With thanks to the Women’s Mental Health Special Interest Group and South African Society of Psychiatrists

 Coping with Anxiety and Psychological Distress related to COVID – 19 during Pregnancy and Postpartum

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Common worries that Pregnant and Postpartum women may have related to COVID-19

  1. How can I prevent myself from getting the infection?
  2. What will be the impact of the virus on my unborn baby?
  3. Will my partner or support person be allowed to stay with me during delivery and before that?
  4. Will transportation be available if I go into labour?
  5. Is it safe to go to a hospital for antenatal check-ups or scans?
  6. Is excessive use of hand sanitizer safe during pregnancy?
  7. Should I get tested for COVID-19?
  8. Will breast feeding affect the baby?
  9. Can my relatives hold the baby?
  10. How can I prevent my mood from becoming low when no one can visit and I don’t have enough support with baby care?

SOME FACTS BASED ON AVAILABLE EVIDENCE

  1. For women in early pregnancy, there is no evidence to suggest an increased risk of miscarriage with COVID-19.
  2. Newborn babies and infants are not at increased risk of complications from the infection – routine antenatal investigations, ultrasounds, maternal and fetal assessments should continue as before with precautions taken.
  3. The safest place to birth your baby is in a hospital or clinic, where you have access to highly trained staff and emergency facilities, if required.
  4. Women who wish to breastfeed their babies should be encouraged and supported to do so. At the moment there is no evidence to suggest that the virus is carried in breast milk. There is sufficient evidence to suggest that breastmilk boosts the immunity of your baby
  5. If the mother has or is suspected to have the COVID-19 infection, she should NOT be automatically separated from her baby, but should be encouraged to take enhanced precautions with general hygiene and consider using a face mask when feeding or expressing and bottle feeding.
  6. Maintain the usual precautions of social distancing and hygiene as you would if not pregnant. Maintain the usual precautions of sanitisation and sterilisation to protect your infant from any other infections that they would be prone to. Continue the usual immunisation schedule for your baby as advised by your paediatrician or clinic sister

Please remember that some amount of anxiety is natural and understandable. However, it helps to talk to someone about it, so talk to friends and family whom you trust. 

Sometimes the anxiety may become excessive and these are times that you must reach out to your healthcare provider, which could be your doctor or your clinic sister or your midwife.

How will I know if my anxiety or distress is normal or excessive?

These are some symptoms that will help you recognise whether you have excessive anxiety or psychological distress

  • Excessive worry about getting the infection even when all precautions are being taken and even after reassurance
  • Lack of sleep because of anxiety; unable to “switch off worries” while trying to fall asleep
  • Focusing excessively on social media messages about COVID-19
  • Getting extremely anxious about infection control procedures in family members
  • Worrying too much about missing work
  • Feeling sad and angry because of isolation and not being able to meet family and friends
  • Feeling nervous, anxious, or on edge
  • Not being able to stop or control worrying
  • Trouble relaxing
  • Being so restless that it’s hard to sit still
  • Becoming easily annoyed or irritable
  • Feeling afraid as if something awful might happen
  • Getting sudden episodes of panic where you may experience some of these symptoms: racing heartbeat, trouble breathing, tingling and numbness in your fingertips, feeling like you’re not getting enough air, feeling trapped and wanting to escape

How can women who are pregnant or with new born babies prevent themselves from getting excessively anxious?

The Four Ways – Sharing and Managing Time, Planning and Preparation, Decreasing Anxious Thoughts, and finding ways of Calming yourself

  1. Sharing
  2. Keep in regular touch with your gynae or GP or your clinic sister. Ask them how you can get in touch if you feel too anxious or worried. Find out if the hospital or clinic has a number you can call.
  3. Divide your day into four parts- Rest, Hobbies, Work, and Exercise. Try to create a timetable for yourself using these four headings equally. Break your time into smaller chunks and only focus on what you need to do for the next hour, instead of the entire day. Continue old routines which will feel familiar and comforting to both yourself and your baby. Encourage your husband and other family members to find their own routine and try not to take on the task of managing everyone’s schedule for them.
  4. Try not to stay isolated and find ways of interacting with relatives and friends through phone and video calls.
  5. Stay away from disturbing social media and TV programs and request your friends and family not to send you messages that are negative. If needed, opt out of groups where there are too many messages. Dedicate a specific time in the day when you will update yourself on current information/news and use reliable websites and certified resources.
  6. If there is a Lockdown, and people are stuck at home, it has been seen that in some households   interpersonal  conflicts might increase. In case you face violence, there is a risk to your baby or unborn child and to you. Please inform a friend or family member about the violence or the threat of violence and have a safety plan ready in case you have to leave home. You can also call the GBV (Gender- Based Violence) call command on 0800428428
  7. During social isolation you may not be able to have the regular pregnancy related celebrations and this may disappoint you. Try to find other unique ways of making yourself feel special such as having a small function with just your immediate family and sharing the pictures with others.

B. Preparation and Planning – One good way of managing anxiety is to be prepared for eventualities. While some things are difficult to plan for, you can have a plan ready in case you have any urgent reason to visit the hospital.

