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."
By Cassie Shortsleeve| July 14, 2020
"Six weeks after I gave birth to my first daughter, I found myself in my OB/GYN’s office for my postpartum checkup. After a quick conversation and a physical exam, my doctor told me that I was “cleared.” I could resume all regular pre-pregnancy activity.
I went home, fed my baby and went on a run — and had to stop after a half-mile. My pelvic floor felt like it was going to give out and — although once an avid runner — I felt clumsy. That night, I lay awake, milk-stained and sweaty. Nothing about me felt “cleared.”
Despite the fact that in 2018, the American College of Obstetricians and Gynecologists recommended that, to optimize women’s health, postpartum care should become more of a rolling process rather than a single encounter, for many new moms, the six-week postpartum appointment remains the only touch point with the health-care system that birthed her baby.
If Latin America has la cuarentena — a 40-day period when women take care of a new mom while she rests — and the ancient Indian medical system of ayurveda teaches us that we must nurture women for 42 days postpartum for the health of her next 42 years, the United States, traditionally, has this: one lone appointment that, in many senses, gives a message of closure to the fragile and monumental postpartum period.
"The four- to six-week time frame has historically been thought to be enough time for women to be able to go back to do more physically demanding jobs, like farming, without having any serious medical issues,” explains Heather Irobunda, a board-certified OB/GYN in New York. Your uterus has usually shrunk back to a pre-pregnancy size, lacerations have healed, soreness from birth has resolved.
But physical changes persist for longer — probably six months or so, says Kecia Gaither, director of perinatal services at NYC Health+Hospitals/Lincoln. Around then, pelvic floor and abdominal musculature tone returns, changes in hair normalize, and the menstrual cycle might become more regular (if it’s returned).
Some research even suggests women wait 12 months to conceive again. But how long does it take for the body to recover? It depends on where you look.
The Centers for Disease Control and Prevention, for one, says that a “pregnancy-related” death is a death of a woman while pregnant or within one year of the end of pregnancy, but “maternal mortality” is defined by the World Health Organization as the death of a woman while pregnant or within 42 days of the end of pregnancy.
The Diagnostic and Statistical Manual of Mental Disorders, often called the “bible” of psychiatric health conditions, defines postpartum depression as depression “with postpartum onset: defined as within four weeks of delivering a child.” But, says Cindy-Lee Dennis, a professor at the University of Toronto who studies the postpartum period, “it’s fairly standard in the research literature to consider postpartum depression up to one year postpartum.” (Take a landmark 2013 study published in JAMA Psychiatry of 10,000 mothers: It found that 1 in 7 women develop PPD within the first year postpartum.)
Birdie Gunyon Meyer, a registered nurse and director of certification for Postpartum Support International, a nonprofit group that lobbied to extend the period following delivery in the definition of PPD, says: “I don’t think anybody really believes that the postpartum period is over at four or so weeks, but we give that impression when you come in for your four- or six-week checkup."
The truth is, the adjustment to parenthood takes time. It takes more than a couple of weeks and more than a couple of months. Researchers say Year 1 is critical for children and parents alike. “For the child, the brain is growing rapidly and the experiences that happen and the neurological pathways that are developed stay with the child for a lifetime,” says Dennis."
"When my wife miscarried, I was alone in my mourning"
By Charles Feng| July 22, 2020
"Three years ago, my wife, daughter and I took a photo shivering on a beach amid the howling autumnal wind. Last year, for 11 glorious, anticipatory weeks, while my wife was pregnant, I planned to update the picture at the same location with a new baby in tow.
But that plan was abruptly upended when we had a miscarriage. Now that picture that sits on our mantel would still be just the three of us, squinting into the camera, buttressing one another against the cold.
