Birth Trauma and COVID-19

Thoughtful pregnant woman looking out the windowPregnancy and giving birth can come with a wide range of joys, challenges, and fears. People who are giving birth during the current COVID-19 pandemic are also navigating unexpected circumstances and added uncertainty that may increase their chances of experiencing a traumatic birth.

As COVID-19 spreads in the United States, public health officials continue to urge people to help flatten the curve by staying home and following other restrictions. The idea is to slow the spread of the disease such that infections are spaced further apart. This reduces the strain on hospitals and other health resources, lowering the death rate from COVID-19. But some strategies to slow the spread of COVID-19 may negatively impact people who are giving birth.

Several hospitals around the country have announced their plan to restrict visitors during childbirth, and in some cases even to eliminate visitors altogether. Citing the public health emergency, hospitals in San Francisco have banned all visitors during childbirth, including spouses. Numerous hospitals have banned doulas. Two New York hospitals also temporarily forbade visitors, until Governor Andrew Cuomo issued an executive order clarifying a pregnant person’s right to support during labor.

COVID-19 is still new, with few large, reliable studies on its long or short-term consequences. Researchers aren’t sure how it affects pregnant people, whether it increases the risk of birth complications, or what risks it might pose to a newborn.

Giving birth in this uncertain climate can be terrifying—even with support during labor and beyond. For those without support, the uncertainty and fear coupled with isolation and birth trauma may trigger posttraumatic stress (PTSD), trouble bonding with their newborn(s), postpartum depression, or intense fear.

Maternity Care System Concerns

Long before COVID-19 entered the United States, the American maternity care system posed limitations. The U.S. has the highest maternal mortality rate in the wealthy world. Americans have seen maternal mortality skyrocket as other nations dropped their rate to nearly zero. An American woman giving birth today is more likely to die than her mother was 25 years ago. The states with the highest maternal mortality, such as Georgia, have higher death rates than dozens of other nations, including some war-ravaged countries.

Maternal mortality is just part of the picture. There can also be a problem of a lack of quality, compassionate care. Some pregnant people report abuse and even assault in the delivery room. One survey found that 87% of birth workers have witnessed obstetric violence, including sexual assaults and other forms of physical violence.

Now, birthing people enter this potentially flawed system as healthcare workers are more stressed, afraid, and overworked than ever. And in some cases, they are entering this system without a support person.

How COVID-19 Affects Pregnancy

Researchers do not yet know how COVID-19 might affect pregnancy. This uncertainty may increase stress for pregnant people.

Pregnancy can affect a person’s immune response and respiratory system, so pregnant people might be more vulnerable to the disease. So far, however, no research indicates higher rates of coronavirus among expectant parents.

One small study suggests that vertical transmission—which happens when a mother transmits a virus to her baby in utero—is unlikely. The same study also analyzed samples from six Chinese women with the virus. Researchers did not find any signs of the virus in milk. However, these studies are small and preliminary.

Many hospitals now suggest that pregnant people diagnosed with COVID-19 be separated from their babies. Birth advocates have pushed back, arguing that a baby is much more likely to catch the virus in a busy hospital nursery than from an appropriately cautious parent.

Psychological Effects of Giving Birth in a Pandemic

No matter where they choose to give birth or what support they seek, people giving birth in a pandemic must grapple with uncomfortable realities, which may include:

  • financial and employment uncertainty
  • a sudden change in lifestyle, as people shift to more extreme social distancing
  • decreased social support thanks to social distancing
  • uncertainty about the future of their family or their baby
  • fears about how coronavirus may affect the baby’s health
  • uncertainty about the dangers COVID-19 may pose to pregnant people
  • potentially facing childbirth alone

Chronic fear, trauma, and anxiety can erode a person’s psychological coping mechanisms. When coupled with the challenges of new parenthood—sleeplessness, a sudden change in identity, endless responsibilities, physical challenges—a person giving birth during this pandemic may face a much higher chance of postpartum mental health issues.

Giving Birth Alone: A Traumatic Reality?

Numerous studies suggest that, even without the specter of a global pandemic, childbirth can be traumatic for some mothers. Provider factors—abuse, inadequate support, and even violence—figure prominently in some people’s traumatic birth stories. For many birthing people, a spouse or doula feels like a barrier who protects them from provider mistreatment and interventions they do not want. Families concerned about the high rate of maternal mortality may feel that a loved one can advocate for the person giving birth, reducing the risk of complications.

