Their recent study, published in BMC Pregnancy and Childbirth, has revealed the results of the investigation and offers suggestions for healthcare providers to help reduce pandemic stressors in perinatal women. “While many have experienced stressors during the pandemic, pregnant and postpartum women have additional stressors on top of the stress experienced by so many others," says lead author Celestina Barbosa-Leiker. “Since stress during pregnancy impacts fetal development, we need to help alleviate these stressors in pregnant and postpartum women.”
About the Study
The study reviewed 125 pregnant and 37 postnatal women via questionnaires that assessed their stressors, coping strategies, and demographics. Of the participants, 79% were non-Hispanic white women and 96% were covered by health insurance. This sample suggests a narrow demographic picture of pregnancy-related stress in COVID which researchers hope to expand upon in the future. From the sample, researchers were able to determine that stress levels were higher in low-income and racial minority populations and coping mechanisms less likely to be utilized.
Common Stressors
On top of the stress that we are all dealing with during the pandemic, pregnant people and new parents are also facing:
Lack of access to healthy food due to shelter-in-place restrictions or financial hardshipLack of access to resources such as diapers, wipes, and baby formula or pumping suppliesFear that their baby would become sick with COVID-19Fear that they or their partner would become sick with COVID-19Feeling unprepared for the birthMissing important prenatal appointmentsDifficulty obtaining healthcareLack of social support in pregnancy and postnatally
Although many women struggled with lack of social support, some women struggled with too much. Barbosa-Leiker revealed that “Our participants noted that they were stressed over trying to not offend family members when asking them to not come and visit in person during the pandemic.”
Coping Mechanisms
For the purpose of this study, women were asked to select coping strategies they were using from a provided list. Key findings showed that postnatal women were more likely to utilize coping strategies than pregnant women. In particular, they were more likely to take breaks from watching pandemic news coverage, eat healthy foods, limit alcohol and/or drugs, exercise, and connect socially with others. The reason may be that a new baby forces women to focus on something other than the news coverage, and encourages friends and family to check in more often. It was also found that women with higher incomes were more likely to employ coping mechanisms than those with low incomes.
Recommendations to Reduce Stress
A walk and a break from the news can be beneficial in reducing stress, but families also need practical ways to resolve stressors. Healthcare providers, friends, family, and partners of pregnant people all play a role in helping to reduce the stressors experienced in pregnancy. “For the general public, we ask that they check in on pregnant and postpartum family members, friends, and colleagues (from a safe distance!) to see how they are doing, if they need anything, if they want to engage with others safely for social interactions.” Suggests Barbosa-Leiker.
Lack of Resources
The inability to access healthy food in pregnancy is both concerning and stress-inducing. Barbosa-Leiker says “lacking key nutrients during pregnancy impacts fetal development and then the development of the baby.” If you are struggling to access healthy food in pregnancy for any reason, there are solutions. “If you cannot afford the necessary supplies to care for your child, reach out to your pediatrician, local hospital, or county social services office for support," says Shairee Lackey, behavioral health consultant and LPC at Howard Brown Health. “They can connect you with community-based services or even free products.“ On a national level, WIC is a nutrition program catering to pregnant, breastfeeding, and postnatal families and children up to five years of age. “WIC is an excellent resource to secure food and even a car seat.” Lackey advises, “Women can access WIC services by contacting their local county social service office.” Women in the study also found it challenging to access necessary baby supplies such as diapers, baby formula, and wipes. Stay-at-home orders, lack of financial income, and lack of available stock all contributed to this concern for participants. Social workers at your local hospital can be accessed with a referral from your medical team. They can link you with community services that can assist in providing the necessary resources for you. Lackey adds, “The National Diaper Bank Network is a great resource to secure diapers because they have partnered with organizations throughout the United States to offer this invaluable service.” Although lack of childcare was not a primary concern for the study participants, study authors recommend that healthcare providers check in with families about this. For many families, it may be a concern and it is vitally important that children are in a safe environment. This is especially important considering that grandparents often form the structure of childcare for older siblings around the time of birthing. During COVID-19, grandparents are among our most vulnerable, which limits their capacity to offer child care. Once again, Lackey advises that connecting with the social services at your hospital can link you with necessary resources in your area, including childcare options.
Feeling Unprepared For Birth
At least a quarter of women missed prenatal appointments with their healthcare provider during the pandemic, whilst over a third of them had appointments via telehealth. Women felt unprepared for the birth due to this lack of access to healthcare. They also suffered a lack of social support with the cancellation or reduction in face-to-face birthing classes and prenatal support groups. Researchers suggest that healthcare providers become familiar with services offered by their facility or in the local area. It is important for the mental health of pregnant and postnatal people to have access to quality health information and support. Online support groups and telehealth do help to bridge some gaps. However, access to an electronic device and stable internet connection is not possible for everyone. Low-income families and those in remote locations may struggle to access online services. Lackey advises that most hospitals across the US should still be providing face-to-face appointments, birthing classes, and support for those who do not have access to telehealth. It is important to speak to your local health care provider to inquire about these. “The National Parent Helpline (1.855.4A Parent) is also a good alternative for women without access to the internet.” Advises Lackey.
Concern About Contracting COVID-19
Half of all participants were stressed about their baby contracting COVID-19 in the hospital setting. This was closely followed by the stress of themselves or their partner contracting the virus. They were worried about what this would mean in terms of separation from their baby and health outcomes for all those involved. This is a real stress for everyone. It is best to discuss this concern with the hospital where you intend to deliver. Ask the questions. Find out what restrictions and guidelines are in place around birthing and care of the newborn. What safety measures do they have and what can you expect? This will change as the pandemic changes. The Centers for Disease Control and Prevention (CDC) provides guidelines for birthing to help decrease the risk of exposure to COVID-19. With these guidelines implemented, you may find that you have a reduced length of stay, limited visitors, and use of masks and other personal protective wear will be used by staff.
General Recommendations for Stress Reduction
If your healthcare provider does not start the conversation about stress reduction during pregnancy, it’s okay for you to do so. Ask about resources available that will help address your concerns. There are often more resources available than we are aware of and you just need someone to point you in the right direction to help alleviate that stressor for you. “Social workers and other mental health providers, such as psychologists and licensed counselors, are typically on staff at U.S. hospitals in a variety of different departments, including pre-and postnatal units,” advises Lackey. “The role of these individuals is to advocate for patients, deliver mental health support, and supply resources needed for the patient to achieve a positive health outcome.” Remember to take breaks from watching the news, move your body as you are able, allow others to help you from a distance, stay socially connected, and don’t be afraid to ask for help. The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.
