I normally keep these posts light and without my “medical” hat on – but given the times, this one is an exception! I’m back at work with women with perinatal depression and anxiety – wherever possible seeing people on Skype, Zoom etc. Here’s just an update on perinatal anxiety in the time of coronavirus.
One in seven is the most quoted statistic for postnatal depression—but add a one in three pregnant and new mothers who at some stage has to grapple with moments of anxiety, panic and being overwhelmed. No surprise to anyone—the current coronavirus pandemic isn’t going to decrease that number.
Much of the focus of perinatal anxiety is the unknown and uncontrollable. It is many women’s first significant contact with the medical system and no amount of birth plan preparation can accurately predict or cover every possible birth outcome; when I had children I decided that a good outcome was me and baby alive and able to go home together, and I’d leave the rest to the experts. The statistics for this happening are actually really good. That is why they do eleven or more years of study, and it was why I was paying them. A hundred years ago it was a very different story.
The focus for new mothers after surviving labour, is then on baby’s sleep and feeding—the moment of what the f*k do I know? First time mothers are now an average age of twenty eight, meaning many are older than that. Women with a lot of training and experience, largely in things other than baby care. Even childcare workers and midwives don’t have the experience of sole responsibility twenty four seven. For an IT specialist give them a data base optimisation problem; a nurse a catheter in a cantankerous, delirious patient to insert; and a teacher twenty five students with a level range two to year nine in a year seven class (and that’s in English. Imagine how the German teacher in coping). But a baby that’s only taken twenty mils milk instead of eighty? That the nurse said something about they might dehydrate quickly and die?
Now women have to deal with an extra uncertainty. And there are no more definitive answers to this than to what might happen in labour. Except.
This virus isn’t anything so different its going to do something we’ve never seen before. Like labour, we know the range of possibilities, and some early reports suggest that its likely any possible virus effects are towards the better end of the range; this is not a guarantee, because there isn’t enough data. Just a little sprinkle to add on the perspective scale. There are no reports of major malformations—but those exposed in utero in first trimester haven’t delivered yet. Maybe it isn’t passed from mother to fetus (a few cases, but a newborn has had it). In the WHO report (16-24 February) it was stated pregnant women were not at a higher risk of the disease (but still only a sprinkle on the perspective scale as their information was inadequate about outcomes and pregnant women do have a compromised immune system). Children don’t seem to be at a high risk. And there’s better data for this.
So what can women do to feel in control? To minimise their risk?
Avoid getting it. Now the government has made it clear what everyone needs to do, pregnant women need to lead the charge and need to be helped to do it when they can’t.
The single most important thing is to stay at home. If a family member gets it they need to be in complete isolation away from anyone pregnant. Complete. Different house. Talk and stay in contact via phones, skype, zoom, whats app and social media. In Singapore, corona positive people went into quarantine facilities even with cold symptoms. And they got on top of it. Flattened the curve. Currently we in Australia are not. Pregnant women shouldn’t do the shopping and if they are caring for children, the children ideally won’t be in childcare. If grandparents are helping then they need to be in isolation too; don’t forget you can chat with them on zoom etc too. But no restaurants, Bondi beach or family BBQs. None.
(If you already have been in contact with someone positive (or have the virus) you need to up the isolation measures; its important to keep things in perspective. Most people only get a cold and younger people especially children not vulnerable.)
The exception to going out is critical medical appointments. Pregnant women and women with children under twelve months can see psychiatrists via a skype/tele-link, but there will be some critical obstetric appointments where an examination is required. Keep the appointment. Don’t avoid the coronavirus and die of something we fixed with modern obstetric services decades ago. Ring before if you think it isn’t essential. Medical services are adapting. Home visits or collections of urine samples may be possible.
Just had a baby? Same thing. Take time out—really out—to enjoy. You had a baby because you wanted one—don’t lose sight of the joy. Partner working from home? Give them time to do that—but use their presence to have a shower. Get an afternoon nap when the baby does (and have your partner in charge for the hour. You can be woken in emergencies!). Get meditation and yoga apps. Go for a walk. Babies thrive on contact so this is THE big number one exception to social isolation (providing those in contact have isolated, for them). Lots of smiles, kisses and cuddles from both parents. And space to sleep. Space to explore as they develop and look to the outside world. To them that will be a toy, a feather, the pots and pans cupboard, some music you are dancing to. Let them know that the world is an exciting, wonderful place to explore. By the time they are one year old, and able to take it in, it will be.
And…if you have time on your hands you can always fill it with a good book!
The Long Shadow, out April 28th, is a rural crime thriller, set around a postnatal depression group. The women’s past and the town’s secrets threaten their relationships to their child…and put lives at risk.