present. Is this something you would recommend? What are the risks women need to weigh as they are making these decisions?
This is a conversation that women should have with the obstetricians who have been caring for them throughout their pregnancies. So many women have needed to leave their homes to be close to family who can provide care for their older children and are transferring their obstetric care for that reason. For some, transferring care will be the right choice. For others with more complicated pregnancies, it may not be wise. It is also important to note that hospitals are needing to change their safety measures as the Covid crisis develops in their areas and that transfer of care certainly does not guarantee that a support will be allowed to be present.
It’s likely that women giving birth during this crisis will experience even more isolation in the postpartum period. What recommendations do you have for getting through those early days?
I think that in some ways, once a mother is home with her newborn, it may feel very natural to be staying home with immediate family. I would advise planning carefully for those in the household to help with caring for mother and baby. Partners may make the mistake of thinking that they can work from home and still be as present as they need to be. Caring for older children in close quarters will be particularly challenging. Some parents are making arrangements for family members who can come to provide help to begin isolating well in advance of the birth.
While some level of anxiety is expected and normal in a situation like this, what signs should women or their loved ones look for in terms of seeking professional help?
It is important to know that mood and anxiety difficulties can develop during pregnancy as well as after. Signs like irritability, obsessive worry, worsened difficulty sleeping and sadness that makes it difficult to enjoy things and to function at work or in your family would be reasons to seek help from a psychiatrist. You also raise the important point that loved ones can really be a help in watching for signs that ordinary worry has shifted to something that requires professional help. It is a good idea to review the signs and symptoms of peripartum mood and anxiety disorders with loved ones to ensure that they are also fully informed.
Dr. Christin Drake is a professor and psychiatrist in private practice focused on the treatment of mood and anxiety disorders and women’s mental health.