Pregnancy + Birth in a pandemic. The anxiety is real but there is a silver lining.

 
Blog4.jpg

When most people think of pregnancy, they usually think of emotions such as excitement, wonder, utter joy, and that oozing pregnancy glow. Or at least that is what people think until they are pregnant themselves. They then quickly realise there are a whole range of other emotions that come with the territory. Such as the most extreme exhaustion ever, anxiety associated with awaiting scan results, apprehension for the birth ahead, and low mood associated with such a big life change. In fact, the rates of anxiety and depression in pregnancy in Australia are 1 in 8 women, and we suspect this is actually underreported.


But what happens if we then throw in one of the biggest global pandemics the world has seen like COVID-19?

Well I can tell you that for pregnant women preparing for their birth it’s not great, and their anxiety level is exponentially increasing just like all of those COVID graphs.

The mental impact:

  • We know that high levels of anxiety in pregnancy is one of the strongest predictors for post-natal depression.

  • In fact, research tells us that Women are 2.6 times more likely to experiencing post-natal depression if they have prenatal anxiety. This is huge, it equates to around a 60% increased likelihood of experiencing PND.

  • And when we look at the impact that adverse events can have in pregnancy, we know that things such as job loss or lack of social support are very highly correlated with increased rates of pregnancy anxiety and post-natal depression.

In a population that already has high enough depression and anxiety rates, I think everyone would agree we need to minimise the number of women heading down this path.

What about the physical impact:
We know that when a woman goes in to labour her nervous system must be in her parasympathetic state for oxytocin release and labour hormones to do their thing. This state is called our’ rest and digest’ state, our sympathetic nervous system is the opposite, it’s our flight and flight state. It is the system that kicks in when we are stressed. This essentially tells our body we are in danger, we are being chased by a tiger and it is therefore not a good idea to birth right now as we will probably be eaten and die.

If we remain in a heightened nervous system state it’s no surprised that birthing will be impacted. Birth requires a woman to relax, open up, trust and surrender. In order to this she must feel safe. She cannot do this if she is anxious, is fearful, feels unsupported or is worried about COVID. She is more likely to stay in her head, not listen to her body, push ineffectively and require additional pain relief. The result of this could mean more tears, more instrumental deliveries, longer labours and higher rates of caesareans than necessary.

As someone who works in the pregnancy, birth preparation and post-natal space, the impact that COVID 19 has the potential to have is of great concern to me.


But first let me explain a little about the reasons pregnant women are feeling a little anxious to set the scene;

  1. Fear of contracting COVID 19
    Let’s start with the obvious one. According to the Royal College of Australian and New Zealand Obstetricians and Gynaecologist (29th March 2020) this is what we know:

    • Pregnant women are considered to be an at-risk group/ vulnerable group

    • Pregnant women who get COVID 19 are no more unwell than the general population.

    • There is no increased risk of Miscarriage.

    • There is some preliminary data that shows COVID can be transferred to babies, however there is no evidence of any harm or abnormalities to babies and women should be rest assured.

    • If you get COVID19 the evidence suggest you should continue to breastfeed

      Essentially there is very good reason that pregnant women need to listen to the advice and stay home, but there is also good reason that if they do this, that the anxiety levels can come down a notch.

  2. All face to face birth education has been suspended.
    For as long as I can remember this has been the primary source of information for couples surrounding birth preparation, coping mechanisms and how to be a “parent’ in those first few weeks. This information is vital for building confidence and understating of what lies ahead. Having these sessions cancelled will absolutely increase apprehension amongst parents, especially first timers, or those trialling a “different approach” second time round are needing guidance.

  3. Hospital tours have been cancelled.
    Similarly, to how a sports player imagines themselves on the sports field, women all around the world get themselves mentally ready for birth by imagining themselves in the birth suite, and for those who have had little exposure to a hospital this tour normally forms a big part if this mental preparation.

  4. Only one support person is allowed at the birth.
    For those intending to have a Doula or a second birth partner such as a sister or mother this is incredible distressing and upsetting as it deviates from what they envisaged and planned for their birth.

    For those unaware, Doulas are trained birth assistance and provide one to one care, right from the very start to the very end. They help with physical techniques, emotional support, and act as an advocate for the partners birth choices during the birth. The Doula has usually worked with the couple in the pregnancy and has developed a very trusting relationship. The research shows us that by having a continuous 1;1 birth support person during the birth that women are more likely to have a spontaneous vaginal birth, analgesia, shorter labours, less instrumental intervention, higher baby Apgar’s scales and reduced caesarean rates. These are great outcomes and are testament to the importance of continuous support for a birthing mother.

