Introduction
The Covid 19 pandemic has added a number of stress factors to all our lives and particularly to pregnant women and unborn babies. At 7 weeks after conception an embryo is 1 cm long and forming a heart, lungs and brain, and the baby is already forming a face. By 14 weeks the ‘young one’ (or foetus) has eyelashes, lips and tongue. While the unborn baby is enclosed in a self-contained system of the mother’s body, each mother faces a unique environment individual to her. Covid 19 has impacted this environment, leading to increased anxiety levels among pregnant and perinatal woman, which can affect the baby’s growth and development. Melanie, the model in our featured image, was happily pregnant despite Covid 19 and felt a deep connection with her baby from early in the pregnancy.
Pre-Birth Baby
The unborn baby at about 22 weeks will begin to be aware of sounds, tastes and smells, light and dark, movement, music and rhythm, and voices (Sallenbach 1994). The mother feels her baby move and becomes conscious of when her baby is awake or asleep. Babies respond to changes in the greater environment such as kicking after a loud sound, or turning away from an ultrasound probe. After birth, a newborn will turn towards the sound of her mother’s voice, and often the father’s voice too. This suggests that the unborn baby is learning in the womb. The way a baby moves in the womb can predict temperament and infant behaviour after birth (Dipietro et al.; 2002). A happy mother who is not anxious during pregnancy produces love hormones that facilitate how the baby grows and develops in the womb.
Sleep and waking cycles can be felt in the last ten weeks of the pregnancy – I will often ask a mother who is struggling with a night waking/feeding newborn what the baby’s patterns of sleep were in the womb during the pregnancy. Usually there is a match. Babies in the womb who are active during the day and asleep at night, will continue this sleeping pattern after the birth. The reverse is also true. A baby in the womb who sleeps during the day and wakes up/kicks just when you want to go to sleep at night, often continues frequent episodes of night waking in the early weeks after birth. Melanie (model from the image above) was aware during her pregnancy that her unborn baby woke up at about 11pm, moving and responding to stimulation from Mum and Dad. Dad would massage Melanie’s belly and the baby appeared to really enjoy this experience while in the womb, by kicking in response to being touched. After birth, Melanie found this pattern repeated itself when at 11pm the baby would be awake and want to play.
Allesandria Piontelli’s (1992) work observing twins via ultrasound while still in the womb is very enlightening and suggests strongly that personality already develops in the womb. Some twin pairs were very affectionate towards each other while in other pairs of twins, one twin may be shy and the other twin dominant. In yet other twin pairs, the babies push and fight with each other as if there is conflict over space. One baby studied by Piontelli in the womb suffered the death of his twin two weeks before birth. As an 18 month old, he was constantly looking for something, under pillows and amongst toys, as if he could not find the desired object. It is hard to determine from these studies how much is innate or genetic, and how much is a result of environmental factors, yet Piontelli’s work suggests a connection between prenatal and postnatal life.
Most of what a pregnant women experiences such as the air she breathes, the food she eats, the quality of the water she drinks, the chemicals she is exposed to and the relationships she has, are experienced by and inform the unborn baby of his chances of survival in the world at large. Dr Barker confirmed the associations between prenatal factors and lifelong health in 1998, showing that what happens to the baby in the womb can lead to being vulnerable or susceptible to disease much later, when people are in their fifties. The future mental health of the unborn baby is affected by severe stress, such as war, starvation and high anxiety and the present, by Covid 19. High antenatal stress and anxiety experienced by the mother makes the babies vulnerable to later developmental or emotional problems as children and young adults. Pregnant women need a safe environment during pregnancy and need to be supported as much as possible in their respective circumstances. Melanie felt safe in her personal relationships, visited her mother regularly, did yoga daily, took walks and travelled to friends in other countries, working around Covid 19 restrictions.
A study of Covid 19 and Stress
Covid 19 lockdowns and restrictions have placed inordinate amounts of stress on pregnant women and women with newborn babies. A small study by Jacqui Wise has found, contrary to expectations, that babies of mother who were ill with Covid 19 during pregnancy showed no neurodevelopment changes, rather, they discovered that all babies showed lower scores in social and particularly motor skills. These findings suggest that the lockdown restrictions and prohibitions themselves, the context of fear perpetuated by the media and decreased opportunities for interactions outside the home, raised the mother’s stress levels and affected their unborn babies. Melanie was affected by the media and the Covid 19 narrative, especially early in the pregnancy, and spent some days vegging out on social media.
Another team of researchers (Denise Werchan et al, 2020) studied various behaviours that women chose to cope with the added stresses during Covid 19. Six behavioural factors factors were analysed, as follows:
- Factor 1:
Self Care = exercise, getting a good night’s sleep, eating healthy, self care (keeping clean, doing hair, nails, etc), meditation and creative, calming activities - Factor 2:
Vegging-out = increased screen time, social media use(e.g. facebook, instagram scrolling) and indulging in comfort foods - Factor 3:
Avoiding media news and less following of news - Factor 4:
Talking with friends and family, helping others, doing things with friends and family and talking with other pregnant couples or other parents - Factor 5:
Talking to health care providers, visiting health care facilities and using over the counter medication - Factor 6:
Using drugs such as cannabis, tobacco and alcohol
What the researchers found
After analysing the factors, the researchers found that the strategies women used could be grouped into four main coping styles. Firstly the low-coping profile describes women who have lower coping strategies on all factors and accounted for 41% of the pregnant women or early mothers. The second passive-coping profile found women(33%) spent more time ‘vegging-out’ and had lower levels of self care. The third profile of women(12%) used active-coping style such as high self-care, engaging with social support, avoiding media news and low levels of vegging-out. The final profile showed high-coping style(13%) with high levels of self-care and social support as well as high vegging out. It also showed moderately increased visits to healthcare facilities and professionals, with slightly higher substance abuse after the birth of the baby in the post-partum period.
Melanie felt that by the 32nd week of her pregnancy she wanted to focus on her nesting impulses, as well as fostering her connection to the baby with massage, music, yoga and meditation, and regular interaction with friends and family. Melanie and her husband moved into a new home requiring extensive renovations. This also occupied her attention and Covid 19 restrictions were all but forgotten.
In conclusion
While it is easy to recognise our own coping strategies by reflecting on the profiles above, Covid 19, lockdowns and restrictions have presented unique stressors, have disrupted routines, made support systems less secure and have impacted behaviours that previously helped women cope, such as meeting with friends, travelling on public transport, or accessing family support. This study highlights the risk factors and protective factors critical in helping to identify women at risk of depression during Covid 19. A mother who is depressed, afraid or anxious is less able to connect and engage with her baby. A mother like Melanie, who actively seeks positive coping strategies, and reaches out to friends and family for support, who visits health professionals regularly and takes care of herself is providing a steady base from which her baby can learn, develop and grow.
To be aware of these coping profiles informs us all, as neighbours, midwives, doctors, social workers and family members, to discover and develop new ways of assisting pregnant and postpartum women and to encourage active coping styles during this unprecedented time of Covid 19.
References
Werchan, D.M., Hendrix, C.L., Ablow, J.C. et al. Behavioral coping phenotypes and associated psychosocial outcomes of pregnant and postpartum women during the COVID-19 pandemic. Sci Rep 12, 1209 (2022). https://doi.org/10.1038/s41598-022-05299-4
Wise, J. Babies born during the pandemic show slight developmental delays. BMJ 2022; 376:o29
https://doi.org/10.1136/bmj.o29