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
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."
A New Study Finds That Postpartum Depression Can Last Years—So Let's Take a Look at What It Actually Is
By Jaime Stathis| November 10, 2020
"Postpartum depression, a strikingly common experience among new mothers, spent decades being a taboo, barely-acknowledged topic.
It wasn’t until celebrities like Brooke Shields, who candidly wrote about her experience with postpartum depression in 2005, encouraged destigmatization and invited women to discuss grief during a time in their lives where they expected to feel nothing but joy.
As PPD continues to be discussed among celebrities and on social media, and as women begin to bring the issue to their doctors and mental health professionals in hopes of getting treatment, this begs the question: What is postpartum depression, exactly? Let’s take a closer look.
What is postpartum depression?
According to The Cleveland Clinic, postpartum depression is a mental shift new mothers experience after delivery, also called the “baby blues.” The symptoms exist on a spectrum and everything from mild blues to postpartum psychosis that falls under the umbrella of postpartum depression. The symptoms can be as mild as sadness, irritability, and trouble sleeping, or as dramatic as paranoia, hallucinations, and obsessive thoughts.
How common is postpartum depression?
The Cleveland Clinic states that an estimated 50-75% of women experience an emotional shift after the birth of their child, with up to 15% experiencing more severe, prolonged symptoms which is called postpartum depression. Among those women, approximately 2% suffer from postpartum psychosis, which comes on quickly and is a medical emergency.
When also taking into account women who had stillbirths or miscarriages, the number of women affected in the United States is around 900,000.
The underlying causes of postpartum depression explain why it’s so prevalent. Hormones drop after pregnancy, and the shifting levels of estrogen and progesterone can trigger mood changes similar to premenstrual syndrome but amplified. Fatigue, stress, and a history of depression are all contributing factors."
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.”
By Anne Miller| April 15, 2020
"When the first pregnancy arrives with little effort, struggling to conceive again can come as a shock."
"The doctor sketched a rough outline of my reproductive organs and nearby anatomy as she talked. The black lines on white paper seemed so sparse, when in reality they represented our hopes for the future. My husband and I had a healthy, smart, sassy, thriving preschooler; but we wanted another child. And with the relative ease of our first pregnancy — three months of trying followed by a clockwork 40 weeks (and three days) of pregnancy — we assumed the second would come easily.
Instead, it took us a little more than two years to conceive. The process hit us like a shock wave, draining our savings and deflating our dreams.
The doctors called it secondary infertility, a sometimes nebulous term that’s often given to women (or couples) who have successfully given birth but are struggling to get or stay pregnant again. As with regular infertility, it’s diagnosed in women who can’t seem to conceive after trying for a year or more (if they’re under 35); or for six months or more (if they’re 35 or older).
For many women, a secondary infertility diagnosis can come as a shock — if you’ve had a baby once, why shouldn’t you be able to have another?
“I had heard that secondary infertility was possible, but I never thought it would happen to us,” said Shannon Stockton, a mom of two girls who are more than eight years apart. “I had gotten pregnant so easily the first time.”
Stockton, who works as an executive assistant for a medical nonprofit, had her first daughter at 28, and hoped to have a second child four or five years later. She and her husband started trying again when she was 33, but she didn’t give birth until she was 37.
“Why couldn’t we figure out the timing? Why wouldn’t our bodies do what they were supposed to do?” they wondered. Their diagnosis: unexplained secondary infertility."
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."
By Karen Kleima| April 28,2020
l"What if I get sick and can't take care of my baby?
What if my baby gets sick?
What if my partner gets sick?
How do I do this all alone?
Being a new mother is hard.
Being a new mother during a pandemic is almost unimaginable. One of the things we have learned-thanks to the increased awareness and circulation of good, accurate information about maternal mental health-is scary, negative intrusive thoughts about harm coming to the baby are a stressful but common expression of normal anxiety. Almost every single new mother and most new fathers experience the presence of scary thoughts that can range from mildly annoying to excruciatingly painful and debilitating.
