Birth in the time of COVID

Was the experience of pregnancy and giving birth during the pandemic all bad? We look at two studies which show the positives and negatives of the COVID-19 response

The spread of COVID-19 to Australia in early 2020 prompted the start of a series of restrictions and lockdowns forcing prenatal and postnatal care to undergo a rapid and significant change. Fewer face-to-face appointments, restrictions on partner attendance at appointments, ultrasounds, and in some cases even the birth, led to deleterious effects on women’s mental health. In addition, the stress of the pandemic itself, as well as quarantine requirements and lockdowns, compounded feelings of isolation and depression for many women.

The Birth in the time of COVID (BITTOC) study, published in the International Journal of Environmental Research and Public Health this year looked at the experiences of over 2600 women during the first year of the pandemic. From August 2020 to February 2021, pregnant women or women who had given birth (since the close of Australian borders in March 2020), completed an online survey and self-reported on depression, social support and experiences related to COVID-19.

The results were significant. The study found elevated depressive symptoms in 26.5% of pregnant women and 19% in women who had given birth during this period. Depression during pregnancy and post-partum is considered a public health concern “due to its association with altered motherinfant interactions, more negative child developmental outcomes and considerable personal and economic costs,” the study reports.

Professor Hannah Dahlen, from the Maternal Newborn and Women’s Clinical Academic Group (MNW CAG), who leads the BITTOC study and was a co-author on this paper, explains that several studies have now found depressive symptoms in perinatal women appear to be greater than before COVID-19.

The BITTOC findings also show impact on the mental health of pregnant women during the pandemic but go further in explaining who has been most affected.

Alarmingly, the study found that 60 to 70% of women who reported as having clinically significant depressive symptoms did not receive any form of mental health treatment.

The study examined the ways in which the pandemic impacted women’s mental health including family stress/discord which they found when moderate to severe increased the risk of elevated depression fivefold compared to women who had no stress/discord.

“These findings highlight the importance of considering pandemic stress in the family, including the potential role of couple interventions to reduce the risk of perinatal depression in vulnerable families,” the study reports.

Interestingly, direct exposure to COVID-19 was not associated with greater depressive symptoms while the study found that exposure

to pandemic-related news played a significant role in the increase in depression.

Social distancing played an impact on women’s mental health not only due to reduced prenatal care in the form of face-to-face appointments but also due to the inability of families to participate in rituals such as baby showers and the loss of social support during the transition into motherhood.

The positives

A study looking at the positive experiences of both pregnant and postpartum women as well as the experiences of midwives during the COVID-19 pandemic was also undertaken under the BITTOC umbrella in a paper titled, Never let a good crisis go to waste: Positives from disrupted maternity care in Australia during COVID-19.

The Australia-wide study looked at what women reported as positive experiences during their pregnancy and birth during the pandemic and what midwives also reported.

The most common positive experience identified was having fewer visitors in hospital which allowed time to bond with their newborn and to initiate breastfeeding without the pressure of socialising with visitors immediately after birth. Having more time with, and attention from, midwives was also a commonly reported benefit of visitor restrictions.

The study also found that women saw increased telehealth services as a positive but only in specific situations. For example, minor appointments such as when receiving test results or referrals.

Receiving continuity of care from midwives and having a home birth were also listed as positives as well as having the partner work from home. Midwives, in particular, were more commonly referenced which, the study explains, “likely speaks to the significance that women place on their relationship with midwives as a key support in the perinatal period.”

The two studies, the first of their kind in Australia, provide insight into women’s prenatal and postnatal experiences during the COVID-19 pandemic and provide useful recommendations for planning for improved care in the event of future pandemics.

To find out more about the work of our Maternal, Newborn and Women’s Clinical Academic Group, go to: https://www.thesphere.com.au/work/ maternal-newborn-and-womens

Professor Hannah Dahlen AM