The Psychological Impact Of Continued Maternity Restrictions
Restrictions and accommodations to ensure the safety of patients across the health service have been a constant aspect of the Covid-19 pandemic in Ireland.
However, the ongoing maternity restrictions, in particular the exclusion of partners and support persons from maternity service, have been highlighted as a cause of increasing distress among pregnant women, fathers, partners, and families.
While restrictions have been eased across some hospitals, they continue to remain across many hospitals in Ireland.
The PSI SIGPIMH has provided some insight into the psychological implications of continued restrictions on families, in particular the risks of such practices and implications for young families’ mental health.
A cross-sectional web base study from Ireland, Norway, Switzerland, the United Kingdom (UK) and the Netherlands highlighted high levels of depressive symptoms and generalised anxiety in pregnancy and breastfeeding women during Covid-19 and pointed to the importance of protective monitoring for both maternal and infant mental health.
Covid-19 is a major stressor for perinatal mental health difficulties, potentially heightens risk of traumatic births, and impacts on need for more feeding support all of which can interrupt subsequent parent/baby bonding and potentially infant mental health.
The increased social isolation experienced by many mothers is concerning as a lack of social support is one of the strongest risk factors for post-natal depression.
These factors are made all the more salient when considered in light of current ongoing maternity restrictions.
Preliminary research is indicating considerable risks to perinatal mental health due to the pandemic.
It is important to consider that ongoing restrictions compound, and likely exacerbate, mental health difficulties elicited by the presence of a global pandemic.
Women who have experienced acute trauma or perinatal loss during a previous birth are disproportionately negatively affected by these ongoing restrictions. Families who experience a pregnancy after loss require an individualised care plan which is sensitive and responsive to the experiences of these families.
Attending antenatal appointments (routine or otherwise) and scans alone is extremely challenging as women often experience significant anxiety and a re-activation of posttraumatic stress.
The inability to support women inevitably has a negative impact on partners who are anxiously awaiting calls from the car park.
Recent research, which has examined fathers’ experiences of maternity services during the pandemic, identified themes of stress, isolation and uncertainty.
Furthermore, attendance at antenatal appointments provides partners with crucial opportunities to begin bonding with their infants.
Fathers and partners play a crucial and often protective role in the family system, particularly during times of stress and transition.
The exclusion of partners due to maternity restrictions, and subsequent obstruction of their protective role has implications for the well-being of the whole family.
Restrictions due to Covid-19, which have resulted in partners’ exclusion until a woman enters the labour ward, have negatively impacted maternal mental health and have been associated with increased levels of anxiety and fear of childbirth.
Birthing partners provide vital emotional and physical support for women in the hospital environment during all appointments, and particularly labour.
Continuous support during labour has been shown to improve outcomes for women and infants such as decreased birth—interventions and shorter labour.
The days and weeks after birth are particularly crucial in the development of both parent infant bonding.
For mothers whose infants have been moved to a Paediatric Intensive Care Unit (PICU) there is a significant impact.
Post C-section mothers, for example, are often alone in the maternity hospital without the buffer of visits from their family and friends save for a brief daily visit from their partner.
This is a particularly vulnerable time given that their baby has often been taken straight from delivery to a children’s hospital, often without an opportunity for skin-to-skin contact.
The intolerability of this period of separation from their baby is thus compounded by the absence of in-person care and connection with other loved ones.
International evidence has indicated the implementation of maternity restrictions is inconsistent across countries and often deviates from the recommendations of international bodies such as the World Health Organisation.
We are aware that, in an Irish context, restrictions have been inconsistently applied across hospital settings.
All women have a right to give birth in an environment which is both psychologically and clinically safe.
The PSI SIGPIMH would argue that those tasked with weighing up risk consider the current psychological risks continued maternity restrictions pose for families.
As outlined, the current restrictions likely increase the risk to parents’ and infants’ psychological well-being.
