The COVID-19 pandemic has amplified anxiety and stressors across the community and resulted in a growing need for psychological interventions via telehealth. Perinatal families, a population vulnerable to stressors and mental health difficulties even when the world is not facing a pandemic, are particularly vulnerable during the current public health crisis.
Perinatal Anxiety During an Anxiety-Provoking Time
Even when the world is not battling a pandemic, it is common for women in the perinatal period to have heightened concerns regarding their own health and the health of their baby and loved ones. The perinatal period in a woman’s life is marked by numerous transitions that often lead to an increase in stress and anxiety as they “cope with physical symptoms, lack of sleep, adjustments to work and home lives, and changing expectations for themselves” (Moran et al. 2014). The concerns, anxiety and stress that are common during the perinatal period are likely to be increased during the current public health crisis. Common pandemic-related concerns being expressed by the perinatal population include:
- The potential for virus exposure during hospital or clinic visits for even routine obstetric care due to the fears of contagion and rapid spread of COVID-19.
- Uncertainty about who can be present during and following labor and delivery due to changing hospital visitation policies.
- The need to prepare for, and take care of, a newborn while simultaneously caring for any older children in their households at a time when schools have moved to an online format and most childcare providers are temporarily closed.
- Concerns about whether or not extended family members can safely help care for the new mother, baby and any older siblings.
- The financial strain on families resulting from business closures, job layoffs and furloughs.
How Prevalent is Anxiety and Depression in the Perinatal Population?
Research on perinatal populations has shown that stress and perceived lack of control positively correlate with anxiety symptoms (Moran et al., 2014). It is estimated that 1 in 9 women experienced symptoms of postpartum depression (Jordan & Minikel, 2019). The rates for perinatal anxiety are not as well known, but recent research suggests that perinatal anxiety is more prevalent than postpartum depression (Jordan & Minikel, 2019). Further, research has found that not only is the rate of perinatal generalized anxiety disorder (GAD) more elevated when compared to the general population, 40%-50% of women in the general population with a diagnosis of an anxiety or depressive disorder endorsed a perinatal onset (Wenzel et al., 2005). In addition to the risk of developing an anxiety or depressive disorder, women during the perinatal period are at risk for Perinatal PTSD (P-PTSD). While the exact prevalence rates of P-PTSD are difficult to determine, recent research has found that 4% of mothers experience P-PTSD following childbirth (Ayers et al., 2018). Further, high risk perinatal circumstances, including pregnancy complications or preterm birth, increase the prevalence rate to 15%- 19% (Grekin & O'Hara, 2014; Yildiz et al., 2017). As levels of psychological distress increase across the general population in response to the pandemic, it is likely that the perinatal population will experience increased levels of anxiety and other mental health concerns. It is therefore imperative that women in the perinatal period have access to services to support them through this uniquely distressing and challenging time.
Temporary Waivers Expand Potential for Offering Telehealth Services
At the same time that the need for psychological support services has sharply increased, the accessibility of in-person services has sharply decreased, making access to telehealth platforms critical. Officials at the U.S. Department of Health and Human Services, Office of Civil Rights (OCR), recognizing the current extraordinary circumstances, recently announced that during the COVID-19 nationwide public health emergency, the agency will exercise enforcement discretion and not impose penalties for noncompliance with HIPAA rules against healthcare professionals in connection with the good faith provision of telehealth services using audio or video communication products. OCR officials also waived telehealth reimbursement restrictions pertaining to mental health services (Office of Civil Rights, 2020). While providers should continue to practice in accordance with HIPAA to the greatest extent possible, these temporary waivers greatly expand the potential for using telehealth services to provide psychological support services for the perinatal population.
Providing Perinatal Mental Health Services During COVID-19
Prior to the current pandemic, The Caring for yoU and Baby (CUB) Clinic within the Graduate School of Professional Psychology (GSPP) at the University of Denver had already begun expanding accessibility of its services for the perinatal population via telehealth delivery. The lessons, experiences, and successes learned by CUB Clinic clinicians may provide a useful supplement for other service providers as they transition to telehealth practice. CUB clinicians have implemented a range of telehealth services, each combining the core therapeutic services expected in standard in-person settings, but adapted to be provided via phone and video technologies:
- Parentline Colorado. Parentline Colorado, offers brief strategic psychotherapy in English and Spanish through video or telephone calls to perinatal families with children up to age five. Parentline Colorado is based upon Parentline, a free telebehavioral health service started in 2016 by Dr. Dhara Meghani and her team at the University of San Francisco. Parentline Colorado includes labor and delivery safety and contingency planning for all pregnant clients (e.g., client identifies a person of support that clinician is authorized to contact if clinician is unable to contact client for an extended period and believes the client may have gone into labor or is having other medical difficulties). The CUB Clinic is actively accepting new clients to Parentline Colorado and due to COVID-19, the clinic has transitioned clients that had only been using in-person clinic services to this platform. CUB Clinic services are offered to a wide range of clients, and are not restricted to perinatal mothers experiencing anxiety or depression. In addition, clinic services are generally available at low- or no-cost to the client.
