| Prenatal |
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Advocate for pregnant women to have an emotional support person present with them (doula, partner, family member) when receiving perinatal care and ensure that supports are available for all women.
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Provide woman-centered care during telehealth visits, ensuring that the woman’s priorities are addressed and that she has adequate support in navigating altered prenatal care services.
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Provide education for families on the latest evidence on how COVID-19 affects pregnant women and infants, as well as infection control and safety measures they can expect throughout their care experiences (information should match the literacy level and preferred language of the woman).
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Assess for preexisting mental health or substance use disorders and connect women with mental health services early in pregnancy.
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Screen for domestic and intimate partner violence and provide women with referrals to mental health and social services, as well as intimate partner violence advocacy organizations, which can provide safety planning, cognitive behavioral therapy, and other ongoing support.
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Understand that marginalized communities affected by systemic racism, housing instability, socioeconomic resource deprivation, poor access to health care, poor technology infrastructure, and lack of economic opportunity may be disproportionately affected by COVID-19 and unable to consistently practice social distancing and may be at increased risk for poor mental health outcomes and inadequate social support.
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Acknowledge that labor and birth in a pandemic is not what the mother expected or planned for and that feelings of anxiety, sadness, grief, fear, or loss are normal.
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| Intrapartum |
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Use principles of shared decision-making that center on families’ values to optimize informed choices that safely align with the desired outcomes for care.
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Promote control and choice to the greatest extent safely possible to minimize power dynamics and the potential for retraumatization by providers and systems.
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Explore how the woman’s birth experience can be made memorable in light of social distancing and infection control measures.
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Assess for COVID-19–specific anxiety, stress, and other psychological symptoms (Lee, 2020).
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Encourage the use of mindfulness as a strategy to reduce stress and to support control over aspects of pregnancy that can be addressed, such as positive health behaviors and using positive cognitive framing.
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| Postnatal |
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Facilitate technology-based mechanisms for family and support person interactions, such as telephone and video calls.
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Avoid separating mothers and infants unless required by clinical condition.
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Promote skin-to-skin contact (e.g., skin-to-skin care) and breastfeeding to the extent safely possible.
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Observe infants who are separated from mothers for excessive stress and ensure that human touch is provided to these infants.
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Reevaluate psychological symptoms (stress, depression, anxiety), support systems, and safety upon discharge to assess for community care needs.
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For women with mental health disorders, determine if behavioral health care has been interrupted; consider a behavioral health consult before the woman is discharged for follow-up care and medication refills as needed.
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| Infancy and Early Parenthood |
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Use virtual methods of follow-up to screen for postpartum depression, anxiety, and posttraumatic stress symptoms in the first days and weeks after birth.
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Become familiar with community-specific programs and resources that support mothers’ mental and emotional health during childbearing and parenting transitions.
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Connect women to virtual and community mental health resources that can be accessed while social distancing.
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Create collaborative networks with the community-based organizations to enhance coordination and optimization of care.
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Advocate for mental health resources and support for pregnant and postpartum women who are health care or other frontline workers.
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