  • Keep phone numbers of ambulance services, two or three of your friends, and your immediate family members handy, and inform them that you may need their help.
  • Send a copy of your Antenatal Card  and share phone numbers of the hospital, clinic or your doctor with your immediate friends or family in case they need to come to the hospital to be with you.  If there is a curfew or lockdown they will need to show it to the police if they are asked for proof.
  • Once the baby is born, keep the telephone number of the pediatrician or clinic handy. Speak to them about what needs to be done about immunization.

C. Decreasing Anxious Thoughts

   What can you do to minimise worry?

  • Name the core worry. This stops it from getting tangled up with too many different issues. Is it about the delivery? Is it about the baby’s health? Is it about how your  will reach home after he went out to get groceries during the lockdown?
  • Sometimes, naming the worry will help point out that the worry is needless.
  • Try to avoid ‘fueling the worry’ or adding `petrol to the existing fire’ by staying away from social media posts, blogs, chatrooms discussing similar topics.
  • Ask yourself – Have I looked at all the options given the current situation?
  • Assign a specific time to worry – when a worrying thought arises, tell yourself you will think about it only during `the worry time’- say between 5 and 6 pm. This helps in postponing the worry and decreasing its intensity.
  • Create a Comfort Box or Bag for yourself – this could have  a picture that makes you happy, a piece of cloth or a stone or a piece of wood to touch, something with a nice aroma, some words of a song in a piece of paper- basically anything that can soothe you and help you calm down.

Positive things to do:

  • Talk to someone, not necessarily about the worry. Just chat.
  • Identify an activity that you enjoy and get immersed in it – reading, listening to music, solving a puzzle, going for a walk, playing with kids around you, trying a new recipe, cleaning a cupboard, trying some craft, making posters out of inspirational quotes, writing a diary/blog or singing
  • Find ways to seek comfort – an inspirational talk, soothing music, chanting, a book of wise words, laughing and sharing jokes with your family, being silly with your children.
  • Try writing a gratitude journal, list all the things that you are thankful for.

D. Relaxing and Mindfulness – Find ways to relax – yoga, meditation, deep breathing, mindfulness. You don’t need any fancy equipment, and don’t try hard for a perfect, undisturbed time/space.

Simple relaxation exercises:

  • Mindful breathing – Close your eyes, relax in a chair or on the bed. Notice your feet resting on the ground. Focus on your breathing. Observe each breath as it comes in, and goes out, and in, and out. If you notice your thoughts straying, bring them back to your breathing. If any sounds around you claim your attention (the doorbell, birds chirping, sound of traffic), notice the sound, but bring your attention back to your breathing.  You can do this for ten breaths (or for 1 minute, or 3 minutes, or 5 minutes), and slowly open your eyes.
  • Square breathing – Breathe in to a count of 1-2-3-4. Hold for 1-2-3-4. Breathe out for 1-2-3-4. Hold for 1-2-3-4. Do this for three to five breaths, or until you feel calmer.
  • There are many resources online for guided meditation or mindfulness practice that you can do alone or along with your family, including ones that are suitable for children. Find the ones that you relate to and try to practice whenever you can.

What can family members of pregnant and postpartum women do to help the woman?

  1. Be aware of the signs of excessive anxiety or psychological distress
  2. Try not to minimise the woman’s worries – tell her it’s natural for her to feel this way
  3. Try to address some of the concerns and encourage her to talk to her healthcare provider about her worries, rather than stressing over them herself
  4. Ensure that she follows a routine and Engage her in interesting conversations
  5. Find some activity that you can do together – playing a game, doing a craft or telling stories. Also help her find quiet time where she can recuperate and not worry about chores.
  6. Ensure that you have a copy of her reports and hospital card or the baby’s card and tell her that you have them readily available. Discuss a plan for handling a situation in case she has pain, bleeding or she goes into labour. Create a plan for support with baby care if the lockdown continues.
  7. Teach her simple methods of relaxing and do them with her.
  8. Ensure that you and other family members also care for your own anxieties and worries. 
  9. Ensure that a mother with a newborn baby gets adequate sleep and help with baby care. Encourage her to sing to the baby and play with the baby and decrease screen time.
  10. Some of the routine childbirth-related rituals may not be possible due to the lockdown or social isolation drive. Try to find other simple ways of celebrating at home, such as creating a memory book of the baby’s first month and writing down messages from friends, grandparents and relatives, or get them to record music or lullabies or messages and send them to the mother and baby. Create palm prints or footprints of babies with natural dyes in the house and save them on paper which can be framed later. These small activities will help the mother to feel connected even if her parents or partner cannot be nearby.

Sources

Note- This is Educational material and NOT medical advice. Please contact your obstetrician or a Mental Health Professional if you would like help. Sometimes your anxiety may not come down with the usual measures, in which case you may need professional help. This will help you to better enjoy your pregnancy and early years with your baby.

Developed by the Women’s Mental Health Special Interest Group of the South African Society of Psychiatrists based on source material from the Perinatal Mental Health Services, National Institute of Mental Health and Neurosciences, Bangalore, India and Task Force on Perinatal Psychiatry of the Indian Psychiatric Society on 29th March, 2020.

Please access the  SADAG helpline 0800212223 for support and help. Women in the perinatal period, partners, families and health care workers can call for advice on any mental health matter

Another useful source of information is the South African Covid-19 Hotline:  0800 029 999 or 0800 111 132