By MGH Center for Women's Mental Health | June 10th, 2021
"When we meet with women for perinatal psychiatry consultations, we now ask about vaccinations. It’s not something we typically do, but after the last year, we are now getting involved in their decisions regarding vaccination against COVID-19. Just as we counsel women to avoid alcohol and to consistently take their prenatal vitamins, providing information on the COVID-19 vaccine is an important aspect of promoting the health of pregnant and postpartum women.
Considering a growing body of evidence indicating that pregnant women are more likely to have certain manifestations of severe COVID-19 illness, including admission to the ICU and mechanical ventilation, the American College of Obstetricians and Gynecologists (ACOG) has urged the CDC’s Advisory Committee on Immunization Practices to include pregnant and lactating women in the high-priority populations for COVID-19 vaccine allocation. ACOG clearly states that all pregnant and lactating people should be allowed to receive the vaccine, and that their decision to do so should be based on a careful discussion of risks and benefits with their healthcare provider.
From our vantage point, there are other benefits to the COVID-19 vaccine. During the past year, before the vaccination was available, we watched as pregnant and postpartum patients undertook the most extreme forms of lockdown. Many of these women were literally housebound: never leaving the house and cutting off contact with friends and family, while at the same time taking on more childcare responsibilities as outside care providers and day care centers were no longer available. And all the while wondering what would happen if they or a member of their family felt ill?
We are yet to fully appreciate the impact of the COVID-19 pandemic on perinatal women, but preliminary studies indicate that during the lockdown, pregnant and postpartum women reported higher levels of stress, loneliness, depression, and anxiety. And this is not really a surprise. So many of the things we typically recommend to reduce stress and social isolation, such as exercising regularly or spending time with friends and family, vanished.
While it might seem like the pandemic is fading into the distance, the resurgence of the pandemic in places like India and Brazil where immunization rates are low, we cannot be so sure about this. So far the most successful way to avoid becoming seriously ill with COVID-19 is to get vaccinated.
A recent article in Medscape, however, suggests that mothers appear to be less likely to get vaccinated than others in the general population. According to a recent poll from Morning Consult, about two-thirds of adults in the US have either already been vaccinated against COVID-19 or plan to do so. In contrast, mothers are the most likely to be hesitant about the vaccine. In this study, 51% of the mothers reported that they are unwilling to get vaccinated or are uncertain about getting vaccinated, at 51% (compared to 32% of other women and 29% of fathers)."
Depression During the COVID-19 Lockdown Highlights the Importance of Social Connections for New Moms
By MGH Center for Women's Mental Health | May 18th, 2021
"Because pregnant and postpartum women face unique challenges in the context of the COVID-19 pandemic, they may be at increased risk for mental health problems in this setting. In a recent study, researchers from the University College of London surveyed 162 new mothers in London between May and June 2020 using a social network survey designed to assess the impact of the COVID-19 lockdown.
Almost half (47.5 percent) of women with babies less than six months of age had depressive symptoms suggestive of postpartum depression assessed using the Edinburgh Postnatal Depression Scale. This is a huge increase in the expected prevalence of postpartum depression; studies carried out prior to the pandemic have shown that about 10% to 15% of women report depressive symptoms during the postpartum period.
The researchers also observed that the more contact new mothers had with other people — whether remotely or face-to-face — the less likely they were to report depressive symptoms. While this finding suggests that social isolation incurred as a result of the COVID-19 lockdown may have increased risk for depression, another interpretation is that women with greater social networks are less vulnerable to depression (whether or not there is a lockdown). However you interpret the data, multiple studies have demonstrated that social isolation is a risk factor for depression, in general, and having adequate social support reduces the risk for postpartum depression.
We often encourage new mothers to bolster their support networks and often recommend new moms groups. While this is a reasonable approach to managing the social isolation of new parenthood, many new mothers struggle to get out of the house and are unable to establish new social networks. One of the silver linings of the pandemic has been increased access to support groups on virtual platforms. For example, Postpartum Support International or PSI now offers a wide array of online group meetings for women who are pregnant or postpartum. Whether or not a lockdown is in effect, these social networks are so important to a new mother’s emotional well-being and may potentially decrease risk for psotatum illness."
-Ruta Nonacs, MD PhD
"Women who had Covid while expecting experienced guilt, shame and unhealthy levels of stress."
By Katharine Gammon | December 14, 2020
"Kate Glaser had chalked up her exhaustion to being 39 weeks pregnant and having twin toddlers in the house. She also wondered whether her flulike symptoms were a sign that she was about to go into labor. But when she woke up one morning with a 100.4-degree fever, she called her doctor and got a rapid Covid-19 test.
Two nurses came to deliver her results to her in the waiting room. They were dressed in full gowns, masks, face shields and gloves.
“I knew by the eerie silence and the way they were dressed that I was Covid positive,” she said. “It was an emotional moment; I felt really disappointed and shocked and, as a mom, I felt a lot of guilt. What did I do wrong?”
Glaser, who lives in the Buffalo, N.Y., area, returned home and isolated from her husband and the twins in her bedroom, where she spent hours mentally replaying all her activities leading up to the positive test result. She also made a public post on her Facebook page about her positive status, and what she was feeling — guilt, embarrassment and panic. The post went viral, and Glaser started hearing from women around the world who were pregnant and worried about Covid-19. The majority of the of the 2,300 comments she received were supportive; a few were harshly critical.
“I was going down a rabbit hole of guilt and stress,” Glaser said, adding that for her, as much as the physical symptoms were bad, the mental stress of Covid was much worse.
Prolonged stress can have real consequences on pregnant people even outside of a pandemic and has been tied to low birthweight, changes in neurological development and other health impacts in children. And the pressure associated with a positive Covid-19 test increases these mental health risks.
The anxiety is not without reason. As of November 30, there have been more than 42,000 cases of coronavirus reported in pregnant women in the U.S., resulting in 57 maternal deaths. U.S. health officials have said pregnancy increases the risk of severe disease for mother and child, and being coronavirus-positive in late pregnancy may increase the rate of preterm birth.
