Written by Nurturing Birth doula and epidemiologist, Georgia Ladbury
It’s now three years since Covid first arrived on our shores, and it’s hard to remember a time where we didn’t live alongside this disease. What’s more, with the world now chugging along as if nothing ever happened, it can be harder still to remember that time where we were all told to stay at home, where it was illegal to hug someone outside of your household, where we lived in the shadow of a new virus as it stalked silently amongst us.
And yet, it did happen. And with it came sudden and drastic changes in the way maternity services were provided to pregnant, birthing and postnatal women. Face to face appointments with midwives and care providers were reduced; and birthing support partners were excluded from antenatal appointments, from accompanying women in early labour (and in some cases, the entirety of labour), and on postnatal wards. In addition, women’s informal support networks in their communities – friends, family, baby groups – were stripped away due to Covid restrictions that forbade people entirely to mix outside of their households, or permitted this in small groups only. This was in a context of a new disease where the severity of infection in pregnant women, and in unborn babies and infants was largely unknown – especially early on in the pandemic.
I trained as a doula in February 2022, at the tail end of the emergency response which was finally, slowly, beginning to be dismantled. Having worked on this response as an epidemiologist, I was very interested in the wider impacts that the Covid restrictions had had on people’s health and wellbeing, particularly pregnant women and new mothers. I was fresh from reading Professor Amy Brown’s Covid Babies, a tour de force in documenting the combined effects that the circumstances of the pandemic had on new mothers and their babies at the time. The book led me to wonder: with such a profoundly different experience of first time motherhood to that which is “the norm”, what would the experience of pregnancy, birth and the postnatal period with a second baby be like for women who became mothers for the first time in the midst of the pandemic – and how could doulas best support this cohort of women going forward?
These questions became the topic for my post-module project. In the summer of 2022, I interviewed six women over the phone regarding their experiences of having a second baby or pregnancy after having their first child during Covid restrictions. All six women had approached me after a post I’d placed in Facebook group explaining the project’s aims. Our conversations lasted around an hour, during which I took handwritten note. Once all the calls were completed I went through these notes in search of common themes that were arising throughout. It was a challenging and sometimes heart rending process, but I was so impressed and indebted to these women for their fortitude and courage in reflecting on and sharing their stories.
When discussing the women’s experience of their first pregnancy, births and postnatal period, one common theme was a sense of abandonment when Covid restrictions set in. They depicted feelings of being left alone without support, and a sense that this was different to normal times. This applied right through from antenatal to birth to postnatal care.
“I felt completely forgotten about.” – quote from interviewee
Linked to this was a sense that the normal healthcare protocols that they would expect for a mother or infant were not being followed and were falling short of minimum standards of care. Several women mentioned long response times after calling for assistance; adequate infant feeding support in particular was often mentioned as being very lacking both during the immediate hours postnatally and in the community.
The women also reported feeling isolated and lonely due to the Covid restrictions. The loneliness was linked to feelings of heightened anxiety because the normal systems of support through which they could access knowledge and reassurance – be they formal systems of healthcare provision, or informal systems of social support – had been removed. They also expressed regret and deep sadness about not being able to welcome and integrate their baby into the wider world.
“I just felt robbed of my experience. There was no going to see friends, no going to see family…it’s silly things, like I started him in nursery early because he had no interaction with other children and no baby groups were running. It broke my heart during settling sessions to see him play with another child.” – quote from interviewee
Some women felt that the pandemic had impacted negatively on the quality of the interactions between themselves and healthcare professionals (HCPs); becoming more distant or dismissive. In some cases, the women rationalised this as being a natural consequence of the actions HCPs were having to undertake in response to the pandemic. However, in other cases, women felt that they were being unfairly victimised by healthcare professionals, as if they were being used as an outlet for the HCPs’ stress:
“I felt like they were taking their frustrations out on me.”
While this project intended to compare the maternity experiences for women birthing during Covid restrictions for the first time versus their experiences birthing for the second time once these restrictions had been lifted, it became clear that, in many cases, restrictions were still in place for the second time. Indeed, women who had birthed in spring 2020 had been able to experience almost normal antenatal care and then were faced with, for example, attending scans alone during their second pregnancy. It was clear that the remaining restrictions had continued to place stress onto pregnant women.
Some women spoke about how the negative experiences from their first pregnancy/birth/postnatal period ended up impacting on their second; still other women mentioned that, while they did not recognise this as an issue for themselves personally, they had other friends who were mothers (e.g. whom they had met through NCT groups) who were experiencing this.
“When I got pregnant again, I went for a scan and bloods at the antenatal clinic. For some reason it was a really long wait. My partner wasn’t allowed in. I sat down in the clinic and I wanted to cry, but I didn’t know why.”
