A young mother was busy raising two kids, a 6-month-old and a 4-year-old, when she found out she was 2 months pregnant. Due to the pandemic, she couldn’t get her birth control renewed in time to prevent her third pregnancy. Her husband was working a lot to support the family. That left her at home to care for 2 young children while coping with an unexpected pregnancy. Stress and anxiety weighed on her so heavily that she planned to take her own life.
Having a baby is one of the most life-changing events you can experience. For many, pregnancy and new motherhood are filled with anticipation, joy and excitement. But for others, this joy may be overshadowed by fear, anxiety and depression. Unfortunately, many women may feel that they are alone in experiencing these negative feelings.
Over the past year, the pandemic has created several challenges for women. For example:
- Pregnancy and psychosis: Psychiatrists have reported more women developing depression and symptoms of psychosis after delivery if they had COVID-19 during pregnancy.
- Substance use: There has been a dramatic increase in substance use during the pandemic, with alcohol consumption among women up 41%. In addition, women are relapsing more frequently during pregnancy due to isolation and dealing with irritable partners.
- Job loss: COVID-19-related job losses have disproportionately affected women, with women experiencing 60% of job losses.
- Domestic violence: Domestic violence has increased 10-30% globally during the pandemic.
How have these challenges impacted mental health during motherhood? Before the pandemic, incidence rates of anxiety and depression during pregnancy were 10-25%. Since COVID-19, these rates have jumped to 37% for depression and 57% for anxiety during pregnancy. In harmony with this increase, the Maternal Wellness Program at Atrium Health Behavioral Health Davidson has seen a 50% increase in group size for support group sessions since COVID-19 started.
Cheryl Dodds, MD, medical director of Atrium Health Behavioral Health Davidson, and Lisa Nona, DNP, CNM, director of advanced practice for Atrium Health Women's Care, discuss the underlying issues and risk factors for depression and anxiety during pregnancy or postpartum. Plus, they provide coping strategies and health resources to help women get the most out of motherhood, even during the pandemic.
Pregnancy and postpartum conditions explained
- Baby blues: This condition is common in the first 2 weeks after delivery. As estrogen and progesterone levels drop after giving birth, this can affect a mom's serotonin levels. This hormonal shift can increase depression and anxiety, causing unexplained crying, sleep issues, mood swings and irritability. Within a few weeks, however, most women adjust to these changes. If these symptoms last longer than a couple weeks, postpartum depression (PPD) may be involved.
- Postpartum depression (PPD): This form of depression can be diagnosed within a couple weeks and up to a year after delivery. Women with PPD tend to have depressed mood, irritability, mood swings, sleep issues (too much or too little), difficulty bonding with the baby, excessive crying and feelings of apathy, worthlessness, guilt or emotional withdrawal. They may even feel like their baby and family are better off without them.
- Anxiety during pregnancy or postpartum: Beyond the natural concerns a woman might have during pregnancy and the baby’s first year of life, this condition occurs when worry and anxiety start to control their lives and impact their daily function. These intrusive negative feelings make women constantly worry that something bad will happen to their baby, even perhaps making them worry that they might hurt their baby. It might also involve obsessive-compulsive worrying about germs and providing adequate nutrition for the baby. These anxious feelings can make it difficult for moms to sleep, leave the home or care for their families. The physical signs of this form of anxiety include heart palpitations, fatigue, nausea, vomiting and hyperventilation.
Risk factors for depression and anxiety
Anyone can develop depression and/or anxiety during pregnancy or postpartum. You may be more likely to develop one of these conditions if you:
- Are a stay-at-home mom.
- Are trying to do everything from home, including working, managing homeschooling and caring for the home.
- Are experiencing isolation or trauma at home, including abuse from a partner.
- Are struggling to care for babies/children who are sick at home or in the neonatal unit.
- Have a preexisting mental illness or a family history of depression, bipolar disorder or another mental illness.
- Have a history of PPD with previous pregnancies.
- Have limited financial or social resources, including less support at home.
Coping strategies for every stage
The following tips and strategies can help you reduce and cope with negative feelings at every stage of motherhood:
For pregnant women:
- Talk to your doctor: To minimize the unknown factors involved in pregnancy and delivery, talk to your OB physician or provider about your concerns. Your doctor can assure you that your feelings are natural and answer any questions you may have.