Prenatal care and birth plans are also disrupted by a positive test result. “Women are expressing so much fear about being infected, but also about going to the hospital, delivering and being separated from their child,” said Laura Jelliffe-Pawlowski, an epidemiologist who is the primary investigator of HOPE COVID-19, a new study that focuses on the well-being of women who are pregnant during the pandemic.
The study launched in July and will follow more than 200 women around the world, from pregnancy to 18 months postpartum, to understand how Covid-19 and the pandemic response impacts pregnancy and infant health outcomes.
Dr. Jelliffe-Pawlowski and her team have analyzed the data from the first group of women, and they are finding “absolutely incredible” levels of stress and anxiety. “Sixty percent of women are experiencing nervousness and anxiety at levels that impede their everyday functioning,” she said, citing preliminary data. “There are a number of women, particularly lower-income women, expressing how hard it is to choose to stay in a job that puts them at risk versus quitting the job and not having enough food for their baby.”
Nearly 70 percent of the participants reported feeling worried about decreasing family income and more than 22 percent worried about food insecurity (though none had experienced it at the time of the survey). Dr. Jelliffe-Pawlowski worried that women were not necessarily getting the psychological care they needed: “If you can’t feed your family, seeking out mental health care is not your top priority.”
She also said more than 84 percent of women reported moderate to severe anxiety about giving birth during a pandemic. “Many women do not want to get tested because they will be stigmatized or separated from their baby or not allowed to have people in the room to support them,” she said. She added that similar visiting rules often hold true for babies in the NICU after being born preterm during the pandemic: Only one parent can be present in a 24-hour period. “It’s heart-wrenching to see families go through those choices.”
Dr. Jelliffe-Pawlowski is particularly interested in how stress impacts births and long-term outcomes for children as psychological stress is highly associated with preterm birth. After the attacks of September 11, 2001, the risk of preterm births almost doubled for people living near or working at the site of the fallen towers. She’s also concerned about long-term effects of stress and anxiety on maternal bonding during the pandemic.
Margaret Howard, a psychologist at Women & Infants Hospital in Providence and postpartum depression researcher at Brown University thinks it is absurd for pregnant women who test positive for an infectious virus to bear any guilt or stress associated with their diagnosis: “Are moms in a special category where they are expected to not get Covid? What about a sinus infection? Hay fever? Cancer? Why is Covid a moral failing for mothers?”
When Erica Evert, a pregnant mom in northern Virginia, received her postive Covid-19 test result, it didn’t make sense. She was near the end of her pregnancy, and hadn’t left the house in four and a half months, except for ob-gyn appointments to check on the baby.
“My first thought was, is this a false positive? I feel fine. And my second reaction was to start bawling,” said Evert. She was scheduled to have a cesarean section with her second baby and the test was merely a formality — until it was a life-changing event.
The hospital gave her a choice: She could deliver the next day and be treated as a Covid-19 patient — separated from her baby with no skin-to-skin contact, per the hospital’s policies. Or she could wait 10 days from the date she received the positive test result and deliver with her regular plan. She had four hours to make a choice she wasn’t expecting. “I kept thinking: am I going to make a decision that results in my child dying?” said Evert."
Opinion| Megan Markle: The Duchess of Sussex
"Perhaps the path to healing begins with three simple words: Are you OK?"
"It was a July morning that began as ordinarily as any other day: Make breakfast. Feed the dogs. Take vitamins. Find that missing sock. Pick up the rogue crayon that rolled under the table. Throw my hair in a ponytail before getting my son from his crib.
After changing his diaper, I felt a sharp cramp. I dropped to the floor with him in my arms, humming a lullaby to keep us both calm, the cheerful tune a stark contrast to my sense that something was not right.
I knew, as I clutched my firstborn child, that I was losing my second.
Hours later, I lay in a hospital bed, holding my husband’s hand. I felt the clamminess of his palm and kissed his knuckles, wet from both our tears. Staring at the cold white walls, my eyes glazed over. I tried to imagine how we’d heal.
I recalled a moment last year when Harry and I were finishing up a long tour in South Africa. I was exhausted. I was breastfeeding our infant son, and I was trying to keep a brave face in the very public eye.
“Are you OK?” a journalist asked me. I answered him honestly, not knowing that what I said would resonate with so many — new moms and older ones, and anyone who had, in their own way, been silently suffering. My off-the-cuff reply seemed to give people permission to speak their truth. But it wasn’t responding honestly that helped me most, it was the question itself.
“Thank you for asking,” I said. “Not many people have asked if I’m OK.”
Sitting in a hospital bed, watching my husband’s heart break as he tried to hold the shattered pieces of mine, I realized that the only way to begin to heal is to first ask, “Are you OK?”
Are we? This year has brought so many of us to our breaking points. Loss and pain have plagued every one of us in 2020, in moments both fraught and debilitating. We’ve heard all the stories: A woman starts her day, as normal as any other, but then receives a call that she’s lost her elderly mother to Covid-19. A man wakes feeling fine, maybe a little sluggish, but nothing out of the ordinary. He tests positive for the coronavirus and within weeks, he — like hundreds of thousands of others — has died.
A young woman named Breonna Taylor goes to sleep, just as she’s done every night before, but she doesn’t live to see the morning because a police raid turns horribly wrong. George Floyd leaves a convenience store, not realizing he will take his last breath under the weight of someone’s knee, and in his final moments, calls out for his mom. Peaceful protests become violent. Health rapidly shifts to sickness. In places where there was once community, there is now division.
On top of all of this, it seems we no longer agree on what is true. We aren’t just fighting over our opinions of facts; we are polarized over whether the fact is, in fact, a fact. We are at odds over whether science is real. We are at odds over whether an election has been won or lost. We are at odds over the value of compromise.
That polarization, coupled with the social isolation required to fight this pandemic, has left us feeling more alone than ever.
When I was in my late teens, I sat in the back of a taxi zipping through the busyness and bustle of Manhattan. I looked out the window and saw a woman on her phone in a flood of tears. She was standing on the sidewalk, living out a private moment very publicly. At the time, the city was new to me, and I asked the driver if we should stop to see if the woman needed help.