    This isn’t to say this won’t be possible in the current climate, it absolutely will be as Midwives and Obstetricians are seriously amazing and do their absolute best to support a woman through the whole process. But due to changing shifts, caring for multiple women, this continuous support isn’t always possible. But that’s ok, that’s what your birth partner is for and we need to empower them with their role. More on this below

  5. During the hospital stay only one visitor is allowed, and earlier discharges are likely to occur.
    This is the same person that attended the birth, which for the majority is the woman’s partner. Many couples will find it upsetting that their family and friends, not even their mum or sister can come and meet the baby and support in those early. This can really kick a feeling if isolation off if we aren’t careful.

  6. Social distancing in pregnancy and on return from hospital
    Social distancing and isolation mean women in the post- natal period will be having less physical contact than ever. They will not have all of the usual family and friends; they won’t get the cuddle from friends when they break down in tears from exhaustion and they will not have the connection that comes from joining a mother’s group.

  7. People are losing jobs and are financially stretched.
    The stress that comes with this and the impact to a family needs no explanation.

 

As someone who is a big believer in preventative health and addressing issues early, we need to recognise this storm in a tea cup now before it fully brews. The health system may be overloaded and stressed out, but babies are still being born, women need to be supported and we need to equip them to do this.

So whenever approached with a problem, there are two ways to deal with it:

A. Wallow in how unfair it is, freak out and freeze.

B. Accept the situation, then put your energy into to modifying the modifiable

Let’s choose B and start by acknowledging how S%#T this situation is. Someone probably ate a bat. COVID-19 is real and has taken over the world. The changes implemented by the Government and the hospitals are necessary to protect ourselves, health workers and babies. They are not changing anytime soon. You are pregnant. These guidelines affect you, but you still have to birth this baby.

It’s ok to feel angry, let down, or concerned. You are human. Its ok to throw an emotion filled tantrum and cry, but and then when you are ready let’s put your energy into owning this situation.

 

Repeat after me:

I am not going to let COVID-19 dictate my birth. I am going to equip myself with more knowledge and skills than ever before. I am going to own my own birth experience by showing up armoured, confident and in control.

 

And this is how you are going to do it…

YOUR ROAD MAP:

  1. Believe in your animal instincts to birth and find your parasympathetic nervous system.
    You are a female. Your body was literally designed to birth. Your uterus is smart, your vagina knows how to help your baby descend and your pelvic floor knows how to open. You need to allow your nervous system to drop, TRUST in your anatomy, and let your body do its thing. Your uterus, vagina and labour hormones don’t care about COVID they are here for you no matter what.

    A few tips to help bring your nervous system down:
    – Stop reading the news about COVID19
    – Do not listen to people’s terrible birth stories. That is their story, not yours.
    – Give meditation ago… 20 mins morning and night is honestly life changing.|
    – Going for a slow walk in a quite location.
    – Practice deep diaphragmatic breathing – it is the quickest way to drop your nervous system and is great practice for birth.


  2. Release that pelvic floor and perineum!
    I cannot stress the importance of preparing your pelvic floor and perineum for birth enough. This means connecting with it, releasing it with your own fingers and getting your partner involved if they are willing. It goes beyond the surface level of the traditional perineal massage; you need to release into the vaginal canal and to the side walls to reach the pelvic floor muscles.

    This is news to many people, but just think, if we were to run a marathon we would stretch and prepare muscles beforehand, and for birth we need to do exactly the same.

    If the idea of this is a little overwhelming, don’t stress it is for most women Here are a few suggestions to help you along:

    – Book a Telehealth consult with a Women’s health physio who can demonstrate online and walk you through and your partner every step of the way using a pelvic floor model. Trust me vie done it 100’s of times and it’s not that scary. Its actually really empowering for women

    – Familiarise yourself with the anatomy of the pelvic floor and the perineum with a picture so you can visualise it whilst you are trying to release. Using a mirror to start is often helpful.

    – Check out the Empowered Motherhood Program. It is a new online pregnancy and post-natal recovery program that has videos inside such as how to release your pelvic floor for birth, birth tips, tear recovery and caesarean recovery and so much more. The EMP is a program that I created and has just launched. Although I feel a little silly self-promoting it, I only am as I truly believe that it can change the health outcomes for women during pregnancy and the post-natal period. I spent two years filming it, and it is filmed with all of the information and exercise women really need for this life phase. We decided to bring forward the launch to make it accessible to women during COVID-19. Women need this to armour themselves physically and mentally now more than ever.

  3. Empower your birth support person to be your very own Doula.

    It’s more important than ever that your single birth support person steps up to the plate, regardless of the type of birth you have planned.
    Discuss with them just how important their role is now and work together to train them up, so you enter that birthing suite /theatre as a confident team that trusts each other. Some people will feel lost as to where to start with this, but the great news is that now more than ever there is quality information and support available online on preparing for birth. One of my favourite options is She Births who do an online course, and due to COVID have started live streaming their face to face courses. She births will empower you with so much birth knowledge that you will leave confident and excited about your birth. I’m sure there are many other Midwives and Doulas online to connect with, and I encourage you to start looking for your right fit. You cannot under estimate the importance of mind set and confidence in your birth outcomes.


