Postpartum in a Pandemic

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As COVID-19 takes over most aspects of our lives, many of us are putting milestones like weddings and birthday parties on hold. But if you’re pregnant, the baby is coming and you can’t press pause. How can new parents minimize stress and find support in the middle of a pandemic? You might have to change your birth plan based on new hospital policies; or maybe you’re seeking remote family support when you’re social distancing. KCRW's Bodies team spoke with a handful of doulas and birth workers to gather tips for expecting parents who are preparing for birth and postpartum. 

How to Keep Calm in the Birthing Room

Helena Vissing, a perinatal psychologist said that “the uncertainty of being a new parent is already like fumbling in the dark.” That’s why she and others we spoke with recommend slowing down and staying inside the birth bubble. Only take in the information you need; and that’s the stuff that’s going to empower you during delivery. Kim Summer Zuleger, a birth and postpartum doula based in Santa Barbara, recommends turning off social media and telling hospital staff not to discuss the virus if it’s not immediately necessary. “We can try to just create this birth bubble and sort of not even think about what's happening [elsewhere],” she said. 

While social media isn’t recommended in the delivery room, understanding what to expect during labor could ease stress for expecting parents; for instance, study details about contractions, dilation and delivering the placenta. This is something a doula would normally assist; they prepare parents for what’s to come, they educate and advocate during the delivery. “You need to know what childbirth is, you need to know what's going to happen to your body, you need to know how to handle it, and you need to know how to cope with it,” said Efe Osaren, a Brooklyn based doula and student midwife. In the past, her clients didn’t have to learn all the information since Efe was there to support them. Now, during the pandemic, she wants them to enter the hospital armed with even more knowledge since she can no longer accompany them physically. 

Remote emotional support is crucial. Claire Nichols, who had her new baby on March 18, was planning on meeting other new mom friends regularly for coffee and walking dates. She can’t do that now, but they send each other late night feeding selfies instead.  Photo by Claire Nichols.

Kim Borchert, an Austin-based doula, chats virtually with her clients as they get ready to go to the hospital. She asks them to bring an iPad or laptop to the hospital and “put it on the table so we can really get a wide view of the room and see what's happening.”  

Some expecting parents are weighing whether they should still give birth in the hospital at all or whether they should induce labor and try to have their babies earlier before the virus continues to spread and overwhelm hospitals. Tara Brooke, director of Doula Training International, warns that expecting parents should avoid making decisions out of fear. 

Borchert recommends using the acronym BRAIN (Benefits, Risks, Alternatives, Intuition, Nothing) to assess the situation. In trying to make a call about something important, ask yourself: 

  • What are the benefits of this action? 
  • What are the risks associated with it? 
  • What are all of my options? 
  • What is my gut telling me? 
  • And what if I do nothing? 

If you need help thinking through all of your options, and how to prepare, ShiShi Rose says lots of doulas, including herself, offer free and sliding scale services. She says if you’re expecting, dig deep into what you want your birth plan to look like. But also: be open to the fact that plans change. 

Preparing for Postpartum 

Many of the birth professionals we spoke with recommend that new parents take time to prioritize their mental health even if it means letting other things slide. Take time to go for walks, get enough sleep, feed yourself and meditate. In New York, Governor Andrew Cuomo helped set up a mental health hotline. Other mental health resources include free guided meditations from UCLA  as well as telehealth therapists; some insurance companies are waiving copays for this. 

TaKeesha White, who gave birth to twins on March 18, says one way parents can stay mentally healthy is by voicing any negative feelings as soon as they have them. “If you were thirsty, or you had to pee or you needed help with something, you would speak up, do the same now with your feelings and your thoughts. Speak up now and let us let it out because it is compounded with what's happening in the world.”

There are things partners can do to ease the postpartum experience for their significant others. For instance, keep snacks nearby the new parent or print out some helpful PDFs with information about breastfeeding positions or anything else that needs extra attention. And even though you can no longer go over to your friend’s house to cook, you can still support new parents by leaving meals on their doorstep or giving them gift cards or coupons. 