He explained that New Yorkers live out their personal lives in public spaces. “We love in the city, we cry in the street, our emotions and stories there for anybody to see,” I remember him telling me. “Don’t worry, somebody on that corner will ask her if she’s OK.”
Now, all these years later, in isolation and lockdown, grieving the loss of a child, the loss of my country’s shared belief in what’s true, I think of that woman in New York. What if no one stopped? What if no one saw her suffering? What if no one helped?
I wish I could go back and ask my cabdriver to pull over. This, I realize, is the danger of siloed living — where moments sad, scary or sacrosanct are all lived out alone. There is no one stopping to ask, “Are you OK?”
Losing a child means carrying an almost unbearable grief, experienced by many but talked about by few. In the pain of our loss, my husband and I discovered that in a room of 100 women, 10 to 20 of them will have suffered from miscarriage. Yet despite the staggering commonality of this pain, the conversation remains taboo, riddled with (unwarranted) shame, and perpetuating a cycle of solitary mourning."
"Health care workers are still fighting to keep their homes and communities safe."
By: Jessica Grose | December 23, 2020
"When I spoke to Dr. Stephanie Whitener, 41, an anesthesia critical care physician and mother of two, the parent-teacher organization at her son’s elementary school was planning an in-person happy hour for teachers. “I spent yesterday trying to rally all the parents I knew in health care to stop it, because of the risk to them, and also to in-person learning,” said Dr. Whitener, who lives in Charleston, S.C.
Though they did end up canceling the happy hour, “it feels like I live in two different realities,” she said, one where people take the virus seriously, and another where they don’t. That dichotomy can make the emotional and psychological toll of treating Covid-19 patients even harder to bear.
As this strange and difficult year draws to a close, I wanted to highlight the experiences of parents who are medical workers — and thank them for their service. Like so many other essential workers, they have put their physical and mental well-being on the line in 2020 to do their jobs. These frontline workers are at greater risk for burnout and PTSD than the general population. Some have been separated from their children for weeks at a time, communicating only on Zoom.
Like all parents, they’re worried about their own kids, socially, academically and emotionally — while also fretting about the children who are falling behind in school because of the barriers to remote learning, and who may be grieving over family members lost to the virus. And even after more than 300,000 deaths in the United States alone, some health care workers are still trying to convince their communities that the virus is a real threat.
“Some of the first deaths I experienced were people only 5 to 10 years older than me, not 70-year-olds,” said Brianna Tremblay, a 36-year-old I.C.U. nurse practitioner in northern New Jersey. She is also the mom of a 3-year-old and pregnant with a baby due in January. Her distress was especially overwhelming in March and April, when the first surge of the virus was hitting the New York City region. “I came home from work every single night and cried with my husband,” Tremblay said.
“When a patient would crash, we would spend hours in the room trying to save them, and then have to call the family,” to give them the bad news, Tremblay said. Her I.C.U. had a mortality rate of 80 to 90 percent in March and April for Covid-19 patients. “It truly was a war zone.”
Several of the workers I spoke with caught the virus themselves. Cecilia Duran, a 38-year-old midwife in New York City, fell ill in March, when she was 10 weeks pregnant. In addition to fairly intense symptoms — “worse than the flu,” she said — she was also dealing with the nausea and fatigue of early pregnancy. “I was quarantining with my toddler, who was also sick, and my husband was trying to figure out his working from home situation in a small New York apartment,” she said. “It was complete insanity.”
Dr. Mary Thomas, a pediatrician in New Jersey, said that she’s much more worried about many of her young patients than she is about her own three children (her whole family already had the virus and recovered). “I’m seeing so much anxiety and depression, and a lot of it has to do with this terrible year,” Dr. Thomas said. “Parents are unemployed or losing money or stressed on top of it, and kids are on screens for hours a day.”
"The tween and teenage years are already filled with heightened emotions and social pressures – adding a pandemic to the mix only makes things more complex. How can we best support older kids who have been impacted by COVID-19?
Our guest experts will discuss how to help your teens and tweens through this difficult time, how to monitor and care for their mental health, and more."
This webinar is a free event being held on Thursday January 28th from 9PM-10PM (Eastern Time).
"Winter's here - how will we continue to keep our youth active and healthy during the pandemic? Many sports have had to take a time-out due to COVID-19. Indoor activities have been cancelled, and, pandemic or not, weather doesn't always permit us to enjoy being physically active outdoors. The cancellation or delay of sports seasons have also had long-term impacts on the futures and identities of youth and young adults.
So, as parents and caregivers, how do we keep our children active, healthy, and strong, while helping them (and us) mourn the loss of the activities that help them thrive? Join us and our guest experts as we discuss the ways to tackle these issues and help our children cope physically and mentally so that everyone "wins."
This webinar is a free event being held on Thursday January 14th from 9PM-10PM (Eastern Time).
By: Cory Turner, Anya Kamenetz, & Meghan Keane| December 10, 2020
"For the kids in our lives, the last nine months have been many things. Scary — because an invisible, unknown illness was suddenly spreading across the globe. Maybe even fun, when the possibility of school closing felt like a snow day. But for many, that novelty has given way to frustration and sadness — even depression and anxiety. Just like adults, kids are wondering: Will I get sick? Will someone I love die?
It's a lot for kids and parents to handle. So we talked to the experts and came away with five tips for how you can help your kids through this.
Make sure your kids wear their masks
"Kids generally don't get very sick from this virus," says Dr. Ashish Jha, dean of the Brown University School of Public Health. But, he says, they can still play a part in making sure others don't get sick by wearing their masks and social distancing.
It might take a little imagination. If you have younger kids, you can explain the spread of the coronavirus by comparing their mouths to a bottle of bug spray. Weird, yes — but it's one way for young ones to visualize the tiny droplets they spread, even when they aren't sick. If they wear a mask, it helps keep those droplets in.
If you've got older kids or teenagers, take this a step further: Encourage them to spread the word. Practice what they might say if they're with friends at the park and someone takes their mask off. Maybe your 13-year-old has been waiting months to see Grandma and could say, "I need to keep my Grandma safe, so do you mind putting your mask on?"
Rehearse it with your kids so the conversation goes smoothly.