It may be hard to distinguish between "normal and scary thoughts" and those triggered by the current extraordinary stressors associated with sheltering in, isolation, quarantining, social distancing and all the other mandates that are imposing gut-wrenching restrictions. It stands to reason new mothers today are bombarded on a moment-to-moment basis with negative thoughts that may feel out of control, never-ending and often shame-inducing. After all, we often hear, "How can a good mother think these thoughts?"
But good mothers do have these scary thoughts. Awful thoughts. Terrifying thoughts. Indescribable and unfathomable thoughts. And if these moms do not find the support and validation they need, the thoughts can swirl around in their heads, gaining momentum from fear. Anxiety is at an all time high right now, for good reason. It's scary outside and some new moms understandably feel out of control with anxiety.
When the anxiety emerges within the context of having a new baby, it often manifests as specific thoughts about something horrible happening to the baby. By accident, or by intent. The guilt and worry can be excruciating."
By Kristen Rogers, CNN
April 22, 2020
"(CNN)Becoming a mother is a variable experience, fluctuating in its joys and challenges before, during and after birth.
These phases are of equal importance, but the postnatal period (post-birth) is key to a mother's well-being, her adaptation to changes and the formation of a positive relationship with her baby.
The postnatal period is also an underserved aspect of maternity care, receiving less funding, service and attention from health providers, according to a new review on what matters most to women after giving birth, published Wednesday in the journal PLOS ONE. Add to that a worrisome pandemic, and it becomes even more crucial to prioritize a woman's well-being during this time of adjustment.
"Once the baby's out healthy, then people are kind of less bothered," said co-author Soo Downe, a professor in midwifery studies at the University of Central Lancashire in England. And commercial hospital systems may not see as much profit in keeping up with the wellness of the mother after birth, she added.
"There's all this intense focus on women's health during the three trimesters of pregnancy and then women deliver and there's really very little support after that," said Dr. Denise Jamieson, chair of the Department of Gynecology and Obstetrics at Emory University and chief of gynecology and obstetrics at Emory Healthcare. Jamieson wasn't involved in the study."
By Al Donato| 4/15/2020 6:48pm EDT
"If you’re an exhausted parent at home right now, you have a friend in Elmo’s dad, Louie. In the latest pandemic programming from “Sesame Street,” the children’s series has released a PSA for parents starring the famous Muppet’s father.
In the PSA, Louie reveals that, like many kids cooped up at home, Elmo won’t leave his parents alone.
“It is wonderful to spend so much time with our children, but it can also be a bit ...” the older Muppet pauses, before letting out the world’s most relatable sigh. “Overwhelming.”
By Carmela K Baeza, MD, IBCLC| Art By Ken Tackett
"Some dyads (mother-infant pair) start their breastfeeding relationship in harsh circumstances. Frequently, due to medicalized births and unfavorable hospital routines, there are so many interferences to initiate breastfeeding that by the time mother and baby arrive home they are already using bottles and formula – despite mother having desired to exclusively breastfeed.
These mothers often feel that they do not make enough milk and that their babies prefer the bottle. They will make comments like “my baby doesn't like my breast”, “I cannot make enough milk”, “the more bottles I give my baby, the less she likes me”, and so on. This can become the road into postpartum depression.
Those mothers who are intent on breastfeeding will often look for support, and may find it in a midwife, a lactation consultant or a breastfeeding support group. These health care professionals or counselors may offer the mother to work on her milk production by expressing milk from her breasts (either with her hands or with a pump) and feeding that milk to the baby, as well as putting baby on the breast.
And this is what we call triple breastfeeding.
Imagine: mother puts baby at her breast. Baby suckles for an hour and a half, falling asleep frequently. Mother will tickle him, speak to him, encourage, often to little avail. After an hour and a half, mother will unlatch the baby (he never seems to come off on his own), put him in the crib, set up her breast pump and begin pumping, going for at least 15 minutes on each breast. Halfway through, the baby wakes up and cries – he´s hungry. But he was just on the breast for almost two hours! Mother turns off the pump (and so little milk has come out!) and feeds her baby a bottle of formula. She cries. She feels exhausted, useless, and unable to meet her baby´s needs. She has not left the house for days, because she is immersed in a never-ending cycle of breast-pumping-feeding."