The worst of Covid may be over (we hope) but the mental health impact of what happened over the last two years may be more enduring.
It was a particularly challenging, and frightening, time to have a child; from attending antennal scans alone, labouring for long periods without a birth partner permitted in hospital, or caring for a newborn with no visitors allowed.
Laura Seebohm, chief executive of the Maternal Mental Health Alliance, says the last two years have placed “extraordinary pressures on new and expectant mums” and increased maternal mental health risk.
“We know referrals to specialist perinatal mental health services are at an all-time high, but we also know that as many as 70% of women will hide or underplay their perinatal mental health problems. This can obscure the true level of need and delay women from being identified, diagnosed and treated.”
Birth and psychological trauma
The birth experience itself, and how mothers look back on it, can have a huge effect on mental health postnatally.
“We are seeing a much higher incidence of birth trauma in both parents (not just mums)” since the pandemic, explains Angela Wood, perinatal and parent infant mental health psychological therapist at Pennine Care NHS Foundation Trust. “Along with obstetric trauma [the physical kind], there is a greater report of psychological trauma.
“Parents who were separated during delivery due to Covid restrictions suffered by being alone and afraid for long periods of time, exacerbated by the fact that maternity teams have struggled to maintain staffing levels.”
Partners had to leave their newborns soon after birth, some parents with Covid were isolated from each other, other parents were not able to visit neonatal units together, those going through surrogacy had to cope with being separated from their birthing parent… and the list goes on.
“This has been traumatic for many parents and, for some, stirred up past traumas they have been through when they have felt alone, unsupported and perhaps unsafe,” Wood says.
Amy Gibbs, chief executive of Birthrights (birthrights.org.uk) adds: “Restriction in choices about where, how and with whom one chooses to give birth often results in lasting impact and trauma.” The charity have raised the impact of what they call “stringent Covid-restrictions” in maternity services on people giving birth throughout the pandemic.
Can you still be affected – even if it’s a year or two on?
As with any trauma (mild or severe) it can stay with you – particularly when it’s happened at such a significant moment of your life.
“Without the right support, it is possible for women to still be struggling for a year or more following the birth of their baby,” says Seebohm. “Timely diagnosis and treatment for perinatal mental health problems is essential to reduce suffering and ensure women get the right care at the right time.”
So if you experienced a lack of access to support at the time, it could very well have had a knock-on effect. But Seebohn says it’s important to understand other barriers, like experiences of racism, poverty, domestic abuse, which have a significant effect on women’s relationships with healthcare professionals.
“Many parents have had to bottle up a lot of distress as the world around them had less capacity to support them and for some parents only now is this beginning to be released,” adds Wood.
Even without a pandemic, it often takes new parents a few years to adjust and process what they’ve been through, but “the pandemic has exacerbated this by almost freezing everything in time for two years.”
Signs you might still need support
“The ways in which mothers might still be struggling with the repercussions of having a baby during Covid could be mild, moderate or severe,” says Wood, but signs it could still be impacting your mental health, months or years on, include “a preoccupation with traumatic memories relating to pregnancy and labour and feeling jealous of people who had a baby outside of the pandemic – then feeling guilty about this.”
Katie Reid, consultant child and adolescent psychotherapist at Pennine Care, explains: “Psychological trauma is unique to the person who experiences the event. You might feel like you have an inability to cope with the feelings the trauma has evoked and may have the overwhelming emotion of fear and a stress response which continues after a traumatic event is over.”
Not being able to cope with social activities and isolating yourself and your baby from others, are also signs you might still need support (a hangover, perhaps, from lockdown rules). As is being very afraid of contamination from Covid and “restricting yourself and baby’s interaction with the world above and beyond the guidelines or taking extra precautions such as excessive washing, due to overwhelming fear”.
Classic perinatal mental health symptoms – like high levels of anxiety, persistent low mood, a lack of confidence as a parent, feeling irritable or angry with your baby and worrying a lot about your baby’s wellbeing – of course still apply and should be checked out (whether you have one symptom or several).
While vivid flashbacks, intense distress at reminders of the birth and intrusive thoughts and images could be symptoms of postnatal post-traumatic stress disorder (PTSD) from the birth (Covid-related or not), say Mind.
What can help?
“Talk, talk and talk some more, don’t bottle things up and suffer alone,” urges Wood. “Seek support, learn that it’s ordinary and OK to struggle and that help is available for people to dip in and out of, no problem is too little or too big.”
A good first port of call is your GP. If you’re still under the care of health visitors or midwives they will be able to help provide support too. You can even self-refer to local NHS psychological therapies (IAPT services) who will assess the level of help you need and refer you for the next step – whether that’s talking therapy, medication or group support. Mind’s helpline (0300 123 3393) or the Panda Foundation (0808 1961 776) are also great, free support resources.
Wood says: “It may feel scary to open up. Asking for help is seen as a brave, responsible thing to do, not a sign of weakness, and no parent should be judged for recognising when they need help – we all need help sometimes.”
Finding a group of other mums could be invaluable too. “Having a peer support network (other parents who have had similar experiences) to connect and share with is very important and mitigates against some of the lasting effects of isolation and loneliness during the pandemic,” says Reid.
This is also likely to be protective for parents who are planning further pregnancies too.
“We are seeing some evidence of parents approaching subsequent pregnancies with increased fearfulness and anxiety as well as experiencing sadness about what had not been in place for them and their babies the previous time,” she says. “Some first time parents only recognise and begin to process this when they have a second child.”