Practice positive thinking and mindfulness
In a recent report, researchers interviewed 46 teenagers in California and found that the teens reported a huge sense of loss — similar to the stages of grief. Most of the teens were sleeping badly because of lack of activity and lots of screen time.
Kids of all ages — as well as their parents — can probably relate.
In addition to the obvious prescription — trade in some of that screen time for physical exercise — try some brain exercises too, like replacing negative thoughts with positive ones. You might try saying a few things you're grateful for each night before dinner or before bed. There's evidence behind that: Gratitude boosts your immune system, lowers blood pressure and motivates us to practice healthy habits. It may feel awkward or cheesy, but practicing mindfulness and positivity very consciously can help kids and parents too.
It's also important to watch for signs of something more serious too.
"Depression in teenagers sometimes looks like a prickly porcupine. Everybody rubs them the wrong way," adolescent psychologist Lisa Damour says. Don't take it personally; just keep offering them a listening ear."
By Rafael Nam| November 12, 2020
"Like many married and working couples first confronting the pandemic, Bianca Flokstra and Victor Udoewa tried to go on with their lives as normal.
Flokstra continued to work full time while taking care of their kids, ages 4 and 2. She also handled most of the housework, with her husband helping from time to time. It didn't work.
"Those first couple of months were really hard," Flokstra says. "There was ... a lot of fighting. A lot of tears."
The pandemic has upended many aspects of domestic life, and that has brought new attention to one of the most enduring disparities between men and women — the wide difference in handling housework and child care.
It's what Marianne Cooper, a sociologist at the Stanford VMware Women's Leadership Innovation Lab, calls one of society's most "stubborn" divides.
"The traditional gender division of labor is very durable," Cooper says. "Even the most egalitarian-thinking couples, after having children, find themselves in a much more traditional division of labor than they ever would have intended."
Cooper, who has studied the issue extensively, says that divide, which is rooted in history and perpetuated by persistent societal norms, has endured even as women have joined the workforce in larger numbers over the decades, making record gains.
Yet even as more families become dual-income households, women still do 30% more of the housework and 40% more of the child care, Cooper says.
The disparity in work done at home is now having a serious economic impact as entire families are forced home with schools closed and no child care options available.
More than 2.2 million women have left the workforce this year, far more than the 1.4 million men who have left as a result of the pandemic, according to the monthly U.S. Bureau of Labor Statistics data.
Proportionally, more women were employed in sectors that were hit hard by the pandemic, including hospitality and retail.
But Cooper, as well as many economists, says the burden placed on working moms during the pandemic is another key variable forcing many women out of the workforce.
Some couples have adapted.
Flokstra, for example, says she had little choice. She desperately needed sleep after exhausting days at a new job in international aid while also taking care of all of her other responsibilities.
She started sending the kids to her husband, unprompted. Then, she started drafting to-do lists — activities she and her husband would split day to day.
But getting there wasn't easy. It wasn't that Udoewa wasn't willing to help; he was.
Flokstra says she had become so used to doing household chores that she found it hard to delegate — and trust — her own husband to do the job.
That hesitancy is surprisingly common among women, according to Cooper.
It's a complicated mix of "mother's guilt" as well as societal expectations on couples, where men are still seen as the breadwinners."
"We’ve been through so much together since this summer, and we still have a long way to go as pandemic parents and caregivers. (Remember, psychiatrist and child trauma expert Dr. Bruce Perry said it’s a thru-hike, not a sprint or even a marathon).
With our co-founders, Dr. Lindsay Malloy and Dr. Amanda Zelechoski, leading the way, let’s take a brisk walk down memory lane (because nobody has time for a stroll right now) to share some of our most impactful moments so far since our first Pandemic Parenting Exchange."
This webinar is free and will be held on Thursday, December 17th, 2020 from 9:00-10:00 PM (Eastern Time) via Zoom.
"Every family is unique in its own ways, and parents are navigating the pandemic the best way they know how. We want to shine a light on our co-parenting parents and single parents who are experiencing their own set of distinctive challenges during the pandemic and provide resources to ease the burdens they may be experiencing."
The webinar will be held on November 24, 2020 from 9:00-10:00 PM (Eastern Time) via Zoom.
Dutch News| August 19, 2020
"Researchers at Amsterdam’s UMC teaching hospital and a number of other institutes have found coronavirus antibodies in the breast milk of women who have tested positive for the virus.
The research team are now looking into whether the milk could be used to prevent coronavirus infections in vulnerable people during an eventual second wave, possibly in the form of flavoured ice cubes.
hey have already found that the antibodies are not destroyed by pasteurising the milk, which is necessary to make it usable by other people.
"We think when drinking the milk, the antibodies attach themselves to the surface of our mucous membranes,’ Hans van Goudoever, head of the Emma children’s hospital at the UMC, said. ‘Then they attack the virus particles before they force their way into the body."
The UMC has now started a campaign to find 1,000 women who are willing to donate 100ml of breast milk for the research project. ‘Women who may have had coronavirus without noticing it may also have made antibodies which can be found in milk,’ Van Goudoever said. ‘So we are looking for mothers who may have been infected as well.’ Even if this turns out not to be the case, their milk can be stored for further research, if they give permission, he said.
Women who want to take part are urged to contact email@example.com."
By Tara Haelle| August 16, 2020
"It was the end of the world as we knew it, and I felt fine. That’s almost exactly what I told my psychiatrist at my March 16 appointment, a few days after our children’s school district extended spring break because of the coronavirus. I said the same at my April 27 appointment, several weeks after our state’s stay-at-home order.
Yes, it was exhausting having a kindergartener and fourth grader doing impromptu distance learning while I was barely keeping up with work. And it was frustrating to be stuck home nonstop, scrambling to get in grocery delivery orders before slots filled up, and tracking down toilet paper. But I was still doing well because I thrive in high-stress emergency situations. It’s exhilarating for my ADHD brain. As just one example, when my husband and I were stranded in Peru during an 8.0-magnitude earthquake that killed thousands, we walked around with a first aid kit helping who we could and tracking down water and food. Then I went out with my camera to document the devastation as a photojournalist and interview Peruvians in my broken Spanish for my hometown paper.
