Over the past few months, I have conducted interviews with people experiencing pregnancy, childbirth, and life with newborns amidst the COVID-19 pandemic. I’ve spoken with single first-time mothers and working mothers of six, those who have had home births and those who have been induced in the hospital, those giving birth with emergency or scheduled cesarean sections. As is typical in any sample of pregnant women, some welcomed and celebrated the transition to motherhood while others resented their pregnancy and feared the birthing process. These women described to me how the physical and social isolation imposed by the pandemic aggravates stress associated with birthing both during pregnancy and postpartum.
During pregnancy, social support tends to buffer the typical anxiety and unpredictability of medicalized birth. But such deep-seated fears are now borne by the pregnant woman alone, heightening reproductive stress, especially in cases of medical complications. After the birth of a child, the pandemic-mandated isolation during the transition to motherhood further threatens psychological stability and safety for those with Perinatal Mood and Anxiety Disorders (PMAD), as outside psychological and social mediation is largely inaccessible.
The medicalization of pregnancy and childbirth requires an intensive appointment regimen with various hospital personnel. During a regular pregnancy, physicians reveal medical knowledge at those visits: potential developmental complications and medical risk factors, anatomical malformations, and, of course, reports of healthy fetal development. Social support from partners and other loved ones typically eases anxiety with the sometimes-invasive procedures undertaken during this period. This can involve holding hands, discussing questions, and mediating the doctor/patient relationship. For those who have experienced medical complications during pregnancy, the absence of social and physical support imposed by the pandemic guidelines has been especially traumatic. Sarah (a pseudonym) recounts receiving the news that her baby has heart, brain and chromosomal issues. She attended her appointment alone due to strict hospital guidelines:
The only thing that I needed in this whole process was someone to touch me. [cries] Like, a hug or a hand hold, a pat on the shoulder even, just some kind of physical touch was what I needed, but no one could even come within six feet. My husband couldn’t be there, no other moms could be there, the doctors couldn’t do it. And I know that they’re trying to keep themselves as safe as possible, but the physical touch, I’ve... I’ve never realized how much I needed physical touch.
Sarah’s dream for a healthy baby has been shattered. She not only experiences loss of control of her baby’s health, an unfortunate potential outcome of any pregnancy, but also loss of control of her social support imposed by the pandemic.
During early motherhood, those with PMAD, anxiety, depression, OCD, and related conditions are typically regulated via medical, psychological, and social support in non-pandemic situations. Julie (a pseudonym), 8.5 months pregnant with her second child, has OCD that led to compulsion and fear that she would hurt herself or her baby after her first child was born. To manage this, Julie didn’t allow herself to be alone with her child. She describes the critical role of having another person physically present postpartum: “The support, to me, is essential. I guess it’s my life jacket. You know, I just need that reassurance and that protection I guess.”
Like Sarah, Julie describes how the physical presence of another person mediates physical distress. Social connection is necessary for the physical safety of herself and her baby. While reflecting on her previous postpartum experience, she recognizes that isolation was a site of danger. Anticipatory anxiety of this experience with her current pregnancy, coupled with the imposed isolation of the pandemic, creates an exacerbated context of potential harm.
While childbirth moved over the past century from the home into the clinic, the social nature of the birthing experience has remained strong. In the aftermath of the women’s health movement, new life is cradled by connectivity. Physical, psychological, and emotional support operate as buffers from the isolating, often anxiety provoking medicalized experiences of reproduction in Western society. While some of my respondents have expressed a dystopic existentialism — expressing guilt at bringing new life into a world in the throes of disaster — many have also expressed a sense of empowerment at their ability to rise to the challenge of the pandemic.
Such findings are not a call to ease restrictions of social isolation during an infectious pandemic. Instead, they reveal how the experiences of pregnancy, birth, and the transition into early motherhood depend upon the cooperation of multiple nodes of support — physical, psychological, social, and institutional. What does this dependence tell us about the institution of medicalized reproduction? And how can we move toward a more inclusive, safe and empowering reproductive movement even after the COVID-19 pandemic has passed?