“A doula is a scientifically proven support system to lower intervention rates that could cause harm and longer hospital stays. Eliminating doulas puts the family at risk unnecessarily for something that is highly preventable,” said Corrinna Edwards, a midwife who also sometimes serves as a doula.

According to the American College of Obstetricians and Gynecologists (ACOG), continuous labor support from a doula improves labor outcomes. It may also reduce the rate of unnecessary cesarean sections.

Hospitals do not have enough staff to provide continuous, one-on-one support to laboring people. So in hospitals where support people are banned, people will spend much of their time alone. After the baby is born, they must care for the baby without support or help, and miss out on sharing the baby’s first moments with a spouse, partner, or other family members. This may have long-lasting repercussions for the birthing person and their family.

The Competing Realities Hospitals Must Balance

As hospitals move to limit visitors, families are increasingly protesting. It is true that the more people an individual is exposed to, the more likely they are to catch the virus. And because a person can have the virus without having symptoms, screening people for symptoms is inadequate. Every hospital visitor may increase the risk of spreading the virus.

However, advocates for families point out that health workers are significantly more likely to be exposed to the virus than a member of the general public. Moreover, a person living with their birth partner has probably already been exposed to the virus if their partner has it, and may themselves be a carrier. It is not clear if banning partners from the birthing suite helps slow the spread of the virus.

Hospital policies to limit visitors are not deliberately malicious. That doesn’t mean these policies are harmless, or that the trauma birthing families may experience isn’t real. Hospitals must weigh the risks and benefits of various policies with incomplete information about COVID-19 or its spread, and do their best to support people giving birth.

Coping With Fear and Uncertainty

People who are now pregnant or who may become so during this pandemic have a number of options for coping with their fear.

“Low risk women need options for out of hospital births,” Edwards advised. “With the recommendation of gatherings of no more than 10 and the need for isolation, the hospital could be the most unnecessary dangerous place to be for a low-risk mother and her family.”

Some media reports suggest that women who were previously uninterested in home birth may be considering it. But home birth is not an option for everyone. Some other strategies that may reduce fear include:

  • Talking to your provider as early as possible about their plans for COVID-19. They should be able to tell you specifics, and advise you about what they will do to protect you. When you know what to expect, the process may feel less frightening.
  • Shopping around. Policies may differ between providers and hospitals. Find a birth team that can keep you safe while respecting your birthing needs.
  • Staying home as much as possible. The best way to minimize your exposure to COVID-19, keep your baby safe, and slow the spread of the disease is to practice extreme social distancing. Ask your health provider about switching to telehealth appointments whenever possible.

The right therapist can help you manage your feelings arising from uncertainty during pregnancy and after the birth. Following a traumatic birth, psychological care can help you process your emotions and move forward. Begin your search for a compassionate therapist here.

References:

  1. Approaches to limit intervention during labor and birth. (2017). Retrieved from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth
  2. Charlton, E. (2018, November 20). American women are 50% more likely to die in childbirth than their mothers. Retrieved from https://www.weforum.org/agenda/2018/11/deadly-delivery-how-childbirth-in-america-is-becoming-more-dangerous/
  3. Chen, H., Guo, J., Wang, C., Luo, F., Yu, X., Zhang, W., … Zhang, Y. (2020). Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet, 395(10226), 809–815. Retrieved from https://www.sciencedirect.com/science/article/pii/S0140673620303603
  4. Maternal mortality. (n.d.). Retrieved from https://data.unicef.org/topic/maternal-health/maternal-mortality/
  5. Martin, N., & Montagne, R. (2017, May 12). U.S. has the worst rate of maternal deaths in the developed world. Retrieved from https://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world
  6. Reed, R., Sharman, R., & Inglis, C. (2017). Women’s descriptions of childbirth trauma relating to care provider actions and interactions. BMC Pregnancy and Childbirth, 17(1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223347/
  7. Roth, L., Heidbreder, N., Henley, M., Marek, M., Naiman-Sessions, M., Torres, J., & Morton, C. (2014). A report on the Cross-National Survey of Doulas, Childbirth Educators and Labor and Delivery Nurses in the United States and Canada [Ebook]. Retrieved from https://maternitysurvey.files.wordpress.com/2014/07/mss-report-5-1-14-final.pdf?fbclid=IwAR0HKKQQGfiKmbUGDImYcd3QUFKJ1ye5wXCrLKi5hlaVRjOyvQ2JIO8vVxk

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