Now we were in a pandemic, and I’m a science journalist who has written about infectious disease and medical research for nearly a decade. I was on fire, cranking out stories, explaining epidemiological concepts in my social networks, trying to help everyone around me make sense of the frightening circumstances of a pandemic and the anxiety surrounding the virus.
I knew it wouldn’t last. It never does. But even knowing I would eventually crash, I didn’t appreciate how hard the crash would be, or how long it would last, or how hard it would be to try to get back up over and over again, or what getting up even looked like.
In those early months, I, along with most of the rest of the country, was using “surge capacity” to operate, as Ann Masten, PhD, a psychologist and professor of child development at the University of Minnesota, calls it. Surge capacity is a collection of adaptive systems — mental and physical — that humans draw on for short-term survival in acutely stressful situations, such as natural disasters. But natural disasters occur over a short period, even if recovery is long. Pandemics are different — the disaster itself stretches out indefinitely.
“The pandemic has demonstrated both what we can do with surge capacity and the limits of surge capacity,” says Masten. When it’s depleted, it has to be renewed. But what happens when you struggle to renew it because the emergency phase has now become chronic?"
Reviewed by: Lisa Hollier, MD, MPH, FACOG, Baylor College of Medicine, Houston, Texas
"Please note that while this is a page for patients, this page is not meant to give specific medical advice and is for informational reference only. Medical advice should be provided by your doctor or other health care professional."
"What is COVID-19?
COVID-19 is a new illness that affects the lungs and breathing. It is caused by a new coronavirus. Symptoms include fever, cough, and trouble breathing. It also may cause stomach problems, such as nausea and diarrhea, and a loss of your sense of smell or taste. Symptoms may appear 2 to 14 days after you are exposed to the virus. Some people with COVID-19 may have no symptoms or only mild symptoms.
How does COVID-19 affect pregnant women?
Researchers are still learning how COVID-19 affects pregnant women. A report released in June 2020 looked at whether pregnant women might be at increased risk of getting very sick from COVID-19. This report from the Centers for Disease Control and Prevention (CDC) notes that:
How can COVID-19 affect a fetus?
Remember that researchers are learning more about COVID-19 all the time. Some researchers are looking specifically at COVID-19 and its possible effects on a fetus. Here’s what they know now:
What should pregnant women do to avoid the coronavirus?
Pregnant women should take steps to stay healthy, including:
Should pregnant women wear a mask or face covering?
As of April 3, the CDC says all people, including pregnant women, can wear a cloth face covering when they are in public to slow the spread of COVID-19. Face coverings are recommended because studies have shown that people can spread the virus before showing any symptoms. See the CDC’s tips on making and wearing a face covering.
Wearing a cloth face covering is most important in places where you may not be able to stay 6 feet away from other people, like a grocery store or pharmacy. It also is important in parts of the country where COVID-19 is spreading quickly. But you should still try to stay at least 6 feet away from others whenever you leave home.
If you have COVID-19 or think you may have it, you should wear a mask while you are around other people. You also should wear a mask if you are taking care of someone who has COVID-19 or has symptoms. You do not need to wear a surgical mask or medical-grade mask (N95 mask).
How will COVID-19 affect prenatal and postpartum care visits?
It is important to keep your prenatal and postpartum care visits. Call your obstetrician–gynecologist (ob-gyn) or other health care professional to ask how your visits may be changed. Some women may have fewer or more spaced out in-person visits. You also may talk more with your health care team over the phone or through an online video call. This is called telemedicine or telehealth. It is a good way for you to get the care you need while preventing the spread of disease.
If you have a visit scheduled, your care team’s office may call you ahead of time. They may tell you about telemedicine or make sure you do not have symptoms of COVID-19 if you are going in to the office. You also can call them before your visits if you do not hear from them."
"Do you ever feel like you’re not doing enough as a parent? Like you might be totally screwing this up and maybe even making things worse for your kids? We’re right there with you. Parenting was already hard, and now we're navigating a pandemic on top of it.
In this webinar, we’ll talk about the self-doubt, anxiety, and uncertainty that has come with pandemic parenting. We’ll also share what the research says about “good enough’ parenting, especially in times of crisis. We’ll be joined by guest, Dr. Sharon Lamb, psychologist and author of The Not Good Enough Mother. Agata Freedle will serve as moderator to guide our conversation and pose questions that you submit.
Join us on Zoom at 9 p.m. Eastern Time for this free webinar."
By: Catherine Pearson| July 14, 2020
"We're facing a year without precedent in modern parenthood. So why do we feel...so detached?"
"When the pandemic first hit New York City in March, abruptly closing my boys’ school and daycare, I was a wreck.
I was terrified of my kids getting sick. I was so anxious sitting in bed at night, listening to sirens scream past my window down the Brooklyn-Queens Expressway, I’d lose my breath. Then sometimes, I’d have moments of delirious happiness: My family was safe and hanging out together at, like, 11 a.m. on a Tuesday. We never do that! It was emotional and logistical chaos all day, every day.
Now, months into this mess, I move through my days feeling basically ... nothing. When I see friends and family (from a safe distance, outdoors, usually wearing a mask) and they ask how I’m doing, I say something like: “We’re good! We’ve kept our jobs, and no one’s been sick. Also, I’m dead inside.”
This is only a partial joke.
The everyday stresses parents are facing now are arguably worse than they were when the virus first emerged. Where I live in New York City, public schools recently announced they’ll likely open for in-person learning between one and three days a week — as though those are remotely similar. I have no idea if my husband and I are sending our older son in. I have zero idea what we’re doing for childcare for our younger kiddo, because I do not see a solution that feels relatively safe and is one we can actually afford. I have no idea how we are going to get through the fall or winter or any part of next year.
But I’m not freaking out; I’m numb.
And I’m not alone.
“After being on high alert for so long, it’s entirely understandable that numbness would set in. No one can sustain a state of emergency for any length of time. We weren’t built that way,” said Olivia Bergeron, who runs Mommy Groove Therapy & Parent Coaching in New York City. “Fight or flight is supposed to be a temporary state to ensure survival, not a permanent way of living.”
