Motherhood and Depression in a COVID World

Q: [Adults] I’m pregnant and I’ve heard a lot about postpartum depression. Is the pandemic impacting this issue for new moms?

Maternal depression is the most common complication of pregnancy in the nation. An estimated one in five new or expectant mothers will experience a mental health disorder during pregnancy or in the first year following childbirth. These disorders include depression, anxiety and the less prevalent but most severe of the disorders, postpartum psychosis. Low-income populations often have higher prevalence of depression and sadly, the impact of the woman’s early childhood hardship can influence depression or anxiety later in her life. The COVID pandemic has added additional layers of concern for new moms and moms-to-be. In addition to increased isolation and stress around sheltering-in-place, there are economic pressures, fears and anxiety about the future, increased risk of domestic violence and fear of exposure to COVID. The birthing experience has also changed with restrictions on family members and visitors being present. If you or a loved one is experiencing any of these symptoms, experts advise:

1. Stay connected to others (phone, virtual gatherings and support groups).
2. Ask for help (friends, neighbors and family).
3. Talk to your physician or call the OC Crisis Hotline: 800-273-8255.

And there’s good news on the horizon. Obstetric providers are now required to screen for maternal depression at least once during pregnancy or postpartum period. As of Jan. 1, hospitals are required to provide maternal mental health training to clinical staff who work with pregnant and postpartum women as well as educate women and families about the signs and symptoms of maternal mental health disorders and local treatment options. An early diagnosis and treatment plan is key. Intervention and support is necessary for a woman’s well-being and reduces impact to the baby’s cognitive and emotional development. Santa Ana-based MOMS Orange County is at the forefront of maternal depression, having provided services to low-income moms and families for more than 20 years. As a board member of this leading non-profit, I can tell you first-hand that their trauma-informed program of home visitation, risk screening and connection to resources go far beyond what is required. As part of monthly home visits, Maternal Child Health Coordinators screen women for depression, substance use and domestic violence and other risks. The Edinburgh Postnatal Depression Scale (EPDS) maternal depression screening is administered before and after the baby is born and additional screening is built into multiple visits throughout pregnancy and postpartum. Results are reviewed by MOMS Orange County’s RN case managers who create individualized care plans for each client. Once a diagnosis is made, they advise and facilitate referrals to support classes, mental health providers, shelter intervention or in rare cases, legal authorities. In late 2019, MOMS’ home visitation teams were trained in the ROSE (Reach Out, Stay Strong, Essentials for Mothers of Newborns) Sustainment Study, an NIH-funded, evidence-based depression curriculum to reduce risk of postpartum depression in low-income women. During the COVID crisis, MOMS’ services have transitioned to remote or virtual and staff members have assisted women with navigating hospital stays and visitors. Home visits are offered via telephone visitation and group classes are offered via Zoom conferencing. If you are pregnant and live in Orange County you don’t need a referral to participate in our home visitation program for prenatal support or Mommy & Me groups to reduce isolation, gain strength and peer support.

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David C. Lagrew, Jr., MD, is the executive director and medical executive leader for the Women and Children’s Services Institute at Providence St. Joseph Health’s Southern California Region. He also serves on the board of directors for MOMS Orange County.