Becoming a mother, particularly for the first time, is a life-altering, hugely emotional, and physically and mentally challenging time. So what about during a pandemic? Hundreds of thousands of women will give birth while the coronavirus crisis rumbles on – and the weeks and months postpartum won't be how they envisioned early motherhood, or the early stages of their child's life, either.
At a time when women are already at a higher risk of mental health issues, how does the crisis and lockdown impact this already vulnerable group?
"The first few weeks and months postpartum can a very overwhelming and vulnerable time for new parents," says Siobhan Miller, founder of the Positive Birth Company and author of Practical Ways To Make Your Birth Better. "We're hearing from new mums every day who are really struggling with lockdown and the social distancing restrictions in place."
She says this can particularly be the case for first time mums, who are navigating early motherhood without the physical support of wider family and friends, and for example, the "reassurance they need from their own mothers, who they'd anticipated being involved".
As Dr Will Dooley, obstetrics and gynaecology doctor and speaker at The Baby Show, adds: "Isolation and lack of support are known risk factors for poor maternal mental health."
On top of this, things medical professionals ordinarily advise to help postpartum women – like getting out of the house, spending time with loved ones, meeting other new mums and going to baby classes – aren't accessible now.
A sense of loss
At a time that's supposed to be celebratory and a coming together of families, there might be a real sense of loss on all sides here – with grandparents unable to meet their new grandchildren, for example, and new parents missing out on that interaction and support.
"There's also a sense of loss regarding what new mums had expected the postpartum period to be like," says Miller. "It's period of life that cannot be brought back. These feelings of loss and grief can be very distressing, particularly at a time when new mums are so emotionally vulnerable in the early postnatal weeks."
Having a baby comes with a huge amount of hope and expectation, and as Millar points out: "Many new parents have been trying for a baby for years and some have suffered multiple losses leading up to this."
That's not to mention additional financial struggles or homeschooling responsibilities some families may be facing as a result of the pandemic. "Mums with other children are now juggling caring for a newborn with the burden of homeschooling," Miller says. "This leaves little time for bonding with a new baby and establishing breastfeeding, or indeed resting and taking essential recovery time post-birth. Instead, new mums are stretched with an unprecedented level of expectation and pressure."
Postnatal mental health issues
Pablo Vandenabeele, clinical director for mental health at Bupa UK Insurance, says: "One in 10 women are thought to experience postnatal depression, but in the current lockdown situation feelings of anxiety and depression may become heightened. For new mothers experiencing it, the uncertainty and isolation of lockdown could make anxiety, insomnia or low moods even worse."
There is also a danger right now that postnatal depression is missed, and help isn't sought because women feel less able to seek it when medical services are stretched or don't seem as accessible. Vandenabeele says: "It's important to look out for any symptoms of more significant mental health issues, such as postnatal depression, and try not to dismiss them as being related to the lockdown situation."
Symptoms can include a lack of appetite, not being able to sleep due to worry or stress, feeling low and tearful, problems concentrating and feelings of guilt and worthlessness. "While all new parents may experience these feelings from time to time, if they persist, speak to your GP or midwife," he says. The 'baby blues' is said to last for a couple of weeks but postnatal depression continues for longer and it's important to seek appropriate support.
There's also perinatal anxiety – high levels of anxiety during pregnancy or in the year after birth. Miller says symptoms include: "Constantly worrying about the pregnancy or baby's wellbeing, feeling on edge, having a sense of dread, difficulty concentrating or racing thoughts, or engaging in behaviours to try and reduce negative thoughts (like constantly checking they baby is breathing).
"We know that having a traumatic birth experience, which could include birthing alone [a situation some have faced under new restrictions], can make you significantly more at risk of experiencing postnatal anxiety and depression," she adds. And both are isolating enough, without having to be in isolation too.
The message is: don't delay in getting help. "It's nothing to be ashamed of, it's very normal," says Vandenabeele. "Anyone feeling heightened levels of depression should not be afraid to reach out for medical help, even in these uncertain times."
Tell your GP or midwife – even if you're isolating, they'll be able to do a consultation over the phone and get you the help you need.
He also recommends the Pandas Foundation (pandasfoundation.org.uk), Action on Postpartum Psychosis (app-netword.org) and Association for Post Natal Illness (apni.org). The Samaritans and Mind are always on hand to help too for any new parents struggling emotionally or mentally, and people with Bupa can use their 'direct access' service.
What we can do
When it comes to safeguarding maternal mental health, we all know the wellbeing basics: try and eat healthily and regularly, do whatever movement and walking you can manage (it's not recommended to properly exercise for the first six weeks), and talk about the ups and downs with friends and family virtually. But of course, it's often more complicated than that – especially now.
"It's normally advised that new mothers live with at least one other person to provide help and support and give them time to emotionally and physically recover, this is even more true in times of isolation," says Vandenabeele.
Miller adds: "Hypnobirthing techniques can go a long way in preventing and easing symptoms of antenatal and postnatal anxiety and can easily be completed at home." So those currently pregnant might want to consider learning some simple calming techniques and breathwork, which could help postnatally too.
"It's worth remembering that midwives recommend you should spend two weeks at home resting after birth; one week in bed, one week on the sofa. Too many women feel the pressure to be up and about, hosting guests' mere days after giving birth," Miller adds.
"You can now use this precious time to relax, get to know your baby, bond as a new family and master those new skills – all guilt-free. Try and focus on the positives where you can."
The Positive Birth Company's Postpartum Pack â a comprehensive guide to the early days, weeks and months â is available for GBP 20 during the Covid-19 crisis. Visit thepositivebirthcompany.co.uk.