“I cried and I begged to go home and get my stuff,” says Davis. “I had a birth plan. I wanted to labor at home before coming to the hospital, but now that wasn’t going to happen.”
A maternal-fetal specialist sent her immediately to labor and delivery, where a series of unexpected events continued. Davis’ baby’s heart rate was too high, and doctors and nurses rushed to get him out. He was fine after a frightening birth: When her son finally made his grand entrance, his umbilical cord was wrapped around his neck and body. “He wasn’t moving,” Davis said. “It was really scary, especially with nobody telling me anything.”
No visitors were allowed at the hospital where she gave birth, in Cleveland, Ohio’s COVID-19 epicenter, on March 26. So although her partner was with her for the birth, her mother and family weren’t able to visit for the three days she was there. Again, it wasn’t the scenario she had pictured, adding to her distress.
The postpartum period has been equally as isolated. It’s been just her and her partner and their new baby. Davis was diagnosed with postpartum depression, and with a lack of physical connection and a present support system because of social distancing guidelines, she’s struggling. Her partner, she says, is depressed too, so most of the child care burden falls on her. “I’m doing this alone, and it’s just too much. I need help.” On top of that, Davis is facing going back to work and finding childcare for her infant during a pandemic, which adds another huge set of worries.
According to a recently released report by Aeroflow Healthcare, 56 percent of new moms said they had family and friends stay with them to help out. Still, 48 percent said they struggled with postpartum depression and 39 percent with social support isolation. Postpartum depression, a serious mood disorder, affects 1 in 7 women and can last for months if left untreated, according to the American Psychological Association. Other postpartum mood disorders, namely postpartum post-traumatic stress disorder (PP-PTSD), can occur when childbirth is stressful and traumatic. To add to that, according to a 2018 study in Frontiers in Psychiatry, low social support is a significant risk factor for PP-PTSD. And those findings came during what now seems like a faraway time when baby showers, hospital visitors, and family coming over was the norm. Now, moms not only face postpartum depression and stressful birth experiences like Davis’, but are even more isolated than before — and the effects are yet unseen.
“As for the postpartum phase, while some are appreciating the downtime with not having to entertain visitors, others are overwhelmed with new motherhood while adjusting to the social isolation and uncertainties of the pandemic,” says postpartum therapist Thai-An Truong. Truong explains that the decrease in adult socialization and loss of support system in addition to other regular household expectations can contribute to postpartum depression and anxiety.
Reena Pande, chief medical officer for mental-health teletherapy provider AbleTo, says we have the perfect makings of a postpartum mental health crisis. “We’ve seen phased approaches for a return to normal, but none of them include steps to ensure mental health is on the upswing,” says Pande. “This is a huge problem.”
And it’s a problem that could disproportionately affect black women.
“There are differing levels of maternal mortality and morbidity in racial and ethnic groups, and I worry that disparity will widen in the midst of this pandemic,” she says. Black women specifically, who are already at greater risk of postpartum depression, are also at higher risk for childbirth complications, premature birth, and death during and after childbirth. The very real fears black women have about giving birth are only compounded by the coronavirus pandemic and the fact that COVID-19 is yet another thing black people are at higher risk of dying from than other racial and ethnic groups. “All of this can contribute to postpartum depression and anxiety, which includes feeling nervous, worried or frightened about the present and future, especially their health and baby’s health,” says Truong.
Current events and the prevalence of racism also negatively impact black people’s mental health. A 2015 study in the American Journal of Public Health concluded that racism black people experienced during the trial of George Zimmerman, the man who shot and killed unarmed black teenager Trayvon Martin, was associated with poor mental health, depression, and distress with black women exhibiting more depressive symptoms than men.
For all new mothers, suicidal ideation is another concern experts have. Suicidal ideation occurs when women begin to have passive thoughts, such as wishing they don’t wake up, or active thoughts about ending their life, Truong explains. Though maternal suicide has largely gone under the radar due to incomplete data and no official requirement by the Centers for Disease Control for states to collect such information, experts estimate that 14 to 30 percent of maternal deaths might be due to suicide and drug overdose. A 2019 study in the American Journal of Obstetrics and Gynecology focused on one million women who gave birth in California found that death by suicide along with drug-related deaths made up 20 percent of postpartum deaths, making it a leading cause of maternal death.
Pande says there needs to be a coordinated effort on behalf of medical care workers to reach out proactively to women after childbirth. “We need to be thinking proactively about how to support new moms of all races and ethnicities, and especially those that are at greater risk,” says Pande. To do so, we need to rethink delivery of mental health care and ensure access.
Telehealth — the currently accepted mode of much health care delivery while coronavirus is still a significant risk — can help bridge gaps in access, eliminate child care concerns, and help reduce stigma for women concerned about going to mental health appointments even after the pandemic is over. “Telehealth is actually a wonderful opportunity to get more mental health services to all the patients who need it and will need it as this pandemic progresses and the mental health effects of it continue to develop,” she says. “Mental health is one that absolutely can be delivered that way with great success.”
Another part of what needs to change is outreach. Employers are a good point of contact, says Pande, for informing postpartum moms about their covered mental health benefits. Because job insecurity is high, however, Pande stresses the importance of community outreach. For example, Truong offers a Facebook support group where moms can link with one another and share their struggles and access resources, including self assessment tools and podcasts. “An important first step is to just start a conversation, share your struggles instead of suffering alone,” says Truong. “While it is hard to believe in the midst of your struggle, you really will get better with taking some action steps forward.”
If you or someone you know is having thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255.
Kelly Glass is a freelance writer whose interests focus on the intersections of parenting, mental health, race and diversity. A city girl at heart, she lives in a smaller Illinois college town with her brilliant autistic teenage son and an ambitious preschooler. Follow her on Twitter.