Isolation could also increase the risk of PMADS, or Postpartum Mood and Anxiety Disorders like postpartum depression and postpartum anxiety. If you’re concerned about this, there are virtual resources available; for example, the Motherhood Center in New York is offering virtual classes, counseling and consultation to people experiencing PMADS. 

Above all, Zuleger wants new parents to continue to value their birth experience. “I feel like we've sort of dropped the bar right now where instead of saying, oh, we're going to have a beautiful empowering birth,” now it’s  how can we mitigate trauma?” Like that's where our bar is at right now” But, she insists, you still can have a beautiful birth experience with the right attitude and preparation. 

*Read the full audio script.*

RESOURCES FOR PARENTS

Virtual classes for new and expecting parents:

Mental health resources 

Finding a Doula + Free and sliding scale resources

Pregnancy specific government sites 

Professional Organizations on Pregnancy and COVID-19


Full script:

KALAISHA: Hello! Hi. 

ALLISON: Hey Kalaisha. 

KALAISHA: You can hear me right?

ALLISON: Yeah. 

KALAISHA: OK, cool. 

ALLISON: Do you have your mic setup

KALAISHA: Ok I think we’re good

ALLISON: How are you doing?

KALAISHA: I’m doing fabulous. Um, she’s in my arms, she just fell asleep right before you called me.

ALLISON: And what’s..what’s her name?

KALAISHA: Magnolia, like the flower.  

ALLISON: I love that. Yeah, all the Magnolias are blooming in Brooklyn… I’m on the phone with Kalaisha Totty. You might recognize her voice from our last episode. She’s the reporter who talked to us about Johnson & Johnson baby powder and the marketing of dangerous beauty products. 

KALAISHA: Actually one of the baby shower gifts that I got was like a Johnson & Johnson gift set. And I’m, like, side eyeing that, and I’m like, "I don’t know about that now. I’m not sure. 

And if you remember, Kalaisha was also very pregnant. She had her baby last week and so I gave her a call to see how she was doing.  

KALAISHA: Through my entire pregnancy I was basically self isolating just because I didn’t feel well, I didn’t have any energy. So I was really excited to have my baby because I was like I’ll feel like myself again, I’ll be able to take her out. So going from nine months of isolation to indefinite isolation, it’s been really hard to kind of cope with. And like I cried for the first few days. Because I was like, I don't know what to do. I can't sit in bed all day. Like, I'm disappointed that I can’t do the things I wanted to do. 

There were days where I was like I don't even know what I did all day. It was just nine o’ clock in the morning and now it’s nine o’clock at night and I don't know what I did. I feel like I stared at a wall all day.... [laughs] But  I had to tell myself no amount of crying is gonna fix anything. You just have to make an alternate plan. So one thing that I try to do is get up in the morning. I take a shower just to like you know...I put on real clothes every day. I have a routine of when she eats, when she sleeps, when I change her. And then I try to go on walks just around my apartment complex just to get outside, because for a whole week I didn't leave the bed really. 

ALLISON: Yeah, yeah I can understand that. Well, the last thing I wanted to ask about, I mean it sounds like a lot of really really tough stuff. But can you tell me about a fun moment, a moment of joy?

KALAISHA: She smiles in her sleep. And I can't get a picture because it's so fast, but it's the cutest, like, oh my gosh I'm obsessed with her little face. She's so cute. But also seeing my fiancee with her, like, I cry every single time, like, he sings to her. The way he talks to her, like, I didn't know [if] I could be more in love than I already am now. 

ALLISON: Aww!

KALAISHA: Seeing them together is just like the best thing I've ever experienced in my life so I'm very fortunate that he gets to be home with us.  

ALLISON: This is Bodies, a show about people solving the mysteries of their bodies. I’m Allison Behringer.

Today, we're taking a break from our usual documentary storytelling to talk about something that's really important right now. And that's postpartum — the time after you give birth. 

This is a topic I’ve been wanting us to cover since I started Bodies. I've spoken to so many parents and birth workers over the years and it’s become really clear to me that we don't support mothers and birthing parents enough AFTER the baby comes.

After a person gives birth, there’s a drop off in their hormone levels which has an effect on emotions and brain functioning. There’s also the lack of sleep...not to mention a HUGE life change.

I think most people know about postpartum depression, but there are other mental health issues, like postpartum anxiety and postpartum psychosis.