By Pooja Lakshmin|July 29, 2020
"While parents may be feeling unsure about school options this fall, there are ways to feel better as you make the tough decision."
"A combination of dread, panic and sheer exhaustion. This is what I see on the faces of patients (and friends and colleagues) when the conversation turns to the most pressing topic on every parent’s mind: what to do about school in the fall. I’m a psychiatrist specializing in women’s mental health, and I have yet to speak to anyone who feels satisfied with the options presented to them, or who feels particularly confident in the choices they’ve made.
The information on children and the coronavirus has been evolving since March, with the most recent data suggesting that children are less likely to become infected by the virus and less likely to have a severe course when infected. But, those words “less likely” suggest that children are at some, albeit smaller, risk. And, the United States still has not come up with an adequate solution to protect teachers, many of whom are high risk.
As I see it, school stress for parents boils down to two main points: Deciding what to do, and then what to do with the uncomfortable feelings that could arise after that decision. As a psychiatrist, I’m admittedly not so helpful when it comes to the decision of whether or not to send your kids to in-classroom learning this fall. Where I can help is how to deal with the uncertainty and difficult feelings that accompany this process.
A risk assessment system, like the one described by Emily Oster, Ph.D., a professor of economics and public policy at Brown University, can be a useful guide when making decisions with scarce data. Instead of focusing on the illusion of “one right answer,” this framework can give you a reliable process for making hard parenting decisions by focusing on evaluating and mitigating risks, and assessing benefits. While no parent is feeling particularly confident about the school options available to them, it is possible to feel good about the process you use to make those decisions.
In an interview, Dr. Oster wrote, “By making clear the choices, the costs and benefits, we can reason our way to better decisions. But I really think even more important is the fact that we can make our way to more confidence in these decisions by articulating a good process.”
Once you’ve delineated a plan, then you’re faced with the task of coping with the onslaught of feelings, like worry, guilt, fear and uncertainty. For this, here are some strategies, many of which come from acceptance and commitment therapy, a form of behavioral therapy that teaches people to accept their difficult thoughts and feelings as opposed to struggling against them, and to prioritize taking actions that are in line with their values."
By: LULU GARCIA-NAVARRO
"So many of us do it: You get into bed, turn off the lights, and look at your phone to check Twitter one more time.
You see that coronavirus infections are up. Maybe your kids can't go back to school. The economy is cratering.
Still, you incessantly scroll though bottomless doom-and-gloom news for hours as you sink into a pool of despair.
This self-destructive behavior has become so common that a new word for it has entered our lexicon: "doomscrolling."
The recent onslaught of dystopian stories related to the coronavirus pandemic, combined with stay-at-home orders, have enabled our penchant for binging on bad news. But the habit is eroding our mental health, experts say.
Karen Ho, a finance reporter for Quartz, has been tweeting about doomscrolling every day over the past few months, often alongside a gentle nudge to stop and engage in healthier alternatives.
Ho first saw the term in a Twitter post from October 2018, although the word may very well have much earlier origins.
"The practice of doomscrolling is almost a normalized behavior for a lot of journalists, so once I saw the term I was like, 'Oh, this is a behavior I've been doing for several years,' " she says.
If Ho's daily reminders aren't enough to break the habit, clinical psychologist Dr. Amelia Aldao warns that doomscrolling traps us in a "vicious cycle of negativity" that fuels our anxiety.
"Our minds are wired to look out for threats," she says. "The more time we spend scrolling, the more we find those dangers, the more we get sucked into them, the more anxious we get."
By: Cassie Shortsleeve| July 07, 2020
"Black maternal health providers share the advice they give their own patients that any Black expectant or new mom can learn from."
"Pregnancy is a life-changing event. But for Black women, this time in their lives comes with uniquely concerning health issues and added layers of struggle.
In the U.S., Black women are two to three times more likely to die from pregnancy-related causes than white women. That figure is even larger in metro areas such as New York City where Black women are up to 12 times more likely to die during pregnancy and childbirth. And while about one in seven women in this country experience a perinatal mood and anxiety disorder (PMAD), Black women suffer at higher rates—and are less likely to receive treatment.
Black moms and moms-to-be also face the biases of a mostly-white medical field, not to mention systemic racism, and stigma in and out of doctors' offices, say experts. But there are ways to prioritize yourself and protect your mental wellness (or help an expectant friend) in the journey to motherhood.
Here, Black doctors, therapists, doulas, and other maternal health experts share the words of wisdom they'd give to Black moms everywhere.
1. Prioritize emotional wellness.
"Given that Black women are at higher risk for pregnancy-associated mortality when compared to non-Black pregnant women, it is important that Black women empower themselves with knowledge about the importance of maintaining emotional wellness so that they take the steps necessary to advocate for their mental health needs during their pregnancy. If you're experiencing significant anxiety, disclose your distress to friends and family. If social support is not sufficient, talk to your healthcare provider about different treatment options."—Christine Crawford, M.D., M.P.H., an assistant professor of psychiatry at Boston University School of Medicine and an adult, child, and adolescent psychiatrist at Boston Medical Center.
2. Find the mental health support you need (even if it's virtual).
"Mental health support during the prenatal period is important especially during a time like this when women have the extra stress of the consequences of COVID-19 and racial injustice and protests. Black women are less likely to receive care for depressive symptoms and are often under-diagnosed. If you have symptoms, find a provider that you feel comfortable with, whether on a mental health app, one-to-one talk-therapy, or group therapy. Another great tool I love for moms is meditation apps. They can help with grounding during times of great stress. If the new mother has access to mental health support during the prenatal period, the risks for postpartum depression decrease."—Latham Thomas, founder Mama"
"Our struggle is not an emotional concern. We are not burned out. We are being crushed by an economy that has bafflingly declared working parents inessential."
By: Deb Perelman
"Last week, I received an email from my children’s principal, sharing some of the first details about plans to reopen New York City schools this fall. The message explained that the city’s Department of Education, following federal guidelines, will require each student to have 65 square feet of classroom space. Not everyone will be allowed in the building at once. The upshot is that my children will be able to physically attend school one out of every three weeks.At the same time, many adults — at least the lucky ones that have held onto their jobs — are supposed to be back at work as the economy reopens. What is confusing to me is that these two plans are moving forward apace without any consideration of the working parents who will be ground up in the gears when they collide.