  4. Create a birth tool box and a birth ‘road map’
    Tool Box – Having a whole range of resources to work through as labour progresses is so important. Have your partner learn acupressure techniques, practice sacral pressure, create a great sound track with all different vibes for the different moods you will go through in labour. My other must do is to get yourself an obstetric TENS machine – these are a GOD SEND for helping to cope with pain. They can be hired often from a women’s health Physio’s, midwives and online.


    A birth road map – I much prefer this than a birth plan. A birth often takes different twists and turns along the way, and often doesn’t go to plan. So, I find the by working through a road map it will help you talk through all of the ‘what if situations’ ahead of time. By doing this with your support person and discussing it with your obstetrician or midwife, it allows a sense of trust for the birthing woman so she can stay in her ‘zone’ whilst still feeling confident her desires are being heard.


  5. Information is your SUPER POWER.
    The more information you have the more empowered you will be to make the right choices for you. Simple.
    If there was ever a time that it was important to act as an advocate for your own birth experience and post-natal journey its now. You are lucky that you are birthing in an age where there is so much information accessible online or via Telehealth so try to seek out credible sources. Then start reading, watching, listening asking questions and soak up what feels right to you.

  6. Exercise, exercise exercise.
    We all know how important exercise is for releasing endorphins which helps to boost mood and helps us to sleep better. We also know that the health benefits to the pregnant mother are indisputable, and there is evidence to show it may also help with birth outcomes.

    The recommendation is for at least 30 mins of exercise a day at a moderate intensity, ideally with two strength sessions per week. In the current climate of COVID your best options are:
    – A fast-paced walk (on not very busy walking tracks)
    – Home based weights sessions if you have them at home
    – Join an online pregnancy specific Pilates class or trainer who works with pregnant women and is running online 1:1 session.
    – Look at the exercise element of the Empowered motherhood program – there is strength, pilates, cardio, yoga sessions – enough to give you a new workout almost every day that is specific to pregnant and post-natal women ( Again disclaimer it’s my program, so I’m biased but I promise you will love it!)

  7. Create your own ‘socially distant’ support network.
    Research has also shown that social support plays an important role in reducing the adverse impacts of life events that occur during the perinatal period on mental health. So be creative with how you can enlist some support. People want to help new mums, so put it out there. A few ideas to get you started:
    - A ‘zoom and coffee call’ schedule is a great way to have a fresh face every day to talk to. Create a roster and ask you friends to allocate themselves a day.
    - If your friends drop you a meal, ask them to share it with you over zoom, just like you were out to lunch. Having a good laugh and chat with them whilst sharing a meal can do wonders for your soul
    - Reach out to local face book groups or community groups to find another mum who has recently given birth or is pregnant. There is nothing like having someone who to discuss things such as baby poo and projectile vomits with someone else who gets exactly what you are going through at the same time.

 

 

AND The Silver lining… there are many.

  • By being able to birth purely with your support person, you will create an even closer bond with the sense of accomplishment you have achieved as a team. This can go along way with how you enter the post-natal space in your relationship and ability to really rely on each other as a family.

  • If I’m honest, I actually believe that there should be no visitors to hospital anyway, and always minimised my own when on the post-natal ward (and in the first 6 weeks!). This is such a special time of meeting your baby, learning your babies’ signals and recovering from the birth that the constant flurry of visitors interrupts it. I’ve had many conversations with midwives over the years about how much better the post-natal recovery would be if women were simply left to rest. This gift has just been handed to you on a platter.

  • Your permission to embrace the fourth trimester has been grated! I’m a big believer in the fourth trimester. It’s a period to cocoon yourself with your baby and really give your body a chance to recover. The post-natal period can often be incredible busy with an array of appointments, constant stream of people wanting cuddles, social dates such as mothers group meetings, coffee and walk dates that it can actually get a little overwhelming. There is no need to have FOMO as no one else is doing anything either! So, go on and embrace this opportunity to slow down, pause, be in the moment and really connect with your baby, and self.

  • Be thankful for the amazing technology that exists that will allow you to be connected to friends, family, health professionals and other online support.

And remember that thing called perspective. This really could be a lot worse. Our medical system in Australia is prepared and ready to deal with it COVID.

All you have to do is stay home, wash your hands, empower yourself with knowledge, move daily and calm your nervous system. Then after you have brought this baby into your world, it’s time to cocoon yourself away and wait for the pandemic to pass. Because it will, it is not forever, and it certainly will not define your birth.

Lyz x

 

References

 
PregnancySTEPHANIE TAYLOR