Pregnancy During The Pandemic
The Impact of Stress
When the Coronavirus hit and everyone was required to quarantine for weeks that became months, one of my first thoughts was, “Well, here comes the next baby boom!” That, of course, was based on the historical precedent of hard times causing spikes in birthrates. Disasters seem to encourage procreation. After all, what else can couples do when they are housebound — but make love and make babies? Even Planned Parenthood’s Director of Medical Standards thought the virus would mean people having more time for sex, hypothesizing that we might see an increase in pregnancies as a result.
Early in the Pandemic many experts predicted what they called a “coronial baby zoom” based on the high stress, high birth rate patterns of the past. Of course, they were thinking of short-term stress, like blizzards, or even long-term events like wars, which are known to increase birth rate. But even before Covid-19, birth rates were dropping. In fact, they have been on a decline since the 2008 recession. In 2019, the U.S. saw the lowest number of births in 35 years. This despite economic growth in recent years, following the recession.
Now, six months into the Pandemic, we are seeing record levels of unemployment, a closing of schools, restaurants, bars and childcare centers across the country, and no end in sight for returning to normal. This grim picture has led economists to predict a lowering in the number of births during the coming year by as much as a half million.
They base their predictions on studies of fertility behavior during the Great Recession and the 1918 Spanish Flu. Dr. Rahul Gupta, Chief Medical and Health Officer for the March of Dimes, speculates that the economic fallout from Covid-19 could further reduce the number of children being born in the U.S. over the next few years. A drop of ten to twenty percent, which he believes to be possible, could greatly impact the next generation.
HOW STRESS AFFECTS PREGNANCY
Meanwhile, couples who are deciding to have children anyway, despite Coronavirus, are under more stress than ever, and this can translate into problems during pregnancy, delivery and beyond. A study by the March of Dimes revealed that stress can cause a shortening of the cervix during pregnancy, increasing the risk of premature birth or miscarriage.
A study in Sweden showed that women suffering from a number of stressors are at higher risk of delivering a baby pre-term. The authors added that maternal psychological and social stress during pregnancy have also been shown in past studies to increase morbidity and lower birth weight.
Recently (August of 2020), a study in Italy that was published in the American Journal of Obstetrics and Gynecology, found that more than half the women studied rated as “severe” the psychological impact of COVID-19. Nearly two-thirds reported higher than normal anxiety. They also cited a survey in Wuhan, China showing similar rates. In the Wuhan study, 53.8% of pregnant women rated the psychological impact of Covid as moderate to severe.
Closer to home, Canadian researchers found that 57% of pregnant women in April of 2020 showed anxiety symptoms.
It appears that the psychological stress from the Pandemic is highest during the first trimester, a time when women are generally more worried about the viability of their pregnancy. The problem is that now they have added concerns, including fears of contracting the virus, facing monthly check ups and eventual delivery without their partner present, and safety concerns about even being in a hospital. As a result, some are opting for home births.
As a therapist, I hear their fears and quandaries on a weekly basis. One client, who is high risk by nature of her age, has decided to have a home birth with a midwife, believing that it will be less stressful than going to a hospital and delivering her baby without her husband at her side.
SHOULD WE WAIT IT OUT?
While every new mother suffers from some stress during pregnancy, the actual risks to the child vary by income, age and general health of the mother. Those conditions are compounded by Covid. Coming down with the virus during pregnancy is one of the biggest fears of both female and male clients. While it is not yet clear how exactly Covid will affect the unborn child, many couples are deciding to wait it out and start their families post-Covid. Older couples (30–40) may already feel pressure to begin the process and don’t want to postpone it. Couples who planned to start their family, or add a sibling, wonder if they will have the income to support a child, even after Covid.
While we don’t know the effects of the virus on children born of mothers who have it, we do know that stress during pregnancy has been implicated in a number of post-birth problems. For example, high stress suppresses the immune system in both mother and unborn child. Maternal stress is also related to development of larger amygdalas in the child, the part of the brain which regulates fear responses. In addition, high cortisol levels (released during stress) in pregnant women is related to corresponding levels in their newborns. And it is hypothesized that high stress during pregnancy reduces the amount of brain activity associated with the mother’s response to her infant’s cries.
