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Pregnancy: Coping with anxiety and psychological distress during the coronavirus outbreak

NIMHANS released guidance note on coping with anxiety and psychological distress in pregnancy and postpartum related to COVID-19

The current COVID-19 pademic is a difficult period for everyone, especially if you are a pregnant or a prenatal woman. Currently available evidence has found that while it is madetory to take the necessary precautions, the safest place to birth your baby is in a hospital, where you have access to highly trained staff and emergency facilities, if required.​

and COVID -19

It is important to remember that some amount of anxiety is natural and understandable. It helps to talk to someone about it, so consider reaching out to a trusted loved one. Sometimes the anxiety may become excessive. Reach out to your healthcare provider, which could be your doctor or your ANM (Auxiliary Nursing Midwifery) during such situations.

How will I know if my anxiety or distress is normal or excessive?

These are some signs that will help you recognise whether you have excessive anxiety or psychological distress

  • Excessive worry about getting the infection even when all precautions are being taken and even after reassurance

  • Lack of sleep because of anxiety

  • Focusing excessively on social media messages about COVID-19

  • Getting extremely anxious about infection control procedures in family members

  • Worrying too much about missing work

  • Feeling sad and angry because of isolation and not being able to meet family and friends

  • Feeling nervous, anxious, or on edge

  • Not being able to stop or control worrying

  • Trouble relaxing

  • Being so restless that it's hard to sit still

  • Becoming easily annoyed or irritable

  • Feeling afraid as if something awful might happen

How can women who are pregnant or with newborn babies prevent themselves from getting excessively anxious?

It is helpful to follow the four ways of coping—sharing, planning, decreasing anxious thoughts, and relaxing

Sharing

  • Keep in regular touch with your obstetrician or primary doctor or your auxilary wife midwifery (ANM). Ask them how you can get in touch if you feel too anxious or worried. Find out if the hospital or clinic has a number you can call.

  • Divide your day into four parts—rest, hobbies, work, and exercise. Try to create a timetable for yourself using these four headings equally.

  • Try not to stay isolated and find ways of interacting with relatives and friends through phone and video calls.

  • Stay away from disturbing social media and TV programs and request your friends and family not to send you messages that are negative. If needed, opt out of groups where there are too many messages.

  • During social isolation you may not be able to have the regular pregnancy related celebrations and this may disappoint you. Try to find other unique waysof making yourself feel special such as having a small function with just your immediate family and sharing the pictures with others.

Preparation and planning 

One good way of managing anxiety is to be prepared for eventualities. While some things are difficult to plan for, you can have a plan ready in case you have any urgent reason to visit the hospital.

  • Keep phone numbers of ambulance services, two or three of your friends, and your immediate family members handy, and inform them that you may need their help.

  • Send a scanned copy of your antenatal card, and share phone numbers of the hospital or your doctor with your immediate friends or family in case they need to come to the hospital to be with you. If there is a curfew or lockdown they will need to show it to the police if they are asked for proof.

  • Once the baby is born, keep the telephone number of the pediatrician handy. Speak to them about what needs to be done about immunization.

Decreasing anxious thoughts

What can you do to minimise worry?

  • Name the core worry. This stops it from getting tangled up with too many different issues. Is it about the delivery? Is it about the baby’s health? Is it about how your husband will reach home after he went out to get groceries during the lockdown?Sometimes, naming the worry will help point out that the worry is needless.

  • Try to avoid ‘fueling the worry’ or adding `petrol to the existing fire’ by staying away from social media posts, blogs, chat rooms discussing similar topics. Ask yourself – Have I looked at all the options given the current situation?

Positive things to do:

  • Talk to someone, not necessarily about the worry. Just chat.

  • Identify an activity that you enjoy and get immersed in it—reading, listening to music, solving a puzzle, going for a walk, playing with kids around you, trying a new recipe, cleaning a cupboard, trying some craft, making posters out of inspirational quotes, writing a diary/blog, etc.

  • Find ways to seek comfort—an inspirational talk, soothing music, chanting, or a book of wise words.

  • Try writing a gratitude journal, list all the things that you are thankful for.

Relaxing and

Find ways to relax—yoga, meditation, deep breathing, mindfulness. You don’t need any fancy equipment, and don’t try hard for a perfect, undisturbed time/space.

Simple relaxation exercises:

  • Mindful breathing: Close your eyes, relax in a chair or on the bed. Notice your feet resting on the ground. Focus on your breathing. Observe each breath as it comes in, and goes out, and in, and out. If you notice your thoughts straying, bring them back to your breathing. If any sounds around you claim your attention (the doorbell or birds chirping), notice the sound, but bring your attention back to your breathing. You can do this for ten breaths (or for 1 minute, or 3 minutes, or 5 minutes), and slowly open your eyes.

  • Square breathing: Breathe in, to a count of 1-2-3-4. Hold for 1-2-3-4. Breathe out for 1-2-3-4. Hold for 1-2-3-4. Do this for three to five breaths, or until you feel calmer.

What can family members of pregnant and postpartum women do to help them?

  • Be aware of the signs of excessive anxiety or psychological distress.

  • Try not to minimise the woman’s worries—tell her it’s natural for her to feel this way.

  • Try to address some of the concerns and encourage her to talk to her healthcare provider about her worries, rather than stressing over them herself.

  • Ensure she follows a routine and engage her in interesting conversations.

  • Find some activity that you can do together like playing a game, doing a craft or telling stories.

  • Ensure you have a copy of her reports and hospital card or the baby’s card and tell her that you have them readily available. Discuss a plan for handling a situation in case she has pain, bleeding or she goes into labour. Create a plan for support with baby care if the lockdown continues.

  • Teach her simple methods of relaxing and do them with her

  • If you feel anxious, try to talk to someone else about it and try not to add to her anxieties

  • Ensure that a mother with a newborn baby gets adequate sleep and help, with baby care. Encourage her to sing to the baby and play with the baby and decrease screen time.

  • Some of the routine childbirth-related rituals may not be possible due to the lockdown or social isolation drive. Try to find other simple ways of celebrating at home, such as creating a memory book of the baby’s first month and writing down messages from friends, grandparents and relatives, or get them to record music or lullabies or messages and send them to the mother and baby. These small activities will help the mother to feel connected even if her parents or partner cannot be nearby.

Sources:

Note: This content was developed by the Perinatal Mental Health Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India on 27th March, 2020. This is educational material and not medical advice. Please contact your obstetrician or a mental health professional if you would like help.

NIMHANS Perinatal Mental Health Helpline - 8105711277