A few days before schools and offices started to shut down around New York City in March, I developed a cough. Then came low-grade flu-like symptoms, clicking sounds in my lungs and total loss of taste and smell.
I spent hours on the phone that week with doctors and nurses, all of whom told me to stay home, isolate and avoid emergency rooms if possible. I recovered without being tested for the novel coronavirus.
My main concern while sick was my pregnancy. Despite the Centers for Disease Control and Prevention’s guidance that transmission of the coronavirus during pregnancy is unlikely, I knew there were still many unknowns. As my stress mounted about not being able to access testing or know whether the baby was OK, I also became stressed about being stressed.
Research links high stress in pregnancy to premature birth and low birth weights, which can have a lasting impact, as well as a host of psychological and physiological challenges that include cardiovascular disease, type 2 diabetes, heart defects, slower cognitive development, poorer immune function, depression, schizophrenia and drug abuse
Even in the best of times, pregnant women are urged to stay calm for the sake of their babies. But what happens when a global pandemic breaks out and avoiding stress is no longer possible?
The uncertainty of this moment is affecting everyone, but pregnant women are facing some unique obstacles. Becky Kuperman, who is expecting her third child in mid-June and will deliver at a hospital in New York City, the nation’s epicentre for the coronavirus, has seen her entire birth plan upended by the crisis.
Reduced prenatal visits
Hospital restrictions mean her doula won’t be allowed at her birth, her mother may not be able to fly up from Florida to help with the older kids, and she could be separated from her newborn if she tests positive for the virus. Her obstetrician has reduced prenatal visits, so she also won’t know the baby’s placement for birth until she is a few weeks from labour.
“It’s definitely a lot of anxiety,” Kuperman said. “In the beginning I was very, very anxious about everything. As the days and weeks go on, it’s become the new normal.”
Research links high stress in pregnancy to premature birth and low birth weights, which can have a lasting impact, as well as a host of psychological and physiological challenges that include cardiovascular disease, type 2 diabetes, heart defects, slower cognitive development, poorer immune function, depression, schizophrenia and drug abuse. Very severe stress early on in the pregnancy has been associated with greater congenital malformations.
Some studies even suggest that the consequences of prenatal stress can span generations.
But stress doesn’t guarantee those outcomes. Women can effectively counteract its effects through a variety of coping mechanisms, according to Marci Lobel, director of the Stress and Reproduction Lab at Stony Brook University in New York.
“During this period of the pandemic, we are all experiencing a high level of stress. What matters is how we respond to it,” said Lobel, who has launched a global study on how the pandemic is affecting pregnant women. It will follow women and babies for several years, tracking birth outcomes as well as hormone levels.
Absence of coping resources
“My hypothesis is not that stress itself is going to affect these outcomes. Stress in the absence of coping resources and healthy behaviours is where I anticipate seeing impact,” she said.
Janet DiPietro, a family and reproductive health professor at Johns Hopkins University’s Bloomberg School of Public Health, holds a contrarian view on maternal psychological stress. Her research downplays its effects, noting that it’s difficult to isolate variables that contribute to birth outcomes.
“Worrying can be a double-edged sword in pregnancy,” DiPietro said. “It’s like a terrible vicious cycle: You’re stressed and so you’re worried that stress is hurting your foetus. My advice to pregnant women is avoid stress if you can because it’s bad for you, not the baby.”
So what can pregnant women do to alleviate stress right now? Physical activity can play a crucial role, but it can be more difficult to access while sheltering at home.
DiPietro suggests deep breathing exercises, saying that they have a demonstrable effect on stimulating the vagus nerve, which lowers heart rate and blood pressure.
“Find a way to communicate with the foetus in a quiet moment,” she advises. “A woman and her foetus interact in many, many ways big and small all the time.”
Putting on some music and dancing can also work wonders, Lobel adds. What helps varies by personality, she notes, but one of the most common ways women cope with pregnancy is to draw on the support of loved ones. She encourages using technology to maintain those ties.
Technology can also provide a way to connect with support services such as mental health providers and prenatal groups that are moving online during this time.
Gili Levitin, a childbirth educator and birth doula, helped launch a free hotline staffed by volunteer doulas who are providing round-the-clock support to women anywhere in the world who are facing difficulty or have questions amid the crisis.
Women call to ask how changing hospital protocols will affect them, whether they should breast-feed if they have covid-19 and how they will breathe comfortably in labour if they have to wear a mask.
Levitin is also finding new ways to support her own clients in births when hospital restrictions prevent her from being there in person. She recently attended two births virtually, coaching the women’s partners through phone and video calls on how to massage them and provide support.
It’s not ideal, she said, but “you just work with what you have. If there is a support person, you educate them to become a doula for the day.”
Levitin specialises in hypnobirthing and says many of the techniques it teaches can help pregnant women come to terms with the current reality.
The idea is to view birth not just as a physical experience but one of the mind, body and soul. Focusing on positive language can help shift focus from pain or anxiety to birth’s beauty, she says.
“When we are fearful, we focus our mind on something negative or something scary that brings us to a place of anxiety,” but we can shift that focus by being aware of that anxiety, she says.
“Put attention on your breathing and your body. Check yourself: Right now you are fine, you’re healthy, you’re breathing. All of what is happening out there does not necessarily have to affect you. Your body knows what to do.”
Kuperman, who regularly connects with her doula and other pregnant women on Zoom, says her previous births help her keep things in perspective. Late in her second pregnancy, her father died. Knowing that she still gave birth to a full-term, nine-pound baby despite that stress reassures her that everything will be fine this time, too.
“I’m trying to go day-by-day and keep a positive outlook,” she said. “The baby will just join whatever chaos we’re in.”
Ambreen Ali is an editor, freelance writer and mother of two based in New Jersey.
— Washington Post