A lot of the experts I’ve talked to have said that one of the first lines of defense against this is community support. 

But how do we find that support in the middle of a pandemic? With social distancing and stay at home orders in place, postpartum can be even more isolating and lonely.

One of the people we spoke to for this episode is ShiShi Rose. She’s an activist, an educator and a doula. As a doula, her job is to support people from pregnancy to postpartum — like helping them create a birth plan or find a good pediatrician.  And she specializes in advocacy for black families.  

Compared to white women, Black women are 3-4 times more likely to die during childbirth and the postpartum period, which includes up to a year after birth. In New York City, where ShiShi lives, Black women are up to 12 times more likely to die. Research has shown that two of the biggest factors are medical racism and weathering — which is when the stress from racism affects physical health. 

And so ShiShi’s doula work isn’t just providing emotional support. It can also be about saving a person’s life. Like this one time, after ShiShi’s client gave birth, the doctor didn’t check to see if the placenta to see if it was intact. And so ShiShi stepped in. And it turned out there was an issue with the placenta. And if she hadn’t been there, her client could have gone home and hemorrhaged to death.

On top of her work as a doula, she just gave birth herself — to a baby girl, named Sula. 

ShiShi was in labor for 12 days.

And when Sula did arrive, 

ShiShi: I remember crying a lot. Like ugly crying. And I remember her crying and, like, the way that, like newborns, their little mouths are,  the way that they scream is just really funny. So yeah, we were just like crying together. 

ALLISON: ShiShi is a single mom and she’s been home alone with her daughter for a few weeks. 

I spoke with her on the phone while she was nursing.

--

So I want to start with your pregnancy — I’m wondering: given your knowledge and your profession as a doula, when you were pregnant with Sula, what were some of the things that you were doing to  advocate for yourself and prepare for the postpartum time? 

ShiSih: I think that I was concerned about possibly getting postpartum depression just because I do have a history of depression. And I had to get off of my antidepressant when I was pregnant, because it wasn't safe for the baby. And I was just like looking for whatever type of body type therapy alternatives that I could find. 

So acupuncture was really helpful for that. And then I also was in therapy with two different therapists.

I feel like I worked really hard in my pregnancy to ensure that I had the mental health support that I felt like I needed and that a part of that was me —  Hold on a second. Part of that was me heavily planning the postpartum time, in order to prevent — not that you can prevent postpartum depression, but in my brain in order to prevent it from happening. I am a heavy planner and I'm like, if I plan everything and I organize everything and I get, like, support that I need and I'm not, like, isolated by myself in those early weeks, then, you know, things are gonna go better. And so yeah I was, and still am very concerned about mental health in this postpartum time. 

ALLISON: And what else did you know about postpartum mood and anxiety disorders going in — like I feel like people a little bit… people know about depression, but I feel like the broader public doesn't necessarily, like, have all the knowledge about the different ways it can look. 

ShiShi: Well, I think one thing too that is definitely left out of the discussion is postpartum anxiety. I feel like everybody instantly goes for depression, but a lot of people have postpartum anxiety and it presents in, like, so many different ways that there's not even, like, one like by the rulebook, you know, way that it can look, because everybody's anxiety shows up differently. 

I feel like postpartum anxiety is harder to pinpoint because as a new parent, you're already so anxious. A lot of the things that it says, like the books say about postpartum anxiety, about, like, watching the baby when the baby sleeps and like you think that something bad is going to happen to the baby. And like all that, like that's just being a new parent in general. So it's really hard to lock down when that becomes more excessive. 

So I feel like that goes under-diagnosed and underreported a lot. And a lot of people don't get support around it because people don't know what's normal and what's not. 

So I felt like as much information as I knew about postpartum depression, I was not prepared for postpartum anxiety as much as I should have been. And I feel like that has been what has, like, come more into play than the depression. 

ALLISON: Yeah. So I know you had your own doula in this. What were some of the things your doula helped you do?

ShiShi: My postpartum doula came to my baby shower and basically passed out a notebook to everybody so that they could sign up for jobs for postpartum. And at first, I, like, didn't want to do it because I just felt like I didn't want to, like, ask my friends that bluntly to be like, “hey, can you guys take my trash out and do my dishes?” But I actually had several friends after the baby shower that were like, that was so cool that your postpartum doula did that. 

