I gave birth to my first child, Lena, in early 2018. A somewhat traumatic birth experience, challenges with breastfeeding, and the expected-but-still-intense sleeplessness left me feeling like my world had been totally turned upside down.
I’m expecting baby #2 this summer, and I can’t help but wonder how being pregnant and giving birth during a pandemic might affect my mental health or ability to bond with my child. I’ve spent the last year isolated from friends and family. I’ve been concerned about the potential effects of COVID-19 on my health and the health of my family, including that of my unborn child. Will the stress of the last year bubble over into the postpartum period? What if I don’t have access to the same tools and resources that I relied on the last time?
Though much of the research on prenatal and postpartum mental health during the COVID-19 pandemic is preliminary, it’s not surprising to see that pregnant people and new parents seem to be experiencing more depression and anxiety. When the pandemic first began spreading in early 2020, prenatal health care was often reduced or converted to online visits; and when in labor, people were often denied access to a support person. In the initial postpartum period—especially when patients were COVID-positive—hospitals put policies in place that separated parents from infants, discouraged skin-to-skin contact, and even limited breastfeeding.
After the child was born during the pandemic, new parents became even more isolated from friends and family. A review of multiple studies found that individuals required to quarantine had worse mental health, including increased depression, stress, low mood, and irritability. A narrative review of studies that looked specifically at women’s mental health during the pandemic found that pregnant and postpartum women (as well as those miscarrying or experiencing partner violence) were at a higher risk for developing these adverse outcomes.
Italy was one of the hardest-hit countries early on—and the government there implemented a swift and serious quarantine. One study of Italian mothers found that those who gave birth during this period reported higher levels of anxiety, depression, and anhedonia, which is a decreased ability to enjoy pleasurable activities or social situations. Additionally, studies that looked at postpartum mental health found that new mothers in Portugal and Japan demonstrated more impaired mother-infant bonding than before the pandemic. This was consistent with previous research suggesting both short- and long-term risks for the relationship when mothers experience mental health issues.
Fortunately, there are science-tested steps new parents can take to mitigate the impact of the pandemic on their relationship with children, and even adapt to the circumstances they face. Here are four of them.
1. Practice mindful parenting techniques
Mindful parenting is the practice of bringing a conscious and non-judgmental attention to parenting situations. This practice includes promoting parenting skills like awareness of both parent and child emotions, listening to the child with full attention, and compassion for the child and their needs.
Mindful parenting can help parents become aware of (and regulate) stress, react less impulsively, and be more attentive toward their children—which sounds great! But some studies have suggested that it may be hard for mothers to adopt a positive and mindful parenting approach when struggling with depressive symptoms, anxiety, or stress, which we now know can be elevated during times of crisis (like a pandemic).
In the previously mentioned study on Portuguese mothers, researchers wanted to explore the relationship between maternal mental health, mindful parenting, and mother-infant bonding, comparing both pre- and post-COVID-19 groups. In May 2020, they recruited 567 participants to complete an online survey.
They found that compared to pre-COVID times, mothers had more anxiety and depression. Parents who gave birth during the pandemic showed lower levels of “emotional awareness of the child,” as well as greater difficulty in bonding with their infant, compared to those who gave birth before the pandemic.
The researchers suggest a few reasons for this. For one, participants may have been more focused on their own emotions around the pandemic—making them less able to decenter their own feelings and focus their attention on the baby’s emotions. Many new parents reported feeling “cheated” out of their pregnancy and maternity experience—exacerbated by guilt over having such feelings—after being unable to participate in traditional activities like having a partner present at medical appointments or hosting a baby shower, which may have made it more difficult for mothers and infants to connect emotionally.
If a mindful parenting practice can support mother-infant relationships in the face of stress, how can new parents learn these techniques? And can they learn them virtually, if in-person training isn’t available due to physical-distancing guidelines?
One review of an eight-week mindful parenting program called “Mindful with your baby” found that the training was important and useful to mothers—and they also became more mindful in their parenting and in general. More recently, the authors of that study looked at the impact of an online version of a very similar program (this one geared toward parents of toddlers)—and found similar results. This suggests that a virtual option could be very effective for parents who are unable to attend an in-person group training.
2. Get physically active
During the pandemic, there were times when gyms, parks, and other recreational facilities were closed or unsafe for certain populations, making it difficult to get adequate physical activity. Research suggests that this was bad for mothers’ mental health.
One study, conducted in Spring 2020, recruited approximately 900 women who were pregnant or who had given birth in the previous year. Researchers asked them to report depressive symptoms, anxiety, and physical activity before and during the pandemic.
Overall, pregnant participants were getting less physical exercise than they did before the pandemic. However, those who reported engaging in at least 150 minutes of “moderate intensity” exercise each week were less likely to report depression or anxiety symptoms, especially when compared to the “before times.” This is consistent with previous research, including systematic reviews and meta-analyses from randomized controlled trials, that found pregnant and postpartum women who participated in exercise programs were less depressed.
This research suggests that maintaining a certain level of physical activity could be a helpful tool for pregnant or postpartum people. Pregnant or postpartum people who are unable to access indoor recreation spaces were often still able to take outdoor walks and online fitness classes—even gardening or other household chores—as options for exercise.