- Develop a game plan for success: Before you give birth, have a plan in place for how you will get adequate sleep and nutrition in the weeks and months after giving birth. If possible, arrange for family members to help with the baby after delivery. If they can’t isolate prior to assisting, arrange for them to drop off meals, pick up dirty laundry, etc. Since it might be more challenging to coordinate at-home support during the pandemic, planning ahead is even more important.
- Prepare yourself and your home before going into labor: Take virtual classes and maternity center tours to help you prepare for motherhood. Atrium Health offers patients access to the Babyscripts app, a leading virtual care platform that supports moms from the time pregnancy is confirmed until 6 weeks postpartum. Be sure to have all the supplies you need at home, including an adequate supply of diapers and wipes, bottles, nursing equipment and a car seat. It’s also beneficial to choose your pediatrician ahead of time.
For new mothers:
- Quarantine and vaccinate: If you’re worried about the risk of COVID-19 exposure, have parents or visitors quarantine for 10 days before visiting. If possible, get vaccinated, and make sure your visitors are vaccinated.
- Mask up, wash hands: Have visitors wear masks around the new baby. Also, encourage visitors to practice social distancing and handwashing as much as possible.
- Talk about breastfeeding: Breastfeeding struggles are often a contributing factor for PPD and postpartum anxiety. If your breastfeeding experience is challenging, reach out to a lactation consultant or consult with your baby’s pediatrician for alternative feeding options.
- Stay active: Wait until you’re cleared by your OB physician or provider to resume exercise. Especially while your body heals, avoid trying anything new or vigorous. Try something practical that will work with your current schedule. For example, put your baby in the stroller and go for a walk.
- Get adequate sleep: Poor sleep quality increases rates of anxiety and depression. Aim for at least 6 hours of sleep per day to safeguard your mental health.
- Stay connected: Make plans for regular social interactions, even if they’re virtual. Join a support group to connect with other women in the same stage of motherhood. Call a friend or family member for support.
- Seek counseling: If you need help with coping skills and strategies, talk with your OB physician or provider who can recommend a qualified therapist.
During the Holidays
With the holidays coming up, there is a lot going on – from holiday travels to high expectations. Dr. Dodds explains how to manage during a time with heighten stress and additional responsibilities:
- Don’t try to be super-mom: Be sure that you and baby are both getting enough rest. If an activity conflicts with nap time or will keep you or baby up too late, feel comfortable turning it down. Make sure you keep the normal structure of your daily routine and add in only 1-2 special seasonal activities a day. Keep nap and bedtime the same if at all possible. Control the amount of stimulation you and your child have. Keep gatherings with extended family small. Do not feel like you have to do everything to make the holidays perfect. At the end of the day, your baby will be more interested in the box than the gift you hunted all over town to find.
- Take time for yourself: You and your family will not enjoy the holidays if you try to do everything and neglect to sleep and eat. Taking time to care for yourself should be your first priority. It is easy to get run down with all the demands of the holiday season and end up sick or tired for the actual holiday.
- Prioritize self-care: Self-care is taking time to relax, rest and feel calm. You can do it in many different ways from exercise to a hot bath to decorating sugar cookies with your children. Schedule regular time for self-care, even if it is just a 20-minute walk with baby in the stroller to get away from the hustle and bustle of the season.
- Ask for more help: Make sure you are getting 6 hours of uninterrupted sleep a day. Don’t be afraid to hire a babysitter while you run errands for the holidays. Moms often feel like the holiday’s success hinges on them and they have to do everything to make it happen. Do not be afraid to ask others to help out with the food, decorations and gifts.
- Pay attention to your mood: Sometimes the holidays carry sad memories from earlier years. The decrease in outdoor light can also affect your mood this time of year. Please notice if you are not sleeping, feeling sadder, feeling you are not a good Mom, eating poorly or your energy is dropping. You may need to reach out to a therapist or psychiatrist to help you through the season.
Pregnancy and postpartum health resources
Atrium Health is dedicated to providing comprehensive mental health resources, including the following:
- Maternal Wellness Program: This program offers access to therapy, group sessions and inpatient services.
- Weekly 2-hour group sessions are available for women who are pregnant or who have delivered within a year along with their babies. Sessions provide education on managing depression and anxiety during pregnancy or postpartum, including coping skills and parenting skills. (Virtual sessions held during the pandemic.)
