On March 18 — a day before California became the first state to issue a stay-at-home order — Courtney Pladsen, 34, a nurse practitioner who lives in Portland, Me., gave birth to her first child. Like many of the hundreds of thousands of U.S. women who have given birth during the coronavirus pandemic, Pladsen’s life was turned upside down.
In preparation for parenthood, Pladsen and her husband had lined up support: a lactation consultant to help with breast-feeding, a physical therapist to aid in postpartum recovery and visits from family and friends. To ease the stress of new motherhood, Pladsen also planned to attend a support group for new moms.
Now, she says, she’s “mourning the loss of my village.”
That’s because pandemic-related restrictions erased her postpartum plans. “My sister lives three blocks away, but she can’t meet my son,” Pladsen explains. Although she’s never struggled with anxiety or depression, the isolation has rattled her mental well-being.
“I keep hoping the covid crisis will be short-term, but there doesn’t seem to be an end in sight,” she says. “Thinking about it makes me tearful.”
Postpartum depression is the No. 1 complication of childbirth, affecting 15 percent of new mothers, according to the American Psychological Association. Symptoms can include feelings of sadness and hopelessness, appetite and sleep changes and, in rare instances, thoughts of self-harm. Researchers say it can be caused by plummeting postpartum hormones, sleep deprivation and emotional stress. Stressful life events, such as the covid-19 crisis, can also make mothers more vulnerable.
“The pandemic magnifies the stress of new motherhood, which can cause women to feel more anxious, alone and out of control,” says Samantha Meltzer-Brody, a reproductive psychiatrist and director of the University of North Carolina’s Center for Women’s Mood Disorders. Mothers with a history of mood concerns are also at greater risk of becoming depressed or anxious during this tense time, according to Meltzer-Brody.
Left untreated, postpartum depression can turn into something more serious, such as chronic depression. Although the United States Preventive Services Task Force recommends that health-care providers screen all pregnant and new moms for postpartum mood concerns, research shows that up to 50 percent of suffering mothers are never properly diagnosed.
Doctors typically use the Edinburgh Postnatal Depression Scale — a paper-and-pencil questionnaire that’s often administered at a woman’s prenatal and postpartum doctor visits — to assess their mental well-being. Moms struggling with symptoms of mood concerns are referred for group therapy or individual therapy; at some hospitals, these services are provided “in house,” which makes treatment more accessible and affordable.
Due to the pandemic, however, many postpartum check-ups and therapy appointments are taking place via telehealth. At her clinic, Meltzer-Brody and her colleagues continue to screen women for prenatal and postpartum mental health issues, but she says it’s unclear how many doctors are able to do the same. With appointments moving online, it may be harder to administer paper-and-pencil questionnaires, she explains.
What’s more, experts say they expect to see a historic wave of mental-health problems arise during the pandemic, including depression, which further risks stretching resources thin.
Depression isn’t unfamiliar for 37-year-old Jennifer Throm, who lives in Fairfax, Va., and gave birth at the end of February. Throm says she has been diagnosed with a mild form of depression called dysthymia, and has “struggled with mood concerns throughout my life.”
Due to her mental-health history, Throm is at risk for postpartum depression. She says she knew motherhood wouldn’t be easy, but caring for her baby during the pandemic has been incredibly challenging. Her son spent a month in the neonatal intensive care unit with a lung condition, she says, “which made the risk of a covid infection very scary.”
Similarly to Pladsen, Throm’s plans to spend motherhood in the company of family and friends have been replaced with social isolation.
The increased social isolation and loneliness brought on by the pandemic is impacting new mothers’ mental health, says Amanda Gorman, a pediatric nurse practitioner who helps new moms overcome breast-feeding challenges. “We’ve seen a higher percentage of mothers reporting symptoms of depression. They’re also worried about the baby’s health, financial stress and job security,” Gorman says.
Pladsen and her husband are both essential workers; he works for the Red Cross. That reality has triggered another level of fear. “Our jobs could put our health and the baby’s health at risk,” she says. Pladsen returns to work in six weeks. “As a nurse practitioner, I’ll likely be caring for positive covid patients,” she says.
Stressors like these can induce anxiety, insomnia and feelings of panic, which often mimic symptoms of postpartum depression and anxiety, making it tricky to distinguish between the two. As a result, there’s a greater need to screen new mothers for postpartum mood concerns. Katherine Taylor, a psychologist in San Francisco who specializes in treating postpartum depression and anxiety, offers teletherapy and coordinates online support groups. To catch a glimpse of a mother’s psychological health, she asks questions like, “How do you feel about the baby?” and “What’s brought you joy in the past 24 hours?”
“Due to the crisis, many moms feel lonely and sad, but may dismiss their grief, which makes it difficult for them to honor their struggles,” Taylor says. When this happens, depression can worsen and anxiety can build, she explains.
Depressed and anxious mothers need treatment, which can include psychotherapy, group therapy and medication when necessary. Amid the pandemic, therapy appointments look different — but, unlike some health treatments, they’re easily administered online. Studies even suggest that teletherapy can be just as effective as meeting with a therapist face-to-face. Meltzer-Brody says teletherapy can also be “an opportunity to reach mothers in ways that weren’t possible before.”
Online psychotherapy and group support, for example, can teach moms how to dismantle self-judgment during these unprecedented times. In her work, Taylor emphasizes that self-care and emotional support are essential for everyone. “I remind moms that it’s okay to put the baby down somewhere safe and take a few deep breaths,” she says. She’s also been recommending stress-management tools like meditation and light exercise.
At her six-week postpartum check-up, Pladsen met with her midwife in-person. At the appointment, Pladsen’s midwife noticed she was overwhelmed. Together, they discussed the pros and cons of having Pladsen’s mother help with the baby, but the midwife couldn’t provide a definitive answer. Desperate for a sense of community, Pladsen enrolled in an online parenting class that meets weekly via Zoom. “It’s a place where we can process our collective grief, which offers a thread of support,” she says.
When Throm’s experiencing negative emotions, she practices tools she learned in psychotherapy. “When I’m frustrated, I name and express my feelings. I also make ‘intentional connections’ by reaching out to people I trust, which helps me to feel less alone,” she says.
Even as shelter-in-place orders lift, women may feel hesitant to meet with health-care providers for in-person visits. “The second wave of the pandemic will be a surge in mental illness, which will increase the need for maternal mental health care,” Meltzer-Brody says.
Teletherapy, she says, is one bright spot: “It is likely to be a lasting ‘innovation’ that sticks and transforms mental-health care to be even more patient-centered.”
For mothers contending with feelings of depression or anxiety, there are myriad online resources. Here are just a few:
Postpartum Support International: A directory of therapists and online support groups for families and new mothers.
Covid Coach: A free app with self-care and meditation exercises for new moms.
Postpartum Support Virginia: Offering online support groups for moms across the nation.