The miscarriage itself lasted only a few hours. But the self-recrimination lingered long afterward because I wasn’t sure how to grieve when my wife’s emotional response seemed more important. When I searched online, women’s perspectives abounded on websites, in YouTube videos and in news articles, but men’s perspectives were scarce. Academic research was little better. A pattern emerged: Although there is a spotlight on Mom’s emotions and well-being during a miscarriage, Dad’s experiences are rarely discussed.
The pregnancy for our first daughter went smoothly. So, when my wife found out about our second pregnancy, we told family members and friends immediately after finding out, around the two-month mark. This meant that when the miscarriage occurred, we had to backtrack and explain to everyone what had happened, in painful conversations.
My wife’s friends, mostly women, showered her with messages and flowers. On the other hand, for the few friends, all men, I contacted, the comments ranged from the trite (“Sorry, that sucks”) to the callous (“Gotta try again!”) to, well, silence. My best friend, with the best of intentions, emailed my wife his condolences but excluded me.
Eventually, another friend who had recently experienced two miscarriages carved out some time to chat over dinner.
“How are you feeling, buddy?” he asked.
“Okay,” I said.
“Tough as it seems right now, it does get better with time.”
“Good to know.” I felt like a sullen teenager.
“You know, while discussing miscarriages is in general taboo, for men it seems especially so,” he said.
The entire arc of the miscarriage, from conception to loss, occurs within the female body. Aside from contributing sperm, I felt like a bystander. I was traveling when my wife watched the double pink lines appear on the pregnancy test. She occasionally saw the obstetrician on her own and started organizing the baby’s room without my input. I had an ancillary role in the pregnancy, so I wasn’t sure I even had a right to feel devastated.
The event itself is permanently etched in my psyche. Throughout the night, my wife had unremitting abdominal pain. I was asleep when she barged through the door from the bathroom.
“The baby’s gone,” she said through tears.
“I’m so sorry,” I said. I got up and hugged her. “What should we do now?”
“I don’t know.”
My wife went to the obstetrician, while I stayed home with our 2-year-old daughter.
After a sushi lunch — no longer pregnant, my wife could eat raw fish again — we dropped our daughter off at my parents’ house. To distract ourselves, we caught an animated movie. That evening, we drove to a deserted parking lot at the local elementary school. I shut off the car ignition and let the jazz radio buzz in the background. I held my wife’s hand as we stared into the darkness. We talked about the movie but little else.
The next day I was back at work.
The best thing I could do was to just be with her. I felt like I didn’t have a right to express my despair, so I actively suppressed my emotions. My wife needed to lean on me, so I became a stoic, unperturbable oak tree for her. According to a study published this year, after a miscarriage, men have described themselves, in supporting their wives, as “rocks, guards and repair men.” We adhere to traditional notions of masculinity, of being steady and capable, and never, ever succumbing to emotions."
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"
"Surrogacy is an important family planning option, but be prepared for a lengthy, expensive and emotional process."
By David Dodge| April 17, 2020
"This guide was originally on October 11th 2019 in NYT Parenting."
"From the time they began dating as teenagers, Rita and Erikson Magsino, now 39 and 43, talked about the family they hoped to have together one day. Almost immediately after marrying in 2005, they tried to make that dream a reality.
But parenthood would have to wait — Magsino learned she had an aggressive form of endometriosis that made it difficult for her to become pregnant. For over a decade, the couple tried everything to conceive — including fertility drugs and advanced treatments like intrauterine insemination and in vitro fertilization. Twice, Magsino became pregnant, only to miscarry late in the second trimester. “After we lost twins at 20 weeks, we decided enough was enough,” she said. A generation ago, the couple’s attempts to have a biological child most likely would have ended there. Instead, thanks to improvements in reproductive medicine, they welcomed a baby boy into their home in May with the help of a gestational surrogate.
