Book Review by Dr Mari Greenfield
Covid Babies: How Pandemic Health Measures Undermined Pregnancy, Birth and Early Parenting by Amy Brown is published by Pinter and Martin and costs £12.99
Those who became parents during the pandemic have experienced pregnancy, birth, and perinatal loss in a way that those of us who became parents before the pandemic can hardly imagine. This well-researched book draws together the wealth of evidence that can help us try to understand the experience, and presents it in a way which is accessible to parents, helpful to healthcare professionals who want to alter their practices, and useful to policy-makers who are wondering how to help.
Brown immediately cuts to the biggest issue faced by perinatal services and expectant parents during the pandemic; have we balanced the physical safety due to Covid with the physical and emotional safety parents need in antenatal, intrapartum and postnatal care? Within the first chapter she states that – at least some of the time – this balance has been wrong.
The cost of getting the balance wrong has had a terrible toll. Women and babies have died. In the first chapter, the statistics about pregnant women who have died from Covid in the UK are broken down, and discussed in illuminating ways. Brown pulls no punches in setting out how many women died either from poor care whilst they had Covid, or from the altered maternity care arrangements. These deaths were all potentially preventable. Neither does she shy away from pointing out that many of the women whose lives could have been saved were Black, Asian, and/or had a BMI>30. She names the role institutional racism has played in those deaths, although she does not discuss whether fatphobia may also have affected care.
The pandemic, Brown argues, also caused the deaths of many babies, though very few directly died from Covid. Instead, babies died (especially in low and middle income countries) from not being breastfed, especially if they were separated from mothers who definitely or potentially had Covid. In the UK, more babies died at the hands of their parents. This was the result of a combination of factors; the ‘pressure cooker’ (p.115) of lockdown, combined with the absence of practical support from family and friends, and the absence of in-person visits from Health Visitors, many of whom had been redeployed. Many more babies did not die of these causes, but were seriously harmed, and will experience long-term effects.
Brown is (rightly) strongly critical of the UK’s ‘chaotic’ (p.35) messaging to new and expectant parents about Covid risk, especially in the early days of the pandemic. She links this messaging, as well the changes that were brought into perinatal care, as contributing to the massive rise we have seen in perinatal mental health difficulties. Messaging about the risks of Covid to pregnant people and their unborn babies was inconsistent, overwhelming in volume, and often plain wrong. Throughout the pandemic, it seems to have been impossible for official sources to admit to a lack of knowledge or uncertainty, resulting in misinformation from official sources. Where an incorrect message had been circulated, whether that was about the risk of death to pregnant people from Covid, or the safety of vaccination during pregnancy, new messages simply replaced old messages, with few public explanations about why the incorrect information was circulated, and no apologies. This situation, Brown argues, has directly increased perinatal anxiety, and led to a loss of trust in official information.
In terms of the changes to perinatal services, Brown says,
‘it seems that the pressures of the pandemic took everything we knew about what works well in supporting pregnant and birthing families and shoved it in a dark cupboard somewhere’ (p.49)
She then proceeds to describe how parents were physically separated from each other during miscarriages, terminations, births, and the illness and even deaths of their young babies. She talks about the removal of all support networks – families, friends, midwives, health visitors, child development services, antenatal education, breastfeeding support, baby groups, other parents, fertility services and perinatal mental health services. The results are unsurprising – increases in birth trauma, increases in mental health difficulties, increases in relationship difficulties and breakdowns.
Throughout the book Brown describes how these changes had an even greater impact on some new and expectant parents, including; those with less economic power, living in temporary accommodation, who do not speak English fluently, who have a hearing difficulty or are Deaf. In each of these circumstances, the changes to perinatal services had an even greater impact, widening inequalities.
At least one group is missing from this discussion though: The specific impacts that changes to maternity services had on LGBTQ+ families are not discussed. We know that pregnant LGB+ women may be more likely to freebirth1, and have higher rates of perinatal mental health difficulties2, when compared to pregnant heterosexual women. Research shows that trans men are much more likely to choose either homebirths or elective caesarean births, because the degree of privacy and control is perceived as greater. The simultaneous withdrawal of both these options during the pandemic would have been useful to explore.
Non-gestational lesbian mothers may co-breastfeed their baby, and sometimes are the sole breastfeeder. Some have reported that during the pandemic the heterosexist visiting policies in both postnatal wards and neonatal care led to them being denied their legal right to breastfeed their babies, even being told by healthcare professionals that they were not mothers, but milk donors. It would have been good to see recognition of the experiences of these parents in the book.
The book concludes with ideas of how to move forwards, first in a chapter that addresses public and social policy, and then in an additional chapter that speaks directly to those who have become pregnant, become parents, or become parents again since March 2020. Brown argues for investment of Governmental money and professional time to support new parents, but also expresses concern that this investment may not be likely. She details how midwifery in the UK has been pushed by the pandemic to a crisis point, and points out that still, two years later, many birth choices have not been reinstated. Her message to new parents is more hopeful, reaffirming that their experiences of pregnancy, birth and loss during the pandemic are unique, and that their reactions to these experiences are valid. She ends the book by helpfully providing a series of tips about coming to terms with these experiences, and a whole collection of organisations who provide support to parents.
This book is a challenging read, because it reflects the difficult times that new and expectant parents have lived through. This will be distressing to all readers, not least to people who have conceived, been pregnant or given birth during this time, and healthcare professionals who have worked hard to support and care for families throughout Covid. Nonetheless, I would urge everyone involved in maternity care, no matter their role, to read this essential book, to better understand how their decisions affect those who are becoming parents as this pandemic continues, and what can be done to make that experience a more safe and positive one.
Dr Mari Greenfield works at King’s College, London, as a postdoctoral researcher in perinatal health. She became an academic after a decade of working as a doula and a breastfeeding counsellor, and is passionate using research to improve birthing people’s experiences. She is the author of the podcast “Pride in Birth”, which brings together for the first time the academic and medical research about LGBTQ+ people’s experiences of conception, pregnancy, birth, and the postnatal period.
You can find Mari on Twitter @ResearchDoula
Pride in Birth podcast: http://www.pinterandmartin.radio/pride-in-birth.html
- Between a Rock and a Hard Place: Considering “Freebirth” During Covid-19 https://doi.org/10.3389/fgwh.2021.603744
- Transgender men, pregnancy, and the “new” advanced paternal age: A review of the literature https://doi.org/10.1016/j.maturitas.2019.07.004
- From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers https://doi.org/10.1186/s12884-017-1491-5