Let me say the quiet part loud: In the Covid-19 economy, you’re allowed only a kid or a job.
Why isn’t anyone talking about this? Why are we not hearing a primal scream so deafening that no plodding policy can be implemented without addressing the people buried by it? Why am I, a food blogger best known for such hits as the All-Butter Really Flaky Pie Dough and The ‘I Want Chocolate Cake’ Cake, sounding the alarm on this? I think it’s because when you’re home schooling all day, and not performing the work you were hired to do until the wee hours of the morning, and do it on repeat for 106 days (not that anyone is counting), you might be a bit too fried to funnel your rage effectively.
For months, I’ve been muttering about this — in group texts, in secret Facebook groups for moms, in masked encounters when I bump into a parent friend on the street. We all ask one another why we aren’t making more noise. The consensus is that everyone agrees this is a catastrophe, but we are too bone-tired to raise our voices above a groan, let alone scream through a megaphone. Every single person confesses burnout, despair, feeling like they are losing their minds, knowing in their guts that this is untenable.
It should be obvious, but a nonnegotiable precondition of “getting back to normal” is that families need a normal to return to as well. But as soon as you express this, the conversation quickly gets clouded with tangential and irrelevant arguments that would get you kicked off any school debate team.
“But we don’t even know if it’s safe to send kids back to school,” is absolutely correct, but it’s not the central issue here. The sadder flip side — the friend who told me that if their school reopens, her children are going back whether it’s safe or not because she cannot afford to not work — edges closer.
Why do you want teachers to get sick?” isn’t my agenda either, but it’s hard to imagine that a system in which each child will spend two weeks out of every three being handed off among various caretakers only to reconvene in a classroom, infinitely increasing the number of potential virus-carrying interactions, protects a teacher more than a consistent pod of students week in and out with minimized external interactions.
“You shouldn’t have had kids if you can’t take care of them,” is comically troll-like, but has come up so often, one might wonder if you’re supposed to educate your children at night. Or perhaps you should have been paying for some all-age day care backup that sat empty while kids were at school in case the school you were paying taxes to keep open and that requires, by law, that your child attend abruptly closed for the year."
Pregnant women and new moms are experiencing 'shocking' rates of anxiety and depression during the pandemic
By Anna Medaris Miller| June 19, 2020
"Pregnant women and new moms are experiencing higher rates of depression and anxiety amid the coronavirus pandemic, a new study suggests.
In the study, researchers asked 900 women – 520 of whom were pregnant and 380 of whom had given birth in the past year – about their depression and anxiety symptoms before and during the pandemic. They found that the crisis elevated depression symptoms from 15% to 41%. Moderate- to high-anxiety symptoms went from 29% to 72%.
Pre-pandemic, about one in seven, or just under 15%, of women experienced such symptoms during the perinatal period.
"I was pretty shocked at the magnitude of the increases," said Margie Davenport, a co-author of the study and associate professor of the pregnancy and postpartum health program at the University of Alberta, Canada.
A number of factors – like physical isolation, increased household and childcare duties, and fears about the state of the world – have contributed to the higher rates of mental health issues among pregnant women and new mothers, a demographic that was already susceptible to developing perinatal and postpartum depression disorder.
Davenport suspects the rates are even higher in people who already face healthcare and social disparities.
"I'm worried that this [data] is potentially underestimating the effects on women who've lost their jobs, and women who don't have secure housing and secure healthcare," she said.
Most participants were white, employed, partnered, and living in a single-family home — in other words, had the types of supports that would typically put them at a lower risk for perinatal mental-health issues. Davenport fears the effects of the pandemic, and now racial justice issues, on pregnant women and new moms in more marginalized communities may be even worse."
June 17, 2020| Produced by Meg Dalton| Hosted by Tanzina Vega
"As the coronavirus pandemic continues, some experts worry about the impact it will have on the mental health of new parents, especially those who have recently experienced childbirth. According to the American Psychological Association, one in seven people who have given birth experience symptoms of postpartum depression.
For more on this, The Takeaway spoke to Kelly Glass, a freelance journalist whose interests focus on the intersections of parenting, health, and race. She recently wrote about the mental health toll on new parents for The Washington Post.
Check out our ongoing coverage of the COVID-19 pandemic here.
Click on the 'Listen' button above to hear this segment. Don't have time to listen right now? Subscribe for free to our podcast via iTunes, TuneIn, Stitcher, or wherever you get your podcasts to take this segment with you on the go."
By Alice Broster| June 10, 2020
"It’s likely that over the last few months you’ll have had to adapt almost every aspect of your life because of Covid-19. For new families and parents-to-be, this has been especially uncertain. The pandemic has dramatically transformed giving birth and the postpartum period. Virtual care and video consultations have stepped up to replace face to face appointments to cut down on the people entering hospitals. A neonatologist explains how postpartum care has changed because of Covid-19 and, while virtual medicine has been good for this period, it will never replace the emotional support that new parents need in person.
Over the last three months, people have faced going to the hospital to give birth alone. Families haven’t been able to introduce their newborns to their loved ones because of Covid-19 and for doctors on the frontline, it’s been an incredibly stressful time trying to deliver a high standard of care while keeping patients safe. An increase in virtual medicine has meant patients have been able to access their doctors without leaving the house. However, it’s also meant some new parents have been left behind. “For the vast majority of new parents, they need hands-on help. You need a hug and you need someone who is going to be there when you’re emotional. Sadly, that’s not something you can totally get through a computer,” says Medical Director of Aeroflow Breastpumps and board-certified pediatrician and neonatologist Dr. Jessica Madden.
With people entering hospitals alone to give birth and clinicians not being able to do at home check-ups Dr. Madden fears that some families have fallen through the net. The six week period after giving birth is key for the physical and mental health of both parents and babies. According to research conducted by Aeroflow Breastpumps, 90% of new mums believe educating parents about what to expect postpartum needs to be improved. Three out of four said they weren’t given enough guidance and 66% said they found the postpartum period more difficult than they thought it would be.
