COVID-19, stress and pregnancy

Welcoming new life into this world should be an exciting experience. For Black women, pregnancy, labor and delivery can unfortunately be stressful and life-threatening experiences.

Black women suffer from pregnancy-related complications (oftentimes heart-related) at significantly higher rates than women of other racial/ethnic groups. Leading University of Minnesota School of Public Health researcher and expert Dr. Rachel Hardeman found that Minnesota Black women are two times more likely than White women to die during childbirth.

Add the challenges of 2020 from the COVID-19 pandemic, and Black pregnant women have several reasons to be concerned about their emotional and physical health. If you are looking down at your growing womb, scared and uncertain, rest assured that the medical community has learned a great deal over this past year about COVID-19.

For Black women, who now must navigate race, racism, and COVID-19 while pregnant, information is both knowledge and power.

COVID-19 and pregnancy

As of December 2020, the  Centers for Disease Control and Prevention (CDC) COVID-19 Tracker indicates 49,036 pregnant women have contracted COVID-19. While this represents only 0.3% of all cases, pregnant women are at an increased risk of developing severe illness from COVID-19. Additionally, Black pregnant women disproportionately represent 16% of these cases.

While everyone should wear masks and practice social distancing, both the CDC and the Minnesota Department of Health (MDH) agree that pregnant women should also:

• Notify their health care provider (obstetrician (OB/GYN), midwife, doula) if they contract COVID-19.
• Attend all health care appointments; discuss virtual options if there are concerns about in-person visits.
• Ask about their care facility’s visitor and delivery room policy; plan virtual support options for those who cannot be physically present at the time of delivery.
• Breastfeed, even with COVID-19. Mother-to-child transmission is unlikely. Breast milk is a great source of nutrients and antibodies for fighting off infections.
• Have a conversation with their health care provider about the COVID-19 vaccine, as this will help them make an informed decision about whether to receive the COVID-19 vaccine. There are limited data available on the safety of COVID-19 vaccines for pregnant women.

We know that new (and changing) information on COVID-19 can be cause for anxiety. Contact your obstetrician (OB/GYN) about any concerns—they are there to help!

Stress and pregnancy

The mental toll of demands that are greater than our ability to handle them results in stress. Be it racism, finances, or home life difficulties, the impact of stress on health is clear. In January 2020, a JAMA Pediatrics study demonstrated that maternal stress during pregnancy can affect the baby’s brain growth and proper development.

Signs of stress during pregnancy

Learning about signs and pregnancy complications of stress is the first step to becoming your best advocate! These include:

• anxiety, rapid heart rate or palpitations, and mood swings
• high blood pressure and headaches (indicators of pre-eclampsia)
• preterm (earlier than normal) contractions
• depression or loss of interest in normal activities
• increased blood sugar levels

Stress management tools

Often, the signs of stress can cause more stress, creating a vicious cycle. Concrete tools to manage stress and break the cycle are important! Here are a few favorites:

• Get real. It is hard to acknowledge that we are not OK, especially after chronically being “strong.” We cannot be our best for those around us if we are not well, especially mentally. Owning this is the first step to change!
• Get centered. Today, pressing pause does not always feel like an option. Taking a social media vacation, meditating, journaling, or strengthening spiritual practices are a few ways to reset. Additionally, “getting selfish” (saying no, identifying triggers and avoiding them) is key!
• Get connected. Family, friends, spiritual communities, and others you trust can reassure you that you are not alone. Reach out to them by phone or video chat. Joining a virtual fitness class or registering for an online workshop may be an exciting (and safe!) way to meet new people! Socially Distanced ≠ Isolated!  (Please, confirm with your health care team about safe options for connecting with others beforehand!)
• Get help. It takes real strength to admit you need help! Mental health days, therapy, psychiatrists, and peer support groups are all options to relieve stress. Seeking help for overwhelming work tasks, home errands, or child care can also reduce stress. Reaching out can change things!

Post-delivery precautions

Lastly, pregnancy-related complications do not end after delivery. It is important to continue these self-advocacy habits after delivery and beyond! Make a postpartum plan, and if something does not feel right at any point in your pregnancy or after, no matter how small, contact your obstetrician.

In Latin, obstetrician means to stand opposite. It is their job to support you through this journey.

Valerie Melson, BS is a second-year medical student at the Mayo Clinic Alix School of Medicine (MCASOM) in Rochester, MN. Prior to coming to MCASOM, she completed a Post-Bac at the National Institutes of Health and worked as a volunteer EMT. She has an interest in women’s health and hopes to have a career working in minority and underserved communities. She has a strong interest in obstetrics, gynecology and plastic surgery (breast reconstruction and gender affirming surgery).

LaPrincess Brewer, MD, MPH is a board-certified preventive cardiologist and assistant professor of medicine within the Department of Cardiovascular Medicine at Mayo Clinic in Rochester, MN. She is passionate about community health and faith-based interventions to achieve healthy equity in disadvantaged racial/ethnic minority communities. She is the founder of the first academic-community partnership program between Mayo Clinic and African-American churches.