Christine Hou's labor was getting closer and closer. Would she hang on a little longer so that her husband could pull into the parking lot and be admitted to the hospital with her, or would she have to go it alone?

It was March 26 in Manhattan, just as the coronavirus epidemic was beginning to peak, and several of New York's top hospitals had responded by introducing new birthing policies that restricted birthing wards and prohibited support partners.

Hou, a 34-year-old writer and yoga instructor, knew that because of these restrictions, her husband would not be allowed in the delivery room with her. But she said, "I just wanted him to come in with me. I was really scared." In the end, her husband made the decision not to risk it; it was their second child, and she was close to going into labor.

Hou entered the ER alone. The only entrance was open, and both COVID-19 patients and other patients had to go through the same door. To ease her pain and fear, Hou remembers that in the waiting room she "counted the things on the walls, the lights on the ceiling, and the patterns on the curtains to pass the time."

She delivered her daughter by C-section. She was allowed to bring her cell phone so she could FaceTime with her husband during surgery. She recalls, "I had to hold the phone, and my arm was so cold from the anesthesia, I was freaking out. 'I cried the whole surgery because I didn't know what was going on.'

The story eventually comes to as happy an ending as possible: Hou and her daughter are now safely home with the rest of their family. Hou and her daughter are now safely home with the rest of their family. After delivery, Hou's baby was immediately rushed to the NICU where she was examined and intubated due to low oxygen levels. Because she had to wait for the results of the COVID-19 test she had previously taken, it was nearly 12 hours before Hou could see her baby.

"It was all really traumatic," Hou said.

Hou's experience, sadly, is probably not uncommon in these times. And it speaks to the kind of mental health risks to which pregnant people across the country are prone during a pandemic.

Although New York hospitals have reversed their controversial decision to ban all support partners in deliveries, following a government order (open in new tab), hospitals across the country have adopted restrictive policies around childbirth, many of which allow only one support partner (These policies are in place as a precautionary measure during a raging epidemic and will continue to evolve as more information becomes available about the virus and its treatment.)

In addition to the stressful and potentially traumatic hospital experience, pandemics create and amplify feelings of anxiety and isolation.

Physicians and mental health professionals are bracing for an increase in pandemic-related mental health issues brought on by stress, isolation, and economic deprivation. We expect a secondary outbreak of mental health problems related to the ongoing stress that people are coping with," said Providence, RI-based pediatrician and psychologist who co-authored the American Academy of Pediatrics' policy statement on incorporating the recognition and management of perinatal depression into pediatric practice Dr. Jason Rafferty, stated." Perinatal depression is included in all of them."

Dr. Pooja Lakshmin, assistant clinical professor of psychiatry at George Washington University in Washington, D.C., says she has already seen an increase in perinatal (a term used during pregnancy through the first year after delivery) anxiety and depression across several categories. 'We're seeing a worsening of symptoms in women who were already struggling with perinatal anxiety and depression, and we're seeing symptoms of depression in women who were previously struggling with anxiety.' Dr. Lakshmin attributes the surge in depression in part to the lack of access to coping strategies. Because we are isolated and indoors, all the stress coping strategies that used to work, such as group exercise, outdoor activities, and time alone to calm down, have disappeared," she said. [These are things related to the pandemic in general (when will it end, how long will social distancing and isolation measures last?), economic hardship and unemployment, going to the hospital and being exposed to the virus, COVID-19, and the effects on pregnant women, newborns, and mothers. There's not a lot of strong data or research to show whether COVID affects pregnancy," said Dr. Lindsey. 'It has created a lot of fear and anxiety. Indeed, for Jessica (last name withheld), a Brooklyn-based attorney who gave birth to her second child in the last week of March, the fear of the unknown was the most stressful. At the hospital, in particular, "everyone is stressed, and the staff is trying to figure out how to deal with everything, and you can feel it. It's not the usual maternity ward atmosphere".

While a pandemic may exacerbate a situation that can lead to perinatal depression and anxiety, there are many ways to get support. Communities and caregivers who typically support women during childbirth and the postpartum period - doulas, lactation consultants, and behavioral therapists - are rushing to adapt their services digitally now that they can no longer physically see their patients.

Doulas typically attend their clients' births, provide massage and coaching throughout labor, advocate for their clients during hospital deliveries, and provide postpartum care, among other very hands-on tasks. Studies (opens in new tab) have shown that the presence of midwives leads to better birth outcomes, including a lower likelihood of low birth weight babies, lower likelihood of birth complications, and a dramatic reduction in the probability of C-sections (opens in new tab). They are currently working on the best way to be virtually close to their clients.

"Our primary focus is empowering families and enabling them to do it on their own," says Domino Kirk, co-founder of Carriage House Birth, a midwifery agency in New York and Los Angeles. The agency offers online childbirth education classes, newborn care and infant feeding classes, and free pregnancy and new mother support groups. Still, Kirk is realistic about its limitations." The current model of care is high-volume prenatal support, high-volume postpartum support, and on-call contact for strategies and advice during labor, but not necessarily having your midwife's face on the iPad for 12 hours." Kirk warns that having a doula on screen during labor and delivery distracts people from the experience and distracts doctors and nurses.

Mahmee, an LA-based telemedicine platform specializing in prenatal and postpartum health care, is hosting more behavioral therapists in anticipation of a surge in postpartum depression and anxiety. Says founder Melissa Hanna, "You shouldn't think of postpartum depression as something to be ashamed of or something you have to deal with on your own." He is already concerned about the long-term effects of the pandemic on new mothers. She says, "This could be traumatic."

Hou went to therapy to help her process the birth." I still feel really discouraged about the whole thing," she says, "but the therapy helped."