“I tried to go on walks whenever I could,” said one person on my Facebook group who gave birth in September 2020. “Getting fresh air and moving my body was essential to my mental health.”
3. Find support where you can
Social support is key for pregnant people and new parents. It can buffer postpartum depression symptoms and provide other mental health benefits. Effective support might include relying on friends, family, or a postpartum doula or night nurse to get help with everyday tasks that seem overwhelming in the early days of new parenthood.
I knew this when Lena was born, which is why I attended new parent and breastfeeding support groups, and met friends for walks around the neighborhood. Unfortunately, few of those connections have been available to people becoming parents during the pandemic. Though we are starting to see many of those restrictions lifting, there may be times in the future when similar measures are put in place for the sake of community safety.
This can involve tradeoffs and informed decisions around community health concerns and also the mental health challenges that new parents face. As one new mother told me after her state implemented a shelter-in-place order:
I was struggling. Someone asked me, “What do you need NOW?” and the first thought that came to me was “HELP.” My medical team actually recommended that we open up our pod to include my mom and she started coming over once a week. Besides getting help with the baby, it was just so wonderful to have someone else to talk to during the day.
But social support doesn’t have to come in the form of in-home support; many pregnant people or new parents find connection in support groups with other people going through similar life experiences.
When I was pregnant with my first child, my wife and I participated in a “Centering Pregnancy” group with five other pregnant people and some of their partners. After Lena arrived, we joined a “PEPS” (Program for Early Parent Support) group that allowed us to meet and connect with other queer families with infants. For us, these experiences were invaluable—we’re still friends with many of those families—and gave us a space to talk openly and without judgement about the joys and challenges of pregnancy and parenting.
In an online survey of new parents during the pandemic, people in support groups like those had better mental health. Contact with health care professionals didn’t carry the same benefits. Perhaps it’s easier for peers to feel a sense of connection around shared “parenting during a pandemic” experiences, or to share and receive empathic support and validation. One mom, whose second child was born in September 2020, said that she felt lucky to have “one friend that had a baby the same age as mine, who I could text in the middle of the night.” Having a peer to connect with in the early days of new parenting can be critical to feeling supported.
This isn’t limited to in-person groups. Much like the mindful parenting groups mentioned earlier, online groups—or other informal channels—can provide support for new parents. One study that analyzed the content of an online support group for those experiencing postpartum depression found that the virtual group was “a safe place to connect with others and receive information, encouragement, and hope.”
Personally, I joined a “due date” Facebook group with my first child, and I’ve experienced similar feelings of support (and commiseration!) in subsequent years. “Our [due date] group was a HUGE lifeline in the days after I had my baby,” said one of the women in that group during the pandemic. “It’s such a lovely, supportive, and safe space.”
4. Cultivate positive relationships with your parenting team
When a child enters the picture, a new relationship forms between caregivers that is separate from their relationship as spouses or partners: the co-parent relationship. There is a whole new dynamic to the co-parenting relationship that asks families to consider how they want to raise their children, how they will divide household labor, and how they might support (or undermine) each other as parents.
Considering these aspects of family life seems especially important in the transition to parenthood, when couples are exploring new roles and responsibilities, and in the face of the pandemic, when couples may experience illness, financial strain, or an unequal division of labor in the household.
Supportive co-parenting involves good communication, expressing gratitude for each other, and helping your co-parent find time for self-care and restoration. When parents do feel supported in their co-parenting relationship, they feel more psychological safety and may be more successful at adapting to challenging life transitions—you know, like becoming parents during a time of pandemic, economic stress, and political upheaval.
Toward the end of our first pregnancy, my wife and I completed an exercise recommended by our midwife: We made a list of all of the things we might need to plan for postpartum, like baby care, house cleaning, making meals, working outside the home, managing visitors, prioritizing exercise and self-care, as well as making time to nurture our own relationship. We then indicated what “the plan” was for each of those items. We both understood a need for flexibility—but at least we each knew the expectation, making it less likely that the burden would fall on either one of us to take care of everything.
Interestingly, we did a similar exercise together at the start of the pandemic, when we suddenly found ourselves both working from home and balancing care of our toddler. Feeling like the division of labor (and access to self-care or “alone time”) was equitable reduced frustration and animosity in our relationship—and allowed us to carve out the time we needed to make sure our own needs were met. I’m adding another round of this to our to-do list before baby #2 arrives!
Similar co-parenting programs can have positive effects on couple communication, parent-child interactions, and depression in mothers. Like the programs mentioned earlier, online versions offer similar benefits as those that take place in person.
Although there is much evidence that people who are pregnant or giving birth during the pandemic may experience greater levels of stress or more depressive or anxious symptoms, I’m reassured to see that there are steps we can take that might mitigate some of those concerns. My family recently added an “after-dinner” walk to our routine to ensure that I’m getting enough physical activity—and during those walks my wife and I take time strengthen both our romantic and co-parenting relationship through collaborative conversations, expressions of gratitude, and planning for our two-kid future. Even when things seem hard, this routine gives me at least a little hope.