While some checks can be done over a video call, Dr. Madden highlighted that some services can’t adapt as effectively. “For the most part, lactation consultants can’t come into the room after birth to provide guidance and support. Breastfeeding clinics haven’t been open in the same way and that’s a massive loss,” says she says, “there’s an extra layer of fear right now for new parents. A lot of people aren’t bringing their babies to see pediatricians and women are scared to access postpartum care because they’re scared they’ll get Covid-19 from the doctor’s office.”
Not being able to access care and support postpartum can have massive implications for new parents. In the U.S. an estimated 70% to 80% of women will experience the ‘baby blues’ after giving birth, with many experiencing more severe postpartum depression. The reported rate of clinical postpartum depression among new mothers is between 10% to 20%. “When you look at how life is for pregnant people right now there are so many more risk factors. People are isolated and there’s excess stress and fear. I don’t think we will really know the effects Covid-19 has had on postpartum depression and anxiety until we look back on it next year,” says Dr. Madden."
"As we hide in our homes waiting out this virus, I’m worried about another, silent, pandemic."
By Lindsay Springer| June 12, 2020
"On any given day, I make 17 snacks, change 12 diapers, listen to 957 complaints, constantly remind everyone to wash their hands, and burst into tears at least three times.
Yes, this is life with young kids. It’s what I signed up for and no, it’s not glamorous. Being a mom doesn’t come with “me” time. Showers are forever getting interrupted by preschoolers and their endless barrage of nonsensical questions. With three kids aged six and under, including a newborn, sleep is segmented, at best.
Before COVID-19, the tantrum-filled, sleep-deprived whirlwind was mostly relegated to the weekends—but at least they were also filled with park visits, lunches with grandparents, playdates, dance, art and swimming classes. And back then, there was actually an end in sight—back to work/school/childcare on Monday, huzzah!
But now, 82 days into the longest weekend ever lived, and I’m so, so tired. Tired of living the same day over and over again. Tired of making toilet paper binoculars and watching Paw Patrol. Tired of Lysol wiping the groceries and Amazon boxes. Tired of staying home. Tired of being scared of COVID-19.
My four-year-old has developed a propensity for never-ending tantrums. My now feral six-year-old refuses to change out of his pyjamas or wear shoes. My husband has set up a home office in our basement storage room, the place least likely for a partially dressed child to wander in during a Zoom call (and literally the only other room in our house that is not occupied by the rest of us). The baby is oblivious, smiling and cooing at the chaos around him. Me? I’m quietly falling apart.
How can I keep doing this? How can I get in the shower every night, wash off the spit up, the glitter glue, and the sandbox, only to crawl into bed, feed the baby, and wake up in the morning of this never-ending Groundhog Day and do it all again, without a break in sight? I, like many parents, am worn out and tired, and I fear this unsustainable hamster wheel we’re on is giving rise to a silent, mental health pandemic.
A recent survey published by the Centre for Addiction and Mental Health (CAMH) in Toronto found that Canadian parents of children under 18, and mothers, in particular, were disproportionately more likely to report new or amplified symptoms of anxiety and depression related to COVID-19. These survey results are alarming, but not at all surprising since COVID-19 has changed parenting and redefined the landscape of motherhood."
By Pooja Lakshmin|may 27, 2020
"New and expecting moms are facing pandemic-related fears on top of social isolation."
Photo: Mikyung Lee
"After going through a harrowing bout of postpartum depression with her first child, my patient, Emily, had done everything possible to prepare for the postpartum period with her second. She stayed in treatment with me, her perinatal psychiatrist, and together we made the decision for her to continue Zoloft during her pregnancy. With the combination of medication, psychotherapy and a significant amount of planning, she was feeling confident about her delivery in April. And then, the coronavirus hit.
Emily, whose name has been changed for privacy reasons, called me in late-March because she was having trouble sleeping. She was up half the night ruminating about whether she’d be able to have her husband with her for delivery and how to manage taking care of a toddler and a newborn without help. The cloud that we staved off for so long was returning, and Emily felt powerless to stop it.
Postpartum depression and the larger group of maternal mental health conditions called perinatal mood and anxiety disorders are caused by neurobiological factors and environmental stressors. Pregnancy and the postpartum period are already vulnerable times for women due in part to the hormonal fluctuations accompanying pregnancy and delivery, as well as the sleep deprivation of the early postpartum period. Now, fears about the health of an unborn child or an infant and the consequences of preventive measures, like social distancing, have added more stress.
As a psychiatrist who specializes in taking care of pregnant and postpartum women, I’ve seen an increase in intrusive worry, obsessions, compulsions, feelings of hopelessness and insomnia in my patients during the coronavirus pandemic. And I’m not alone in my observations: Worldwide, mental health professionals are concerned. A special editorial in a Scandinavian gynecological journal called attention to the psychological distress that pregnant women and new mothers will experience in a prolonged global pandemic. A report from Zhejiang University in China detailed the case of a woman who contracted Covid-19 late in her pregnancy and developed depressive symptoms. In the United States, maternal mental health experts have also described an increase in patients with clinical anxiety.
In non-pandemic times, as many as 14 percent of women will suffer from pregnancy-related anxiety, which refers to fears that women have about their own health and their baby’s over the course of pregnancy and delivery, and up to 20 percent of women will experience postpartum depression.
Samantha Meltzer-Brody, M.D., M.P.H., who is the chair of the department of psychiatry at the University of North Carolina at Chapel Hill and the director of the Center for Women’s Mood Disorders, said, “The natural vulnerability of this major life transition is exacerbated when you just have sort of global anxiety, and things like going to the grocery store to pick up diapers suddenly become a much more anxiety-producing event than it ever was before.”
In my clinical practice and in a Covid-19 maternal well-being group I co-founded, women have voiced their fears about a number of possible distressing scenarios: delivering without a support person; being one of the 15 percent of pregnant women who is asymptomatic for Covid-19 and facing possible infant separation; and recovering during a postpartum period without the help of family or friends to provide support. There’s also grief about the loss of a hopeful time that was meant to be celebrated with loved ones."