Healthy Women Had Negative Childbirth Experiences at the Outbreak of COVID-19
- This study compared 637 uninfected women who gave birth during COVID-19, mostly U.S. residents who delivered in March or April 2020, with 637 women who gave birth prior to the pandemic
- The two groups were statistically matched on factors such as demographics, trauma and mental health history, prior birth stressors, primiparity, delivery mode, gestational age and weeks postpartum
- The odds of clinically significant acute stress were higher in the women who gave birth during COVID-19 than in the controls (OR, 1.38; 95% CI, 1.01–1.89; P=0.008)
- Heightened acute stress response to childbirth was associated with more symptoms of childbirth-related posttraumatic stress disorder (CB-PTSD, P<0.001) and more problems with bonding with the infant (P<0.001) and breastfeeding (P<0.01)
- Mental health screening should be expanded for early identification of women at high risk of CB-PTSD and other negative maternal and infant outcomes; in particular, routine screening for acute traumatic stress resulting from having a traumatic birth experience may be warranted in postpartum units
Prior to the COVID-19 pandemic, childbirth-related posttraumatic stress disorder (CB-PTSD) was estimated to affect 6% to 19% of women (published in Frontiers of Psychology). This condition can interfere with successful maternal postpartum adjustment, have enduring effects on maternal mental health and undermine child development.
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Massachusetts General Hospital researchers have documented that the COVID-19 pandemic has added a significant amount of stress to childbirth even among women who are not infected with SARS-CoV-2. Gus A. Mayopoulos, graduate researcher, and Sharon Dekel, PhD, principal investigator of the Dekel Laboratory in the Department of Psychiatry at Massachusetts General Hospital; Anjali J. Kaimal, MD, MAS, director of the Deborah Kelly Center for Clinical Research in the Department of Obstetrics and Gynecology; and colleagues present the details in the Journal of Affective Disorders.
Using social media, professional societies and hospital announcements, the research team began on April 2, 2020, to recruit women who had delivered a live baby in the past six months. They received responses from:
- 1,611 women who had given birth since the COVID-19 outbreak in their community (primarily during March or April 2020)
- An additional 640 women who had given birth before the pandemic
The respondents completed an anonymous online survey that included the:
- Peritraumatic Distress Inventory (a cutoff of 17 was used to define a clinically significant acute stress response to childbirth)
- PTSD Checklist for DSM-5 (to measure symptoms related to CB-PTSD)
- Life Events Checklist for DSM-5 (to measure prior lifetime exposure to traumatic events)
- Mother-to-Infant Bonding Scale (to measure impairment in mother-infant bonding within the first postpartum days and weeks)
- Maternal Attachment Inventory (to measure impairment in mother-infant bonding within the first postpartum days and weeks)
Women were also asked about their breastfeeding habits (answer options were "exclusive," "partial," "currently not but in past" and "never offered").
The researchers matched the two groups on factors such as demographics, trauma and mental health history, prior birth stressors, primiparity, delivery mode, gestational age and weeks postpartum. The final sample included 637 women who delivered during COVID-19 and 637 who delivered pre-pandemic. 86% of the total sample lived in the U.S., 85% delivered a healthy baby at term and 72% had a vaginal delivery. 59% were primiparas.
- The odds of clinically significant acute stress were higher in the women who gave birth during COVID-19 than in the matched controls (OR, 1.38; 95% CI, 1.01–1.89; P=0.008)
- Heightened acute stress response to childbirth was associated with more PTSD symptoms (P<0.001) and more problems with maternal bonding (P<0.001) and breastfeeding (P<0.01) in the very early postpartum period
Expanded Screening Recommended
Among these healthy women, contributors to stressful childbirth during COVID-19 may have included fear of infection of the mother or newborn during the hospital stay, reduced social support because of visitor restrictions and the discrepancy between pre-pandemic birth expectations and the actual experience of giving birth during the pandemic.
During COVID-19 and any future pandemics, it will be important to expand mental health screening in hospitals and birthing centers for early identification of women at high risk of PTSD as a result of traumatic childbirth and other negative maternal and infant outcomes. In particular, routine screening for acute traumatic stress may be warranted in postpartum units. Clinicians should also remain alert to women who need enhanced breastfeeding support.
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