Considering all the stresses of pregnancy, what perhaps weighs most heavily on a couple’s minds today is money. Can they afford to have a child in times of massive financial insecurity? Of all the stresses, income may actually be the most critical variable. Income alone seems to be associated with overall success of a pregnancy. Low income mothers are most at risk for chronic stress, even during good economic times. During Covid, many households have lost one or both wage earners to unemployment. The rates are higher among those with low paying jobs, like those in the service industries, the ones first cut during the pandemic. Economic insecurity threatens the ability to get good prenatal and postnatal care and takes an emotional toll on both parents, as well as the health of the child.
Couples who were already struggling before Covid may feel buried in debt during the Pandemic. Chronic financial hardship creates chronic stress. Philip Cohen, a sociologist at the University of Maryland, explains it this way: “If poor parents are working multiple jobs, if they have chronic shortages of resources, if they’re trying to patch together low-wage jobs, government benefits, help from friends and family and neighbors, just the job of managing all that is a tremendous source of stress and anxiety.” Add to this fears of illness and death, and it makes family planning almost impossible.
Couples under financial pressure, regardless of income, are also more prone to marital stress, which may affect the child directly or indirectly. Couples cooped up together 24/7 may argue or get irritated with each other more often than couples with dual careers and time away from each other. Research shows an uptick in cases of domestic violence during Covid. Depending on how fierce the fighting is will determine the effect on the unborn child. Intense or sustained anger can interfere with brain development in the unborn baby. Physical abuse of the mother can lead to low birth weight in the child, and can affect whether the mother makes it full term.
All this is to say that couples who would normally encounter stress during pregnancy are now vulnerable to higher levels of it and possibly to worse pregnancy outcomes.
OLDER COUPLES MAY DO BETTER
Ironically, older mothers (35–45), who are at high risk during normal times, may actually do as well or better during the Pandemic, as compared with very young mothers, especially if they are highly educated. Even a 45-year-old mother with a bachelor’s degree or more has a 3.7% chance of giving birth to a cognitively disabled child, which is the same as that of a much younger woman with less education.
The younger, less educated woman may have a higher chance of getting pregnant, but she is at risk for encountering a different set of problems. Philip Cohen maintains that “while delaying childbearing creates many risks, including birth defects and infertility, the problems it poses are not as widespread as those created by low income.”
As noted in my own book, Midlife Parenting; A Guide to Having and Raising Kids in Your 30s, 40s and Beyond, older mothers (and fathers) tend to be more mature and better able to handle stress. They are also more likely to have a job and have entered careers that are stable. So they are financially more secure. They are also more likely to own a home, and home ownership, interestingly, is related to better birth outcomes.
Regardless of age, economic status, and other factors, new mothers or those considering having a child during Covid can benefit from stress reduction. Following are some suggestions:
- Perception Matters. Remember that it’s not necessarily the stressful event, but how one assesses it (one’s perception), that counts. How a person chooses to deal with stress determines the physical and emotional effect it will have. Developing attitudes and skills for dealing with stress is thus of utmost importance. Therapy can help, as well as 12-step programs and other forms of self help groups. See my article on the Serenity Prayer published by Medium this month.
- United we Stand. The more couples create a united front, communicate with each other and support one another, the better for everyone. Pregnancy outcomes are better when the husband takes an active and supportive role.
- Exercise, meditation, and guided imagery are known stress reducers. Engaging in creative projects also helps, as well as laughter. Lots of laughter! Try to find the humor in things, even if it’s “dark” humor. Soldiers in battle know the benefits of humor. Ask any veteran how they survived their deployment. They will tell you, humor and prayer.
- Avoid additional stressors. For some, this may require less time watching news or talking with irritating friends and family. Don’t create more stress. Surround yourself with people who love and support you.
- Be grateful for what you do have. Therapists will tell you that focusing on what you are grateful for, instead of on what you don’t have or resent improves your outlook on life and puts you in touch with what is really important — before, during, and after the Pandemic
Having a child is among the 10 most stressful events one encounters in life. The current Pandemic only adds to it. Younger couples have time and reason to wait it out before starting a family, whereas older couples may feel they are already losing time, and waiting for the Pandemic to end only creates more stress. However, they may actually be best positioned economically and psychologically to weather this stormy time. Alternative birthing options may also reduce the stress around hospital births. Financial security, supportive family, and good coping skills are essential. For some this may be the worst time, but for others it may be more manageable than they think.