- Perinatal Support Groups. The CUB Clinic recently launched online perinatal support groups in English and Spanish based on Group Interpersonal Psychotherapy (Reay et al., 2006) to ease anxiety, promote community, and bolster social support. Group members are being recruited through social media and through referrals from our community partner, MotherWise Colorado (providing support services for perinatal women and mothers of infants). Each support group is limited to 20 mothers to help foster cohesiveness among group members and each group is led by two facilitating clinicians.
- WePlay Program. Prior to the pandemic, the CUB Clinic and Children’s Museum of Denver at Marsico Campus collaborated to offer the WePlay program, weekly in-person parent-infant play and social support groups held at the museum. In response to the pandemic, the CUB clinic now offers WePlay to a broad, online audience via short online videos and infographics easy for families to access.
- Daily Sing Along Sessions. In collaboration with music teachers at a childcare center affiliated with the University of Denver, The Fisher Early Learning Center, we now offer live, sing along sessions each day for families with young children via Zoom.
- Daily Dance Party. The Director of the CUB Clinic is hosting a daily, family-friendly dance party over Zoom focused on encouraging families to get moving, remain connected, and have a regularly scheduled, fun way to start their day.
- Links to other resources. The clinic is providing families with links to a range of other supportive and reputable resources that might be helpful during these difficult times via the GSPP COVID-19 website (https://spark.adobe.com/page/ONJeUkiXCJhss) and social media account. Examples of some of the resources links include: guidance to help caregivers create a daily schedule and routine for their child based on the child’s developmental stage (Craycroft, 2020), ideas for working parents juggling simultaneous parenting responsibilities and suggestions on how to talk to your child about COVID-19 in a supportive and developmentally sensitive manner (Kamenetz & Turner, 2020).
COVID-19 has amplified levels of anxiety and stress across the community. Perinatal families, a population that commonly experiences heightened anxiety or stress levels, face unique challenges during this public health crisis that are likely to further increase levels of psychological distress. Because the pandemic has limited the accessibility of in-person psychological support services, the ability of providers to offer psychological services using a telehealth platform is more important than ever. The CUB clinicians’ familiarity with service provision over telehealth and established collaborations with community partners has facilitated innovation and resulted in our ability to offer additional supportive services for Colorado residents during the pandemic. In an unstable and unpredictable time, the reliability of daily routines and the telebehavioral mental health services provided by the CUB Clinic offer respite for worried families. The CUB Clinic team and GSPP are also offering ongoing training webinars to help other clinicians across the state and country learn how to quickly transition to telehealth platforms.
Cite This Article
Pinch, S., Jacobs, J., & Vozar, T. (2020, June). At home with COVID-19: Hope and resources for perinatal families. [Web article]. Retrieved from https://societyforpsychotherapy.org/at-home-with-covid-19/
Ayers, S., Wright, D. B., & Thornton, A. (2018). Development of a measure of postpartum PTSD: The City Birth Trauma Scale. Frontiers in Psychiatry, 9. https://doi-org.du.idm.oclc.org/10.3389/fpsyt.2018.00409
Craycroft, M. (2020, February 17). Create a daily schedule that works for your family. Carrots are Orange. https://carrotsareorange.com/daily-schedule-for-kids/
Grekin, R., & O’Hara, M. (2014). Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis. Clinical Psychology Review, 34(5), 389-401. https://doi.org/10.1016/j.cpr.2014.05.003
Jordan, V., & Minikel, M. (2019). Postpartum anxiety: More common than you think. The Journal of Family Practice, 68(3), 165-168. https://www.ncbi.nlm.nih.gov/pubmed/31039214
Kamenetz, A., & Turner, C. (2020, March 13). Coronavirus and Parenting: What You Need To Know Now. National Public Radio. https://www.npr.org/transcripts/814615866
Moran, T. E., Polanin, J. R., & Wenzel, A. (2014). The Postpartum Worry Scale–Revised: An initial validation of a measure of postpartum worry. Archives of Women’s Mental Health, 17(1), 41–48. https://doi-org.du.idm.oclc.org/10.1007/s00737-013-0380-9
Office for Civil Rights. (2020). Notification of enforcement discretion for telehealth. U.S. Department of Health and Human Services, Office of the Secretary. https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency preparedness/notification-enforcement-discretion-telehealth/index.html
Reay, R., Fisher, Y., Robertson, M., Adams, E., & Owen, C. (2006). Group interpersonal psychotherapy for postnatal depression: A pilot study. Archives of Women’s Mental Health, 9(1), 31-39.
Wenzel, A., Haugen, E. N., Jackson, L. C., & Brendle, J. R. (2005). Anxiety symptoms and disorders at eight weeks postpartum. Journal of Anxiety Disorders, 19(3), 295–311.
Yildiz, P. D., Ayers, S., & Phillips, L. (2017). The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. Journal of Affective Disorders, 208, 634-645.