- This matched case–control study compared internet survey responses from 68 women who had suspected or confirmed COVID-19 during pregnancy and/or childbirth, and 2,276 women who were COVID-19–negative
- 49% of COVID-19–positive women vs. 26% of women without COVID-19 had a clinically significant acute stress response to childbirth (OR, 2.64; P<0.001)
- COVID-19–positive women experienced higher levels of pain during delivery (2.75 vs. 2.41 on a five-point scale; P<0.05) and gave birth to newborns more likely to be admitted to a neonatal ICU (16% vs. 9%; OR, 2.03; P<0.05)
- 34% of COVID-19–positive women vs. 16% of the control group had no visitors allowed throughout the hospitalization (OR, 2.65; P<0.001), and 15% vs. 0% were separated from their infant throughout hospitalization (OR, infinity)
- Women with COVID-19 should be routinely assessed for traumatic childbirth in postpartum hospital units, and after hospital discharge, they should receive ongoing monitoring of their mental health
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.
Subscribe to the latest updates from Psychiatry Advances in Motion
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.
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
- Marital status
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.
There were significant differences between the groups in:
- 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)
- Separation from infant throughout hospitalization—15% vs. 0% (OR, infinity)
- No visitors allowed throughout hospitalization—34% vs. 16% (OR, 2.65; P<0.001)
- 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)
- 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.
Learn more about the Post-traumatic Stress Disorder Research Laboratory
Learn more about the Department of Psychiatry