From pop-up support groups to pop-up data collection – we already have the capacity to improve maternal well-being.
The coronavirus has forced entire populations into experiencing isolation. Normal routines around work, play, exercise, even eating are disrupted and at the mercy of forces outside our control. Leaving the house is an ordeal requiring planning and preparation unlike ever before. And it is lonely; even if you’re home with other people, it can be heartbreakingly lonely.
While this may be new for some, it is all too familiar for others — in particular, mothers. Especially in the early days of new-motherhood, isolation is a common experience, and one that can linger and whose effects can be severe. Now, the isolation resulting from COVID-19 is being shared across genders, races, and geographic lines, and (we hope) it could catalyze broad-sweeping awareness of and changes to issues plaguing maternal health.
In the United States, we have unacceptably high rates of poor maternal outcomes, including injury, depression, and death — the worst of which impact women of color disproportionately. Compounding this issue is the fact that we do not collect data on several aspects of maternal well-being — thus preventing us from fully evaluating problems and identifying solutions.
The evidence we do have clearly demonstrates that supporting women during pregnancy, childbirth, and postpartum improves these outcomes. Support can come in many forms, like having doula assistance during childbirth, having a lactation consultant at home, or having a maternal mental health specialist to call. Conversely, when women are lacking in these types of support they can become emotionally and medically isolated — thereby making them more likely to experience postpartum conditions.
The COVID-19 pandemic is going to further expose (and worsen) what has historically been a challenge: How can we help women who have been isolated from labor, birthing, and postpartum support? But the shared experience of isolation across society, and the deep impacts it can have, may also help us all develop empathy for the plight of mothers. In this article, I examine how we might use this “corona-induced insight” to create long-term change in how we support mothers – socially and scientifically.
Alone together – COVID-19, motherhood, and loneliness
After giving birth, many mothers find themselves alone at home facing a total breakdown of a “normal” schedule, habits including personal hygiene, exercise, and homemaking become all but obsolete in the face of a newborn demanding food, attention, and care on an irregular schedule. For mothers who work from home, there is an extra layer of complexity where their maternity leave may include having to meet deadlines or produce deliverables — further compounding the mental health effects of isolation. Personally, I recall having a NICU baby during a winter season where cold/flu rates were unusually high. I was told to stay indoors at all costs, had to care for my newborn without resorting to my normal routines, and was expected to stay productive at work. It was impossible, much like the expectations accompanying coronavirus today.
Isolation or feeling lonely is not simply a state of being geographically alone. It is the quality of the relationships around you that determine the extent of this experience and emotion. While many mothers have friends and family in their social circles, the day to day experiences with newborns can still render one with the feeling of being alone. The health impact of loneliness has been compared to the detrimental effects of extreme daily smoking habits by the former surgeon general of the United States, Dr. Vivek Murthy. For new mothers, the effects of this are exacerbated by the inherent vulnerability that having a child brings to the body — with intense physiological changes including neurological shifts which contribute to depression and anxiety — mood disorders which are often underdiagnosed during the postpartum period. In response to today’s societal-wide isolation due to COVID, Dr. Murthy has suggested that “to compensate for the reduction in in-person social interaction, we must ramp up our virtual communication and ensure we are not losing touch with friends and family.” The same advice is absolutely applicable when we consider strategies for connecting mothers to a supportive community, public health pandemic notwithstanding.
COVID has sparked the creation of “pop-up” support groups
One example of this can be found in the Greater New York City area, the epicentre of the crisis in the United States. In response to pregnant mothers and new mothers facing new and unique challenges in accessing health care resources, the United Perinatal Support Coalition (UPSC) of Long Island was created during the COVID pandemic to provide support to families. The Coalition has quickly set up and mobilised a volunteer-based team from the existing local doula community. They have created hotlines that can be called to match you to a one-on-one “support mentor.” Additionally, they offer free webinars to learn more about various topics such as lactation. In doing so, UPSC is providing incredibly valuable societal support to pregnant women and new mothers who otherwise would not have had access to it – because they recognise that the absence of that support breeds isolation.
Researchers have created new tools to collect missing data
One area of maternal health that is significantly limited is the complete lack of systematic data collection on birthing and postpartum care experiences. Recently, ad-hoc data registries (an organized recording of health information collected over varying periods of time) have been launched to study the effects of COVID exposure on maternal and child health. In the United States, University of California has quickly created a study called PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY) to evaluate the effects of COVID exposure on women and children. Within three weeks of the registry’s launch, there were 1000 women signed up. The project plans to collect data on any symptoms and outcomes for women and their babies for a year.
The speed by which these registries were launched, the rapid response and volume of women enrolling in the study, and the registry goal of capturing health status of mothers for a year are all remarkable features — all of them are completely lacking in pre-COVID surveying of maternal health information. It begs the question – why can’t we do this in the absence of a pandemic, so that we can better understand questions such as, how does the care provided during birth impact the chances of a mother developing postpartum depression months later? Or does a mother’s relationship with her midwife or obstetrician influence future conditions of incontinence or pelvic floor dysfunction? These are questions that researchers are not able to answer simply because we do not have the information. Maternal Spotlight is working to change this by creating survey tools and research projects which will address such inequities in maternal health data.
Concluding thoughts
Today, we are globally mobilised and engaged in improving well-being for all. In doing so, we have created innovative social and scientific initiatives that have quickly emerged to address COVID-related challenges for soon-to-be and new mothers. If nothing else, it definitely illuminates what we are capable of creating during acute episodes of societal need. The next big step will be in continuing these approaches to address chronic systemic issues which have been negatively impacting maternal health for decades.
About the Author
Shilpa Londhe, PhD, Founder, Maternal Spotlight, a nonprofit research organization
Shilpa is a social scientist trained in health services research and public health. The goals of her research are to improve population health and create value in delivery systems. She earned her Ph.D. from the Heller School for Social Policy at Brandeis University, a master’s degree in Health Administration and Policy from Cornell University, and completed a postdoctoral fellowship at the Yale School of Public Health. Dr. Londhe has over a decade of health care experience spanning hospitals, pharmaceuticals, information technology, consulting, and governmental agencies. She is currently an adjunct associate professor in the Health Administration graduate program at Hofstra University.
