COVID-19: Mental health problems in pregnant and postpartum women during the pandemic

Perinatal mental health (PMH) issues are those that arise during pregnancy and in the first year of childbirth. This period in general is a more vulnerable phase.

By Dr Manjula S. Patil

“Doctor, what if I am tested Covid Positive?’’, this has become a common query in our OPDs. We can sense the fear, anxiety and uncertainty of the future when we hear this from a ‘would be mom’. No doubt this pandemic has affected everyone, in fact the second wave has hit harder still. Unlike the first wave of Covid-19, which had caused the least damage in all pregnant and lactating mothers, within a month of this second wave we are seeing vulnerability of pregnant women to the disease and chances of severe infection and adverse foetal effects.

During the COVID-19 pandemic, pregnant and postpartum women face specific challenges that may put them at higher risk for mental health issues. Concerns include a greater severity of COVID-19 disease, possible effects on mother and the unborn baby, effect on labour and delivery, an increased risk of adverse neonatal outcomes and uncertainty of long-term effects of the disease on mother and baby.

Mental health in pregnant and lactating woman

Perinatal mental health (PMH) issues are those that arise during pregnancy and in the first year of childbirth. This period in general is a more vulnerable phase. Anxiety and depression are the most common presentation of PMH and affect about 7 to 20 percent of perinatal women. Depressive symptoms are more common in postpartum mothers than before delivery and depending on the severity are categorised as postpartum blues, the most common but mild variety; postpartum depression, and the most severe form, postpartum psychosis. Prevalence of these has been reported to increase with this pandemic with anxiety seen in nearly 50-60 percent and varying degrees of depression in about 30-35 percent.

Common high risk factors for PPD are previous psychiatric illness, antenatal depression, stressful life events and lack of social support.

If left untreated, mental health problems can have serious and long-term consequences for the mother, her child and the rest of the family. Specialist PMH programmes offer care and treatment for women with specific mental health needs, as well as support for the parent-child relationship. They also provide pregnancy planning tips to women with mental health issues.

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Increased risk for PMH in pandemic are due to following reasons:

  • Rapidly spreading disease and more number of pregnant and lactating mothers catching infection.

  • Uncertainty of disease diagnosis, prognosis and treatment.

  • Losing near and dear ones to the disease.

  • Social media and news channels play a counterproductive role.

  • Impact of lockdown and poor social support due to restricted movement of people.

Symptoms of anxiety and psychological distress during perinatal period due to pandemic are:

  • Excessive worry about contracting infection.

  • Lack of sleep.

  • Focussing excessively on social media messages about Covid-19.

  • Getting anxious about infection control procedures in the family members.

  • Feeling sad and angry because of isolation and not being able to meet family and friends.

  • Not being able to stop or control worrying.

  • Feeling nervous and anxious, becoming easily annoyed and irritable.

  • Being so restless that it’s hard to sit still.

Two simple assessment tests are:

  • No interest or pleasure in doing regular things

  • Feeling depressed or hopeless

 If these are noticed in more than half of the day in 24 hours in the past two weeks, please seek help of a psychiatrist via teleconsultation.

What if I am diagnosed with COVID-19?

If you are diagnosed as Covid positive during pregnancy, don’t panic. More than 80 percent of pregnant women are asymptomatic or mildly symptomatic and can be managed with home quarantine strictly following all home isolation protocols. Plan for a teleconsultation with your doctor who will assess the disease severity and suggest home quarantine or hospitalisation. During the two-week home isolation, have regular chats and video calls with your family members to remain positive throughout. If diagnosed two weeks before the expected date of delivery, you need to be hospitalised for monitoring.

Chances of transmission of Covid infection from mother to foetus are least likely (there have been very few case reports), and a majority of the patients have had uneventful pregnancies with healthy babies. Caesarean delivery may be the preferred mode of delivery in a majority of hospitals though data available presently indicate caesarean for only obstetric indications.

If you catch infection  following delivery, you can breastfeed the baby if you don’t have severe illness since the virus is not transmitted through breast milk but don’t forget to  wear an N95 mask throughout and maintain hand hygiene. The baby can share the same room with six- feet distance managed by other healthy family members. The baby can be observed for any symptoms of Covid and can be tested in 48 to 96 hours if the need arises but not as routine.

There is a serious awareness gap for adequate maternity care at this time. In the absence of such formal data, the pandemic’s potential for negative mental health effects should be recognised as a serious public health issue, with adequate treatment and assistance to avoid and mitigate any negative consequences.

ALSO READ |How to get back to normalcy after childbirth

How to prevent covid-19 in pregnant and lactating mothers

‘ Stay home, stay safe’ is still the best preventive measure. Step out only when it is essential and follow Covid appropriate behaviour. Don’t forget ‘ SMS ’- Social distancing, Mask and Sanitisation all the time.

Understand the signs and symptoms of COVID-19 infection in infants

The majority of babies who test positive for COVID-19 have little or very minor signs. There have been reports of severe illness in infants, but it seems to be uncommon. COVID-19 can pose a greater risk of serious illness in babies with underlying medical conditions and babies born prematurely (before 37 weeks). Fever, lethargy (being too tired or inactive), runny nose, cough, vomiting, diarrhoea, poor feeding and increased work of breathing or shallow breathing have all been recorded in newborns with COVID-19. If your baby has symptoms or you suspect your baby has been exposed to COVID-19, contact your baby’s healthcare provider immediately and follow the steps for child care. If your baby exhibits COVID-19 emergency alert signs like breathing difficulty, seek medical attention right away.

Maintain your social, emotional and mental well-being

At this critical juncture self-care, emotional and mental well-being are key to fight the pandemic blues. Yoga or deep breathing coupled with a healthy and balanced diet can provide comfort and relief. Keep your spirits high, reading books, walking in the garden or perhaps having a hearty chat and laughter with your loved ones can soothe your nerves upto a great extent.

If you think you’re stressed after pregnancy, talk to your doctor. Find out how to deal with depression and how to take care of yourself during the COVID-19 pandemic.

(The writer is Consultant Obstetrician & Gynaecologist, Motherhood Hospitals, HRBR, Bangalore)

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