Surrogacy has also created an avenue to biological parenthood for thousands of others who can’t conceive or carry children on their own, such as same-sex couples and single men. As a gay, H.I.V.-positive man, Brian Rosenberg, 54, figured biological fatherhood was forever out of reach. But thanks to surrogacy, and a technique known as “sperm washing,” which prevents H.I.V. transmission, he and his husband, Ferd van Gameren, 59, welcomed twins, biologically related to Rosenberg, in 2010. “It’s still hard to believe,” Rosenberg said. “I thought this was a door that was shut to me.”
Still, would-be parents need to be prepared for a process that is far longer, more expensive and emotional than many people expect — it’s called a “surrogacy journey” for a reason. For this guide, I interviewed the types of experts you can expect to encounter during a surrogacy journey, including two fertility specialists, a lawyer, a psychologist and an agency caseworker."
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."
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."
Finland just gave both parents 7 months of parental leave. Here's why it could drastically reduce postpartum depression in the country.
By Allana Akhtar| February 7, 2020
Photo: Finland Prime Minister Sanna Marin just approved 7 months of parental leave for both parents. Reuters.
"Finland may have made a significant move in reducing postpartum depression among new moms.
The country's government, led by 34-year-old Prime Minister Sanna Marin, will give both new parents seven months of parental leave after childbirth. Pregnant women get an additional month of leave before giving birth.
The updates will replace the country's current policy that provides gender-based pay for four months for new mothers and two months for new fathers, according to NPR. The new policy will go into effect in 2021.
Marin says the move will improve gender equality and is part of her government's plan to pass wide-sweeping social reforms. Marin is the youngest female prime minister in the world, and a majority of her cabinet members are women.
Along with giving fathers more time with their newborns, the progressive policy can improve new mothers' physical and mental health, research suggests, and prevent postpartum depression.
Research finds that having both partners at home after childbirth improves a new mom's anxiety and wellbeing.
While everybody is focused on the baby after it's born, mothers are acutely at risk.
Worldwide, 17.7% of new mothers experience postpartum depression.
While the potential causes of maternal distress are many, new research on Sweden suggests that simply having fathers more available to help out with the newborn can lead to huge gains in mental health for mothers. Sweden has Europe's most generous parental leave, NPR reported, at 240 days per parent.
Mothers are 14% less likely to visit a doctor for childbirth-related complications when fathers are present for the first few of a baby's life. They are also 11% less likely to require antibiotic prescriptions, and 26% less likely to need anti-anxiety medication.
The new National Bureau of Economics working paper, authored by Stanford economists Petra Persson and Maya Rossin-Slater, focused on the impact of parental leave policies in the Nordic country, which offers some of the world's most generous parental leave."
By Allison Aubrey| February 4, 2020
Photo: Chelsea Beck, NPR
"Have you ever noticed how tough it is to be present? We spend so much time planning and worrying about the future or dwelling on the past.
"We're in a trance of thinking. We're time traveling," says Tara Brach, a world-renowned psychologist and mindfulness teacher. "We're in the future, we're in the past."
And all this ruminating gets in the way of enjoying life — we can miss out on the good stuff.
If you reflect on your life, Brach asks, how often can you sense that the fear of failing or not being good enough "was in some way dampening or contracting or pulling you away from real intimacy or spontaneity or enjoying a sunset?"
Life Kit host Alison Aubrey spoke with Brach about her latest book, Radical Compassion: Learning to Love Yourself and Your World with the practice of RAIN. The book outlines the mindfulness tool, RAIN, an acronym for a four-step process: recognize, allow, investigate and nurture.
This interview has been edited for length and clarity.
What is mindfulness at its core. Can you describe mindfulness in a sentence or two?
Mindfulness is paying attention to what's happening in the present moment without judgment.
What is the purpose? What is the benefit of paying attention to the present moment?
We step out of our thoughts about the past and the future, and we actually start occupying a space of presence that is bigger than the particular emotions or thoughts that are going on.
Mindfulness gives us more choice as to how we want to experience things, what we want to say, what we want to do. So instead of reacting, we can actually respond from more intelligence, more kindness. It actually lets us inhabit our best selves."
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."