And they're like, I always want to support friends that have a baby, but I never know what to do. 

I also like this idea of asking people to show up in this time, because this is not meant to be done alone. And even for people who are single and, or people who choose to be single parents or whatever, like, it's you're never supposed to, like, parent alone. There’s supposed to be a community aspect to all of this. 

ALLISON: Yeah, definitely, definitely… And so, you know, you come home from the hospital. It’s end of February, beginning of March. Really? Couple weeks away from the CDC announcing there's a pandemic. So what was that first week like? 

ShiShi: The first week was like everything that I had planned with my doulas. It was me being fed and people bringing me drinks and, you know, staying over to help with the baby and my postpartum doula, like, massaging my body because I was so swollen from the birth.  And it felt amazing that basically, like, I pulled it off, like it actually worked. They actually showed up. And I'm really grateful for that. 

Everybody was kind of on a schedule of who could do what when and who could do overnights. It was really nice for a week and a half to have that and to have them coming over and helping me get a break, and like loving on us and everything. And then this Corona situation hit and yeah, that kind of all went out the window. 

ALLISON: ShiShi felt prepared to be a single mom, but not like this. After about a week of being home with Sula, the Governor of New York City put a stay at home order in place. And all the people that were supposed to show up, couldn’t come anymore.

ShiShi: We’re stuck in isolation and that’s not something I would that I would really wish on anybody in the immediate stages of postpartum or really just in parenthood in general. It sucks. I don’t even know how to describe it. Because it’s actually the exact opposite of what is needed during this time.

So many people were ready and willing to show up. And even though they can’t be here right now because of this coronavirus, it is nice that we have that support system and that when this is over, we will still have that to rely on. It is hard not being able to have that right now. But it does give me comfort to know so many people were ready to show up for me and my baby during this time. People were jumping on Zoom calls, like, nonstop and doing Zoom hangouts and all these like Zoom events. 

And I'm just like: “where was this energy before when, you know, we were all so busy with our lives constantly.” 

And so I do like that we've been told to slow down and like forced to talk to each other. I do hope that after this whole thing is over or whatever life looks like when it’s over, I hope people continue to show up with the same energy and really show up for each other.

___

ALLISON: More of ShiShi’s story and her work as a doula… after the break. 

___

I’m talking with ShiShi Rose, an activist and a doula, who is at home in New York City with her newborn baby. 

The Coronavirus outbreak has not only changed her own postpartum plans — it’s also impacting her work as a doula.

ShiShi: Yeah. So the plan before I had her had basically been that I was going to like take off from doula work for a while. But since all of this happened, I've realized that there's a lot more need for virtual care, because that's the model that most doulas are having to switch to right now, is to like virtually support clients. 

Now they can have one partner with them, but now they still have to choose between having a doula or their husband or wife or like whatever other partner, maybe their best friend or whoever was supposed to be there. So mostly it's just helping them to prepare for what life is going to look like birthing during this pandemic. 

ALLISON: Do you feel like doulas are more important now and do you feel like they're more important for the black families that you work with? 

ShiShi: I wouldn't say that they're more important now during the pandemic. 

But doulas were always important. Having a supportive person to help guide you through your birth process and advocate for you and support you. That's always important. And I think that everybody deserves a doula. But marginalized communities like the Black community does need doulas more than anybody else, because they need that person there advocating for them. They need that person telling them that they're gonna do OK and that they can like they can advocate for themselves and that they can have the birth that they want when everyone has been telling them that they can't have it.

ALLISON: You know, a lot of people are talking about how the coronavirus has exposed gaps in our healthcare system or shortcomings in our healthcare system. I'm curious, what do you think about that?

ShiShi: I think it's really interesting that people are acting like these gaps were not exposed this entire time. Because Black people have been screaming about all these gaps in the medical system constantly. People didn’t kind of like wake up until white women were told that they couldn't have their doulas in the room with them. You know, Black people have been trying to fight against hospital policy and unfair policies for forever. We've been talking about medical racism and unfair practices. And doctors inducing for no reason and doctors doing C-sections for no reason. And, you know, us really needed to change the way the medical system works and families deserving better. And we've been trying to, like, advocate around this for so long. 

