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."
By: Mikaela Kiner
"Pre-pandemic, being a mom meant figuring out the tricky balance between parenting, home, career and self. What that meant in practice was that women in heterosexual relationships took on about two-thirds of domestic responsibilities.
The global coronavirus pandemic has resulted in dramatic shifts for everyone, especially for families, with parents working from home, school and day care closures and a general loss of stability and support. Now moms are homeschooling older kids, caring for little ones, feeding their families three meals a day, and sanitizing everything, all while trying to keep everyone healthy and keep up with their day jobs.
While many partners have stepped up to take on more responsibilities at home during the pandemic, the workload balance has not shifted enough (despite nearly half of men claiming they do "all" the homeschooling, a claim that most women disagree with).
Women are legitimately concerned that they will become the default caregivers and take on most or all of the household chores, leaving little or no time for their careers or their own well-being.
Here's how to keep that from happening by coming to an agreement with your partner about sharing the workload at home.
1. Have the hard conversation.
Many people avoid hard conversations out of a fear that things will become adversarial. But now more than ever, we need to talk about roles and expectations. Remember that your partner also wants what's best for you and the family. View this conversation as a collaborative conflict, one where the two of you are working together toward a win-win solution.
Phrase to try: "Let's sit down for half an hour this evening and review both of our to-do lists," or "Can we find a time in the next day or two to go over everything we're both trying to get done?"
2. Start with your goals in mind.Your goal is to come up with a plan that works for both of you. The focus is you both teaming up against the problem.
Phrase to try: "I'd like to talk about how we can both find a good balance between work and helping the kids," or, "So much has changed. Let's talk about how we're going to make this work for us both."
3. Share your hopes + fears.
Tell your partner what you're worried about, and what's been most challenging. Be honest about your experience and what you're afraid of. You'll notice there are no assumptions, personal attacks, shaming or blaming, which is important. My friend Melissa Strawn was in the middle of launching a business when the virus hit. Her husband works full-time and they're raising five boys. Melissa suggests, "Communicate openly and honestly about what's working and not working. Sometimes, I am just looking to feel validated given how much I actually juggle with five kids and a startup. Other times, I need him to just #getitdone."
Phrase to try: "I'm concerned that I've taken on all of the homeschooling and I don't have time to do my work," or, "I realize I'm trying to cook, clean and watch the baby. When I sit down to focus on my job, I'm already exhausted."
By Meghan Holohan| April 20, 2020
"After experiencing infertility for almost four years, Sarah and Brian Piett felt thrilled to welcome their new son, Brooks, on February 26. Soon after, the COVID-19 pandemic dramatically changed life. Now friends and family can’t meet the baby or offer to babysit. As the quarantine lingers, Sarah feels more listless, worried and frustrated.
“Our whole family has really been waiting for Brooks forever and have been on this journey with us. We finally have our baby and nobody can even see him,” the 29-year-old recovery room nurse from Canonsburg, Pennsylvania, told TODAY Parents. “I’ve cried a lot.”
"After facing infertility for almost four years, the Pietts were excited to finally welcome a baby. But that feeling lessened as stay-at-home orders means Sarah feels isolated." -- Courtesy of the Piett family
"Sarah struggled to breastfeed and a phone call with the lactation consultant made her feel guilty about pumping and supplementing with formula. She wishes she had a little more help around the house or could even go to a moms group or walk around a mall.
“I love my baby and I love holding him,” she said. “Sometimes you wish that somebody was here just to hold him for like five minutes to give you a break.”
At her six-week follow up appointment, she scored high on a diagnostic test for postpartum depression. Her doctor gave her a prescription and a therapist recommendation. She feels like being isolated is making her depression and anxiety more severe.
“It sounds so selfish but I keep thinking this isn’t the maternity leave I envisioned. I thought I’d be able to see friends and they’d be able to see my baby and enjoy him,” Piett said. “It just totally all around completely sucks.”
How to shift your mind-set from giving so much of yourself to others.
By Pooja Lakshmin| May 5, 2020
Photo: Dadu Shin
"I was teaching a group of new mothers a few years ago how to recognize postpartum depression and anxiety when a woman raised her hand. “My work is letting me take an extra two weeks of paid maternity leave. I don’t know what to do. I feel bad if I take it. My team will have to pick up the slack. I feel bad if I don’t. I’d be giving up precious time with my daughter.” I responded, “Is there any option you wouldn’t feel bad about taking?”
As a perinatal psychiatrist who takes care of women coping with the transition to motherhood, I meet mothers who lean into their guilt like it’s a security blanket and hold up their self-sacrifice as a badge of honor. Adopting a martyr identity doesn’t always correlate to clinical depression or anxiety. It’s a role that women can inhabit even without a diagnosable mental health condition.
I don’t blame those mothers for shielding themselves under a cloak of suffering. Appearing too well adjusted can be a liability. Leaving your kids in the car for three minutes to get a coffee can be grounds for a call to Child Protective Services and daring to bottle-feed your baby without trying to breastfeed can lead to criticism from strangers.
In 1996 Sharon Hays, Ph.D., a sociologist, coined the term “intensive mothering” to describe parenting that is “child-centered, expert-guided, emotionally absorbing, labor-intensive and financially expensive.” Two decades later, the mental load describes the invisible labor that goes into running a family. We still find ourselves living in a world where most mothers, even while working outside the home, bear the brunt of household work. The coronavirus pandemic only seems to be intensifying that pressure."