Pregnancy in the time of Covid-19
Pregnancy therefore presents itself as a moment of considerable psychological complexity and therefore also of potential vulnerability. What does it mean to deal with it during the Covid-19 health emergency?
Advertising message I am a psychotherapist and I am pregnant. Not that these are privileges of these times, but with this article I would like to share some reflections on what it means to become a mother in Covid19 times. I will try to give my personal and professional contribution, shedding light on the current state of research, on the psychological aspects involved in gestation and on the opportunities present on the national territory.
Pregnancy in itself constitutes a particular moment in a woman’s life, in which aspects of psychological and somatic change require complex adaptation skills.
In addition to physical transformations, gestation implies new and important balances regarding individual, couple and social identity (Della Vedova, 2009). The pregnant woman must deal simultaneously with the bodily changes taking place and with the assumption of the maternal role, a process that involves responsibility and fears. The aspects relating to the construction of the female-maternal identity must also be reconciled with the changes that the new role imposes on the context, on the work, cultural and sexual identity of the woman (Ibidem).
Pregnancy therefore presents itself as a moment of considerable psychological complexity and therefore also of potential vulnerability.
In this period of change, the management of emotions becomes even more complex if our points of reference are distant, if we find ourselves fighting against an invisible enemy that we do not know, if we cannot rely entirely on Health Services.
However, what makes all this unbearable and makes us feel even weaker and more helpless is the absolute and indispensable need to have certain answers on how things will go.
Anxiety derives precisely from the perception of having lost predictive ability with respect to a certain domain of phenomena (Kelly, 1955; Lorenzini and Sassaroli, 1995). Suddenly the system knows it doesn’t know. It is not the simple “not knowing” that generates anxiety. The many things we don’t know don’t bother us. The latter only takes over following a forecast failure (Lorenzini and Scarinci, 2013). Until then we thought we knew, then an invalidation convinced us that we were wrong. In a certain area we knew and instead we no longer know. And the wider the field in which we remain without predictability, the greater the anxiety (Lorenzini and Sassaroli, 1995).
But there is not only anxiety. Discouragement is the feeling that one has when faced with the need to do strenuous work, with an uncertain and completely unexpected outcome (ibidem). In fact, faced with an invalidation, the system must carry out an overall restructuring work having to update the maps that have proven to be inaccurate (ibidem). This internal restructuring work will be all the more tiring, long and demanding the more the invalidation (or the prediction of it) will strike a central belief of our being in the world (ibidem).
We think of the importance we attach to the purpose of “becoming a good mother”: the more uncertainty we perceive around us and the more catastrophic our forecasts for the future, the more difficult it will be to live in the present moment in order to exploit all the possible resources available and enjoy the well-being of sweet waiting.
Then there is the emotion of anger aroused by the perception of the sense of injustice immediately: certainly we had imagined a better pregnancy, right now it had to happen?
The sense of guilt also does its part: the fear of being able to contract the virus if not sufficiently careful, anticipates a catastrophic scenario that must deal with our sense of responsibility; the possibility of not being able to offer the child the security that was hoped for, delineates us as the artifices of an immoral act.
But all is not lost!
There are several tools available that allow you to regain greater predictability than in the future and that allow you to manage the strong emotional load that future mothers are facing today.
Important is the scientific knowledge of the state of research. A study published a few days ago in the American Journal of Obstetrics and Gynecology – Maternal Fetal Medicine (2020), concerns the analysis of initial data on the outcomes of pregnancies in patients with Covid 19. The analysis evaluated the first cases reported in literature, from China, pending the publication of the first data on the Italian experience (Di Mascio et al., 2020). From the results of the study, it emerges that in mothers infected with coronavirus infections, including COVID-19,> 90% of whom also had pneumonia, preterm delivery is the most common negative result of pregnancy. Spontaneous abortion, preeclampsia, cesarean delivery and perinatal death (7-11%) were also more common than in the general population (Ibidem). An important fact, however, is the apparent absence of evidence of vertical transmission of the disease, or of transmission of the infection from the mother to the fetus in utero (Ibidem). In other research it was found that the amniotic fluid, the cord blood, the nasopharyngeal swabs of the newborns, the placental and vaginal swabs and the blood samples of positive COVID mothers had in fact always been negative in the search for the SARS-CoV-2 virus ( Chen et al., 2020; Fan et al., 2020; Wang et al., 2020; Zhu et al., 2020; Li et al., 2020; Chen et al., 2020; Chen et al., 2020).
These analyzes provide the first tools to satisfy the urgent need for numbers that can guide the counseling and management of pregnancies affected by Covid 19. The analysis is certainly limited by the scarce presence of data on the first trimester of pregnancy, on which they will have to make light the research projects which are already underway.
Advertising message Other tools available to combat the uncertainty of the future are those that allow new mothers to feel “more prepared”, which in more fortunate times would have been provided by accompanying courses at birth. Technology runs to help: by turning on the web it is possible to find all kinds of courses (also free of charge) that offer the possibility of receiving obstetric and gynecological support with respect to various aspects of gestation: the labor phase, the expulsion phase, the preparation of the suitcase, breastfeeding. Many ASLs or associations in the area offer the opportunity to get to know the outpatient clinics in the delivery room of their hospital and the spaces specially reserved for pregnant women at Covid19,
But practical solutions are not always the only pill to be taken to decrease anxiety and discomfort. These emotions are also fueled by the other side of the coin: the inability to foresee everything and the impossibility of having certainties about future outcomes. Being supported on this aspect has the important function of reducing the vulnerability of the pregnant woman and the risk of developing short and long-term psychopathologies.
Developments in the study of mental health in pregnancy and in the puerperium show that about 40% of women who suffer from postpartum depression have obtained a similar value referring to the pregnancy period (Heron et al., 2004). Recent research indicates the importance of the hypothalamic-pituitary-adrenal (HPA) axis for the transmission to the fetus of the effects of a highly stressful condition of the mother. In fact, a depressive or anxiety disorder can not only activate the maternal HPA axis, but can also increase the release of corticotropin releasing hormone (CRH) from the placenta, causing interference on the birth itself, inducing it.
Due to the profound biological, psychological and social changes it entails, pregnancy can thus represent an important stress factor and therefore be considered in itself an etiological agent for the onset of psychological disorders in vulnerable subjects. In other words, the emotional state with which pregnancy is faced is an element favoring conditions of psychopathological decompensation in already vulnerable women.
The clinical pictures that are most frequently found in the pregnancy period are anxiety disorders and mood disorders with the former occurring in about twice as many cases as the latter (Brockington et al., 2006).
If we add to this vulnerability the one induced by the spread of Covid19, we understand how indispensable a close collaboration between Psychology and Obstetrics / Gynecology is even more so in these times.
It is essential to face emotional suffering from the early stages of pregnancy and to legitimize the need to feel some emotions, to recognize and share them also through a path of psychotherapy. On this level, there are several professionals who continue to carry out online psychotherapy offering various treatments that allow them to feel less alone, less weak, less vulnerable and more competent, both in the period of gestation and in the postpartum.
If it is true that we would have hoped to give our children a better world, it is also true that they are the symbol of rebirth and the certainty that Life knows the way to go.
I conclude by making a sincere and heartfelt wish to all of us.