"Who Decides Which Care Is Essential?" Perinatal Women's Mental Health and Access to Care during the COVID-19 Pandemic

Background and Purpose: Despite accumulating evidence for heightened psychiatric risk and unique parenting challenges, there is limited research on the experiences of expectant and new mothers during the COVID-19 pandemic. We aimed to explore perinatal women’s mental health during the pandemic, with an emphasis on understanding the stressors they faced and availability of needed supports.

Methods: In late 2020, we conducted semi-structured interviews with 30 mothers of babies born or due that year. Participants were recruited through online mothers’ groups. They came from 21 states spanning every region of the United States. They ranged in age from 28 to 40 years old (mean age 33.5), 73% identified their race and ethnicity as non-Hispanic white, and the majority reported household income greater than $100,000. All participants were married to or partnered with men and 2/3 were first-time mothers. Interviews addressed experiences of pregnancy, birth, and early parenting during the COVID-19 pandemic. We conducted thematic analysis of the data, drawing on principles of grounded theory including iterative analysis and constant comparison, to identify themes from mothers’ accounts of their perinatal experiences. Transcripts were coded by two members of the research team independently, with disagreements resolved by discussion.

Results: This study identifies a set of stressors faced by perinatal women early in the COVID-19 crisis: coping with the compound psychological impacts of the perinatal period and a pandemic; parenting an infant in the absence of expected social support; and risk assessment to keep infant and family safe. Women with prior history of depression and anxiety, particularly in the perinatal context, additionally confronted disruption to plans they had developed to protect and promote their wellbeing in the postpartum period. Participants reported that reduced hours and clinic closings limited their access to in-person health care and suggested that telehealth is not equally well-suited to all aspects of care, in particular noting discomfort with mental health and breastfeeding support via telehealth. Several mothers described profound and lingering distress resulting from COVID-related traumatic events surrounding childbirth, including separation from partner and/or baby due to COVID-19 protocols, and difficulty resolving distress in light of reduced access to care.

Conclusions and Implications: This study illuminates the profound and lasting toll of the pandemic on perinatal women’s mental health, as well as ways that it has undermined their access to care. Findings suggest that policies implemented by health care providers to reduce risk of COVID-19 transmission have frequently come at a cost to mothers’ emotional wellbeing and demonstrate the urgency of enhanced support for perinatal women in times of heightened stress and uncertainty. Maternal mental health has significant consequences for mothers, children, and maternal-child relationships and warrants sustained attention from social work researchers and practitioners during and beyond the COVID-19 pandemic.