Childbirth Often Traumatic for Women with COVID-19

Studies of pregnant women during the COVID-19 pandemic have focused on obstetrical and neonatal outcomes. Gus A. Mayopoulos, graduate researcher, and Sharon Dekel, PhD, principal investigator of the Dekel Laboratory in the Department of Psychiatry at Massachusetts General Hospital, and colleagues conducted the first study of the subjective experience of childbirth among women with COVID-19.

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In the comprehensive case–control study, the team found evidence that these women are at increased risk of traumatic responses to childbirth and associated psychiatric morbidity. They published their data in Scientific Reports.

Study Methods

Between April 2 and October 2, 2020, the researchers recruited women from the hospital and the community who had given birth in the past six months to complete an anonymous internet survey. In the final sample of 2,344 women, 68 had suspected or confirmed COVID-19 during pregnancy and/or childbirth.

They were matched to the 2,276 women without COVID-19 on demographic factors—primiparity, prior trauma and pregnancy complications, prior mental health, residence, date of childbirth and date of survey completion.

Participants were matched on demographics that included:

• Maternal age
• Education
• Marital status
• Income
• Race/ethnicity

A matching procedure that included primiparity, prior mental health, prior pregnancy complications, trauma history, time since delivery, survey completion date, and place of residence, allowed to control for the influence of factors that are known to increase risk of traumatic birth response to childbirth. By controlling for these factors, groups were created that were similar on important aspects besides their COVID status allowing to examine the impact of COVID-19 on the birth experience.

Results

There were significant differences between the groups in:

Psychological Experience

• Acute stress response to childbirth (Peritraumatic Distress Inventory total score ≥17)—49% of women with COVID-19 vs. 26% of women without (OR, 2.64; P<0.001)

COVID-19 Restrictions

• Separation from infant throughout hospitalization—15% vs. 0% (OR, infinity)
• No visitors allowed throughout hospitalization—34% vs. 16% (OR, 2.65; P<0.001)

Obstetrical Factors

• Sleep deprivation (<6 hours on the night before childbirth)—74% vs. 59% (OR, 1.92; P<0.05)
• Degree of pain during delivery (five-point scale)—2.75 vs. 2.41 (P<0.05)

Infant-related Factors

• Average birthweight—7.10 lb vs. 7.62 lb (P<0.05)
• Neonatal ICU admission—16% vs. 9% (OR, 2.03; P<0.05)
• Rooming-in with infant—85% vs. 94% (OR, 0.37; P<0.01)
• Skin-to-skin contact with infant—79% vs. 91% (OR, 0.40; P<0.01)

Implications for Maternity Wards and Outpatient Clinics

Pre–COVID-19 research, published in Archives of Women's Mental Health, showed that traumatic childbirth can result in enduring maternal psychiatric morbidity (e.g., childbirth-related posttraumatic stress disorder and comorbid depression) that increases the risk of maternal death. Maternal morbidity can also interfere with mother–infant bonding, undermining the child's welfare during a critical period of development (published in Archives of Women's Mental Health).

Thus, the findings from this study are concerning. They suggest women with COVID-19 should be routinely assessed for traumatic childbirth in postpartum hospital units. After hospital discharge, they should receive ongoing monitoring of their mental health, as they may face social isolation during the postpartum period.

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