Postpartum stress and protective factors in women who gave birth in the United States during the COVID-19 pandemic

Abstract

Objectives: The COVID-19 pandemic has caused considerable stress throughout the world. Little is known about how postpartum women who gave birth during the early months of the pandemic were impacted. The purpose of this study was to explore and describe the associations between potential risk, protective factors, and psychological distress among postpartum women who gave birth during the early months of the COVID-19 pandemic. Methods: Postpartum women over the age of 18 years who gave birth in the US hospitals between March and July of 2020 and spoke English completed a survey about their experiences. Demographic and health variables were measured via self-report. Stress was measured using the Perceived Stress Scale-10. Mastery was measured with the Pearlin Mastery Scale. Resilience was measured with the Connor–Davidson Resilience Scale-2. Results: This study included 885 women. Participants had higher stress and lower resilience relative to pre-pandemic norms. Participants had high levels of depression, anxiety, and stress. Women who had an infant admitted to the neonatal intensive care unit had more stress. Income, full-time employment, and partnered relationships were associated with lower stress. Resilience and mastery were related to lower stress, depression, and anxiety. Black, Indigenous, or People of Color women showed higher stress and lower resiliency. Single women were likely to report lower levels of mastery than partnered women. Conclusion: Stress, depression, and anxiety were high in postpartum women in this study. Income, partnered relationships, and employment security, along with protective traits such as mastery and resilience, may reduce the impact of stress on postpartum women in a pandemic. Care models should be modified to support women during a pandemic. Health disparities exist in postpartum stress. Future interventions should focus on building resiliency and mastery and ensuring appropriate resources are available to postpartum women in a pandemic.

Early Postpartum Stress, Anxiety, Depression, and Resilience Development among Danish First-Time Mothers before and during First-Wave COVID-19 Pandemic

“…An American mixed-methods study of 16 pregnant and 15 postpartum women reported six times higher levels of prenatal anxiety during the pandemic as compared to previous studies conducted in the Colorado area, and wellbeing and resilience scores were lower than before the pandemic [12]. Another American crosssectional study including 885 women found that participants had higher stress and lower resilience relative to pre-pandemic numbers, and that resilience and mastery were related to lower stress, depression, and anxiety [13]. An Italian cross-sectional study of 163 women found depressive symptoms in 44.2% (using EPDS) of the participants and post-traumatic stress syndrome (PTSS) in 42.9% of them.…”

Effect of Suryanamaskar on Stress in Delayed-Postpartum Indian Women – A Pilot Study

“…Though a phase of nourishment, enrichment, and amelioration, the postpartum period is also marked by dramatic shifts at corporal, mental and social levels in a woman's life including but not limited to hormonal swings and nervewracking parenting tasks that can cause women to experience stress and fatigue [3]. The physiological changes that can be seen during pregnancy include modifications in neuroendocrine hormonal shifts, inflammatory, and autonomic nervous system activation, which has the potential to aggravate the stress response and intensify the peril of perinatal physiological and psychological difficulties of the women [6]. Hence, as a distinct susceptible group, pregnant and postpartum women become high-end prey to stress and other such mental illness [4].…”

“…Stress can be understood as the responses one gives at the mental, emotional, and physiological levels to the demands of life [5]. However, how stress is experienced and understood by an individual depends on their preconceived perceptions, existing coping mechanisms, and their previous interactions with the environment rather than the stress-causing stimuli itself [6]. Postpartum maternal stress is usually connected with poor health outcomes and the advancement of psychological problems.…”

“…Postpartum maternal stress is usually connected with poor health outcomes and the advancement of psychological problems. The factors impacting stress levels during this period include any form of pre-existing stress, mental health status at the baseline, mother or neonate's health status, and demographic characteristics [6]. When uncontrollable, stress augments the risk of attracting maternal depression and anxiety, which may result in undesirable maternal and child outcomes [8].…”

Birth Experience, Postpartum PTSD and Depression before and during the Pandemic of COVID-19 in Russia

“…A growing body of research shows that mothers who gave birth during the pandemic had more clinically acute stress responses in comparison to those who had children in previous years [ 3 , 4 , 5 ]. In turn, higher levels of stress during birth were associated with more childbirth-related posttraumatic stress disorder (PTSD) symptoms and less bonding with the infant [ 3 ].…”