The current SARS-CoV-2 pandemic has devastated communities across the United States since early this spring and continues to do so on a global scale. The impact on maternal health and welfare, and by extension child health has not been lost on mothers across the world. Hospitals have closed their doors to visitors and accompanying loved ones for those seeking healthcare – victims of COVID-19 fight alone and too often succumb to the illness without their primary emotional support systems, but rather in isolated rooms with little human contact.
In the case of pregnant and expectant mothers, this means potentially giving birth alone. These women are now also kept in isolation rooms, away from their families and loved ones, and surrounded by healthcare workers masked in personal protective equipment – a far cry from the societal norms previously established and long withstanding (Hermann, Fitelson, & Bergink, 2020). This newfound isolation and the impact of the pandemic extends to reaching antenatal care and post-natal care, and has lasting repercussions for the mental health of both the mother and her infant. Pregnant women are already at high risk for anxiety and depression; however, if they are threatened by COVID-19, they are at risk for exhibiting psychiatric symptoms that are not only indicative of poor maternal mental health, but also can impact the welfare of the child (Poon, et al., 2020).
Antenatal care has changed as a consequence of COVID-19. Telehealth appointments have become increasingly popular as a form of providing antenatal care. However, telehealth comes with its own set of unique challenges and barriers that may have lasting implications for access to sufficient antenatal care. This type of care, that occurs during pregnancy and before birth, involves providing pregnancy-related information, remote clinic consultations, and educational services that help inform expectant mothers about practices such as breastfeeding, pre-natal vitamins, and birthing options. While telehealth may be sufficient for some mothers, this is not the case for all mothers and reports of mothers skipping antenatal care because of movement restrictions are unfortunately common (Caparros-Gonzalez & Alderdice, 2020). Telehealth requires adequate access to internet through the form of stable connection and a platform such as a tablet, laptop, desktop, or phone. Not all families have access to technology that facilitates these appointments, and not all expectant mothers will trust the quality of these services (Wu, et al., 2020). In order for telehealth to become adequately implemented, it will require cost-effectiveness, access to technology, and most importantly trust between providers and patients – which is a little harder to do over a screen than in person.
The way women give birth has also drastically shifted since the beginning of the COVID-19 pandemic. Studies have shown that in the past, having continuous support during labor has led to better outcomes during birth for both the mother and child (Bohren, Hofmeyr, Sakala, Fukuzawa, & Cuthbert, 2017). These outcomes included: shorter labor, decrease in caesarean births, increased spontaneous vaginal birth, decreases in analgesic and instrument aid usage, decreases in low five-minute Apgar assessment scores (which indicate how well the baby is tolerating initial life outside the mother’s womb), and even has been connected to a lower propensity for negative feelings towards childbirth as a whole (Bohren, Hofmeyr, Sakala, Fukuzawa, & Cuthbert, 2017). Childbirth with support is less traumatic, less medically intensive, requires less interference, and helps promote a far more positive experience for both mother and baby. Women who are made to give birth without adequate support may risk losing the benefits that
having a support system present may provide for a more positive birthing experience that has follow through implications for the welfare of the child.
The World Bank Group, the Bill and Melinda Gates Foundation, the United States Government, the Centers for Disease Control, and many other institutions all recognize that the first 1000 days of a child’s life is critical for their development and maturation over the course of their lifetime. This 1000 days includes the time that the mother is pregnant, all the way up till the child’s second birthday. It is fitting that within this period of time, the impact of growing up during a pandemic can be largely detrimental to outcomes that will have long term impacts on an infant as they grow into an adult (Our Story, 2020). Women who get COVID 19 and who are separated from their babies are particularly at risk for negative outcomes – early bonding between infants and their mothers, as well as the establishment of lactation practices are both critical parts of establishing a mother-infant relationship and to provide nutrition and sustenance to the child (Poon, et al., 2020). This can even extend to maternal suicidal ideation as a consequence of poor mental health and separation from their child (Poon, et al., 2020).
The same measures put in place to protect the general public and prevent transmission of coronavirus have also exacerbated causes of maternal stress – such as isolation from extended friends and family, financial difficulties, increased risk of domestic or intimate partner violence, overcrowding in the household, remote work, and homeschooling if other children are present in the household (Caparros-Gonzalez & Alderdice, 2020). These causes of maternal stress impact maternal mental health and create environments that are not conducive to a successful 1000 days.