Letters to the Editor • Opinion
We already know how to prevent pandemics
The Washington PostDemocracy Dies in Darkness

Coronavirus placing high stress on new, expecting moms and raising risks for mental health issues

“I have my days that I’m struggling, or antsy, or depressed, but I just feel like there’s a reason we’re going through this,” Natalia Castillo says. (Family Photo)

On March 31, Andrea Root of Whittier, Calif., gave birth to her first child surrounded by doctors and nurses equipped with thick plastic face shields and multiple face masks who kept their distance, fearful that the 38-year-old was carrying covid-19.

Within moments of her son’s birth, doctors whisked him away into the nearby neonatal intensive care unit — a precautionary measure taken to protect the infant from potentially contracting the novel coronavirus from his mother. Dazed, Root began to sob.

The next day, Root was sent home to quarantine at a relative’s house after testing positive for the coronavirus, while her newborn went home with her husband, Jason. Over the next two weeks, she lived in isolation, battling bouts of depression and anxiety while longing to hold her child for the first time.

Mental health and maternity experts worry that her experience speaks to a disturbing trend developing across the United States: The coronavirus is placing severe stress on new and expecting mothers, increasing their risk of postpartum depression and other maternal mental health illnesses.

“Giving birth is already such an overwhelming process, but it’s heightened when you’re surrounded by doctors equipped with face shields, when the nurses are wearing multiple masks and are scared to come too close to you,” says Root, who believes she contracted the coronavirus at her grandmother’s funeral in mid-March. “Not getting to hold my son, breaking down crying as he was carried away from us, it was just too much. I kept replaying those scenes in my head over and over as I sat there alone.”

After careful consideration, Root finally returned home to her family on April 12 despite continuing to test positive for the coronavirus. Remaining separated from her child had proved too psychologically draining, she said. Though she’s since overcome her sickness, she’s still grappling with the mental scar tissue left behind by her traumatic birthing experience.

“I couldn’t stop crying. The isolation and time away from my child was overwhelming,” she says. Even when she returned home, she had difficulties, having to wear a mask when she held her baby, who was beginning to study her face. It pained her that he couldn’t even see what she looked like. “How do you make peace with that as a mom?”

Maternal mental health experts are on high alert right now, says Ann Smith, board chair at Postpartum Support International (PSI). From the isolation that stems from shelter-in-places orders to the lack of available help from friends and family members because of social distancing recommendations, the ongoing pandemic has left some moms on an island like never before.

“Despite the common name ‘postpartum depression,’ anxiety is the number one symptom that most women face if they experience maternal mental health challenges,” she says. “It doesn’t take a lot of imagination to know that if you drop an already-anxious person into a nerve-racking situation like this, with essentially no hands-on help from their social support network, it’ll exacerbate their mental health symptoms across the board. I’m very concerned what this could do to new parents.”

According to Smith, 1 in 7 mothers experience what’s now referred to as perinatal mood and anxiety disorders (PMADs), a name that better captures the vast breadth of maternal mental health conditions and their symptoms.

While it’s too early to say just how far-reaching the effects of the coronavirus could be on PMADs, Smith says her organization has seen a significant attendance spike in their digital support groups and therapy sessions. They’ve also had to create new resources to account for the surge of calls they’ve received from expecting mothers.

“The fear and uncertainty enveloping our lives is having a pronounced effect on pregnant moms, who already make up a third of all women with perinatal disorders,” says Melissa Bentley, a licensed therapist and support coordinator manager for PSI. “Women come up with intricate birthing plans to ensure they’ll have the support they need, but all of a sudden, those plans are out the window. This is especially troubling for those with a history of anxiety, depression, or trauma.”

To aid struggling mothers, PSI has begun offering professional trainings for people interested in creating online maternal mental health support groups and pushing for a broader use of telehealth medicine options for those who are homebound during the pandemic. The organization is also working to reduce stigma and educate front-line providers (such as family doctors and nurse practitioners) across the country about the litany of forms PMADs can take — including the negative obsessive-compulsive thoughts that can cause moms’ fears for their children’s well-being to escalate to extreme levels. If left untreated, these types of symptoms can be particularly crippling during a pandemic, Smith says.