Several women described that their first experience of pregnancy and motherhood had been so strange and so isolated, that they were still unsure of what should be considered “normal” – both in terms of what kind of maternity care they should receive, and in terms of what to expect from pregnancy and infancy. They described an expectation of being “experienced second time mothers” who were no doubt well-informed having been through the process of pregnancy and birth before, but felt that they could not meet these expectations and perhaps needed more support and direction than was assumed by HCPs and wider society.
“I’m more knowledgeable now but there’s a massive expectation from midwives that you should know what you’re doing because this is the second time around – but everything was so different with my first.”
There was a sense from several women that they had put up with a lot during their first maternity experiences, and were often unquestioning about it owing to this being their first time and/or because they recognised the pressure that the health services were under as a result of the pandemic – but that, second time around, they felt more inclined to be less accepting, to push back against poor care and to advocate for themselves. This is possibly true of all second time mothers, Covid or not, but these feelings have perhaps been exacerbated by the added powerlessness that women felt during the pandemic. And while many women expressed regret over not having the opportunity to share their newborn baby with others after their first birth, some women in hindsight recognised that in some ways, this enforced period of cocooning was helpful for bonding and recovering, and especially for establishing breastfeeding – and that they had missed out on this with their second child by their own eagerness or by social pressures to introduce their baby to wider family and friends as soon as possible.
“Lockdown helped with skin to skin and feeding on demand, and so the baby was very happy. Compared to my second born, who gets overwhelmed by being passed around.”
So, what can be learned from these conversations that we can use as doulas to improve our practice in supporting women who are pregnant for the second/third time in the coming months and years? There are three key areas that I believe merit out particular attention:
- “Covid is not over”
Now that the pandemic emergency response has been stood down, life is almost back to normal and it is easy to live as though Covid never really happened; indeed, it may be particularly tempting to do so as it is seldom enjoyable to dwell on an unpleasant experience. However, the restrictions will cast a long shadow for women who became mothers during this time – and this applies not only to women who birthed in 2020 in the pre-vaccination era, but for a long time after that, as restrictions lasted for a very long time on some maternity units (evidenced by the #ButNotMaternity campaign). This short project has shown how impactful restrictions have been on the women who experienced them as first time mothers. In an ideal world, women would be able to talk through these issues with their midwife, building up a trusting relationship through continuity of care, and through this diminishing the possibility of these earlier experiences triggering trauma in subsequent pregnancies and births. However, given the pressures that maternity services are currently under it is unlikely this scenario will be realised for most women. Doulas can step into this role here, and should be prepared to see the effects of Covid on women for some time yet, making sure they build time specifically for conversations about these matters into their meetings with clients antenatally.
- Every pregnancy is different – but Covid pregnancies were really different
There is widespread acknowledgement within the birthing community that every pregnancy and birth is different, so even if a woman is a second time mother and has gone through the process of pregnancy and birth before, her first experience cannot fully inform nor prepare her for her second. It is very important to remember that this is never more true than for women who became mothers for the first time during the Covid period, for a whole host of reasons from the organisation of maternity services to the types of social and community support that were accessible to new mothers (or not) at that time. Doulas must not assume that mothers who had their first pregnancies and births during Covid restrictions are “old hands” who know what services are available locally, or who are adept at managing life with an infant when the rest of the world has not stopped. Clients may need assistance navigating through a more normal pattern of maternity care, need signposting to local services which may have been halted during the pandemic, and perhaps need more intense practical and emotional support with balancing the demands of the outside world with the needs of a new baby (eg by preserving an element of protected time with mother and infant in those first weeks following birth).
- Advocacy and information
This project showed that women who became first time mothers during the pandemic have a strong desire to advocate for themselves in subsequent pregnancies, but also that they remain relatively unsure of what standards of care they should normally be receiving in a maternity system. Given that birth partners were often excluded from maternity appointments, births and postnatal wards during the pandemic, it can be assumed that women’s partners are similarly unaware of the care they should be expecting for their partners. Doulas, who tend to know their way round local maternity and community support systems (or at least, where to start to find things out) could really come into their own in this regard by helping to amplify women’s voices and wishes precisely where they need to be heard.
I hope that readers have found this blog post useful to their doula practice – please get in touch with me if you would like more information (you can find me at www.georgialadbury.com). I would like to end by thanking all of the women who took the time out of their busy days to share their stories with me, despite the deeply personal nature of these experiences; having to think back on challenging and often distressing times; and the multiple competing priorities for a mother who has that scarce window of opportunity brought by sixty child free minutes. I am humbled by and deeply grateful for their participation.