And so it's almost like, it's almost like offensive to think that people are saying that these gaps in the healthcare industry have been exposed because of the Coronavirus. Then it's like: “what the hell have we been yelling about all this time?” 

ALLISON: What is your advice for people, especially marginalized people...What's your advice? Giving birth, preparing for birth, preparing for the postpartum period during this time

ShiShi: My advice would be to take in as much information as you possibly can. Try to find yourself a virtual doula if you can. There's a lot that are doing free and sliding scale options for the people that can’t afford it. I am one of those people. 

Just find as much information as you can because basically you're going to have to be your own doula if you're going in there without one. And to be your own doula means that you're going to have to like understand how this system works in more ways than you would have if you had a doula there with you. 

Like really dig deep into what you want your birth plan to look like, how you plan to get them to like listen to your birth plan, like maybe also being open to the fact that plans change. 

Educating yourself and being open, I feel like the two biggest things that I can suggest. 

ALLISON: Things didn’t go the way ShiShi wanted, not in her birth or her postpartum — But she’s creating new plans to adjust, and adapt. 

ShiShi’s friends still drop off groceries at her door — and she’s seeing one of her friends, who agreed to also self isolate so she could safely visit ShiShi. She says that human contact and having someone caring for HER has been really important to her mental health.

And she is doing her best to focus on taking care of herself and Sula. And thinking about the future. 

ShiShi: I'm looking forward to just seeing my friends and like having her around my friends. And I'm looking forward to hugs and parties and looking forward to holding people's hands again. That’d be great without worrying. 

It's hard to be this isolated. And it is depressing and sad. But at the same time, I don't want to look back on this and only see sad times. 

I mean, every day with her joy, even right now, she's just like smiling at me so much. It's it's joy, too. It's all the things at once, which is just parenthood in general. 

Thank you to Shishi Rose for her time 

In reporting for this episode, we spoke to lots of experts and parents. 

Some of them told us what they were missing; others offered advice: 

Efe Osaren: Think of the power that people had before in terms of laboring alone and birthing alone. Yes, it's not the ideal, but people have been doing it for centuries, right? Like I talk about childcare, being a very intuitive process that you really need to know how to trust yourself. You really need to know how to trust your instincts. 

TaKeesha White: Immediately, as soon as you're feeling your feelings, feel them. First of all, you just gave birth. So you know what it's like to feel the pain and let the pain pass, So let your feelings be similar, let the feelings come and feel them. 

It's a little,  it's a little painful. I wanted so much more. And I’m such a big supporter of that. Like, you know, we celebrate life, new life in our family. Like most families, you know, and we. And we want to be there and cook and have the house smelling like good food and hold babies for the mommy, and make all these jokes. You know, even now, like I'm tearing up, I'm letting myself fully express my feelings, and I'm not trying to stop my emotion.

Claire Nichols: So we were looking forward to a different kind of maternity leave where we met for coffee and took walks with the babies and got out of the house together. When you're sleep deprived, is that coffee with a friend can...it's like Disneyland. You know, when... when is it gonna be over, that's the hard part is not knowing. 

Kim Summer Zuleger: Do some screaming if you need to. If you need to do a primal scream in the car, go ahead. I get it. We are seeing people — pregnant people — and families really having to dig deep and do more than they thought they were ever going to have to do. They already knew they were going to have to dig deep to birth. But this is a whole other level.

 

Takeesha White, Helena Vissing, Tara Brooke, Regina Conceicao, Mary de Vera and Kimberly Zuleger contributed to this list. Article written by Hannah Harris Green.

Credits:  

Host and Producer: Allison Behringer
Associate Producer: Hannah Harris Green 
Editor: KalaLea
Composer/Sound Designer: Dara Hirsch
Mix Engineer: Myke Dodge Weiskopf 
Additional editorial support: Sharon Mashihi 
Story Consultants: KalaLea, Caitlin Pierce, Cass Adair
Research Assistant: Liz Charky 
Managing Producer: Kristen Lepore

Credits

Host:
Allison Behringer