But like many mental health issues, PMADs have a pronounced effect on vulnerable populations like single mothers, teen moms and women struggling economically. People in these positions are already in need of help caring for their children during normal times, says Dyann Avila, a clinical therapist at Any Baby Can, an Austin-based nonprofit that provides child development and parental support services to thousands of families, many of which face extreme poverty and other challenges. Now, if you’ve lost your job or are left alone to constantly care for your child, you’re at an even greater risk of experiencing anxiety and stress, Avila says.

“Shelter-in-place is a privilege. We have some clients that have several generations or multiple families living under a single roof. We’re getting a lot of requests for basic needs to address things like food insecurity,” she says. “When you’re a young mom, a single mother, someone who has limited economic resources . . . the risks of perinatal mood disorders are compounded and further complicate an already difficult circumstance.”

Natalia Castillo, one of Avila’s clients, has been especially affected by the health and economic ramifications of the coronavirus. A 25-year-old single mother, she spends most of her day caring for her 7-month-old daughter, Mariana, who she describes as “a miracle baby.”

Because Mariana was born with a skeletal muscular disorder that impedes her ability to breathe and swallow without assistance, she’s always hooked up to a ventilator and eats through a feeding tube, both of which are monitored daily by an Any Baby Can nurse.

Castillo works at a radiology office in South Austin and showing up each day has become increasingly distressing for her. With many patients requesting chest X-rays to verify if they’ve contracted the coronavirus, she’s in constant terror of bringing the disease home to her child. But with her hours cut to 25 hours a week because of the pandemic-fueled economic downturn and no word back from the state about her request for unemployment relief, Castillo says she’s had to swallow her fears to keep a roof over her family’s head.

“Even a regular cold could be deadly for her, so I have to always be careful. Keeping her safe is my goal every single day,” she says. “We’ve also taken a big hit economically, so I told my mom (who lives with me), we’re just going to pay the essentials to keep the lights on. Everything else outside of our mortgage and utilities — credit card debt, anything like that — is just going to have to wait.”

As the weeks have passed, Castillo has been stricken by anxiety, struggling to sleep while feeling like she’s failed her daughter. To stay afloat, she’s tried to revel in her rare moments of free time, stealing a few minutes of solitude during her drive from work and listening to music while giving Mariana her nightly bath. These exercises, along with Any Baby Can’s mental health and nursing services, have been critical to maintaining her well-being, Castillo says. Still, it can all seem like too much some days.

“I have my days that I’m struggling, or antsy, or depressed, but I just feel like there’s a reason we’re going through this,” she says. “Mariana has taught me what it means to fight for your life, to live every day like it’s your last. The whole situation with covid-19, a lot of people are going to learn that as well.”

Looking ahead, experts fear stories like Castillo’s could become increasingly commonplace as the coronavirus continues to spread throughout the United States.

“The second wave of this pandemic is going to be a mental health pandemic. This isolation is detrimental across the board, but especially for parents, it’s just even more exacerbated,” says Alexis Edwards, a doula and maternal therapist who specializes in trauma-informed care.

“The likelihood of maternal trauma, the fact that there are so many unknowns for women heading into their birthing process — that has an incredible impact on a birthing person’s mental health, on the development of their child. Now more than ever, we’ve got to be especially intentional about how our society talks about, and addresses, perinatal mental health.”

If you’re experiencing symptoms of a perinatal mood and anxiety disorder or would like to speak with a maternal mental health expert, call the PSI hotline at 800-944-4773 or visit postpartum.net.

What to know about being pregnant during the pandemic

The stress of the coronavirus pandemic is especially hard on black moms

Pregnant women are urged to avoid stress. What happens when a pandemic makes that impossible?

Coronavirus: What you need to know

Where do things stand? See the latest covid numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people.

The state of public health: Conservative and libertarian forces have defanged much of the nation’s public health system through legislation and litigation as the world staggers into the fourth year of covid.

Grief and the pandemic: A Washington Post reporter covered the coronavirus — and then endured the death of her mother from covid-19. She offers a window into grief and resilience.

Would we shut down again? What will the United States do the next time a deadly virus comes knocking on the door?

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot. New federal data shows adults who received the updated shots cut their risk of being hospitalized with covid-19 by 50 percent. Here’s guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

For the latest news, sign up for our free newsletter.