- Individual therapy is available from therapists specially trained in psychotherapy during pregnancy or postpartum. Timely access to therapy is provided to get symptoms addressed as quickly as possible.
- Medication management during pregnancy is also available.
- Point-of-care consult: While patients are visiting their OB physician or provider or another healthcare professional, they have the opportunity to get screened for depression and referred to a counselor at the same appointment. If needed, they are virtually connected with a counselor through a 2-way camera in the exam room. The counselor then arranges for outside management through counseling or medication.
- Postpartum support group: Through Atrium Health’s Women’s Care division, a postpartum support group for mothers at 2-3 weeks postpartum will be available starting May 2021. Topics will include tips for breastfeeding and social support and will be specific to postpartum support and not PPD. Any mothers who are struggling or have PPD will be contacted about scheduling an appointment for individual counseling or referred to Behavioral Health if the mother chooses. (Virtual sessions will be held during the pandemic.)
- Treat pregnant psychiatric inpatients together: Atrium Health treats pregnant psychiatric inpatients together on a low acuity unit at Atrium Health Behavioral Health Davidson. In this unit, there are staff who are specially trained in prenatal care to provide the best possible care and resources for these patients.
Support through medication
“Many patients have anxiety about using medication during pregnancy,” explained Dr. Dodds. “To reduce anxiety, talk to your doctor about medication options. We provide comprehensive information about safety and efficacy during pregnancy and breastfeeding. And then we let the patient decide about treatment.”
“Depression can be more damaging to the fetus than medication, so it’s really important to weigh the risks and benefits,” Dr. Dodds revealed. “All pregnancies have a risk of birth defects. Mental illness increases that risk by 1%, regardless of treatment. So it’s important to get the depression under control as soon as possible.”
The danger of untreated anxiety and depression
If left alone, untreated depression and/or anxiety during pregnancy or postpartum can lead to:
- Maternal suicide: Suicide is a leading cause of death in mothers after delivery.
- Difficulties caring for baby: Depressed mothers often have poor bonding with their babies. They also experience increased rates of abandoning breastfeeding at 2 and 4 months.
- Developmental delays: Untreated depression in postpartum women has been shown to impact a baby’s development in the first year. That’s because of depression’s impact on the mother’s ability to properly feed and care for herself and interact with the baby. These babies are more likely to develop slower and less robustly than babies of mothers without depression.
- Long-term problems for children: Children of depressed mothers have 5 times the risk of developing behavioral problems by age 3.5 and 5 times the risk of developing depression by age 18.
- Depressed partners: PPD increases the risk of depression in partners by a factor of 2.5.
“Mothers need to be as healthy and functional as possible to care for their families properly,” explained Dr. Dodds. “Mental health is a key component of maternal health and wellness. Recognizing that something isn’t right is the first step in getting the help you need and protecting your family.”
Know that you’re not alone
“If you’re feeling anxious or overwhelmed, let someone know how you’re feeling,” encouraged Nona. “Don’t be ashamed or hide your feelings. You’re not alone; many women share your same feelings.”
Remember that depression and/or anxiety during pregnancy or postpartum can affect anyone, so someone could seem fine on the outside but be struggling on the inside. “These conditions can affect women who are still taking care of themselves and their families,” Nona said. “In spite of the ongoing stress of the pandemic, we want to do all we can to help women in need so they can enjoy this time of their life as much as possible.”
Fortunately, the young mother mentioned above got the help she needed before it was too late. After months of struggling, she decided to seek help from her OB physician. She was admitted to the hospital for a brief stay to get her health back on track. She also got the social support she needed by connecting with the Maternal Wellness Program and starting individual therapy. Within weeks, she was able to return to work and continue caring for her family.
Follow-up care options
Talk to your OB physician or provider if you’re coping with feelings of anxiety or depression. Many are trained to recognize the warning signs and can provide the appropriate screening. To enroll in our Maternal Wellness Program, call our clinic at 704-801-9200 or have your OB/GYN or primary care provider send a referral.
If you or a loved one is struggling, call Atrium Health’s Behavioral Health Help Line at 704-444-2400 for 24/7 mental health crisis assistance. We can help. You are not alone.
