New parents hit by lockdown blues, UCT study finds

New parents are experiencing an added mental health strain during Covid-19's protracted lockdown, a new South African study has revealed.

According to the study by a team of University of Cape Town (UCT) researchers, parents with children born during lockdown were less likely to have their preferred choice of birth method, had worse self-reported birth experiences, were less likely to have skin-to-skin contact with their babies after birth and were frequently unable to have someone at their birth that they had wanted to be there — all adding up to their mental health woes.

Researchers said that, as a result, new parents are experiencing psychological strain and symptoms of depression are common.

“Women who delivered during lockdown were more likely to have negative birth experiences than those who delivered pre-lockdown and the lockdown clearly worsened the usual challenges of birth and new parenting,” said Dr Tammy Phillips, senior lecturer at UCT’s division of epidemiology and biostatistics.

In the study, Phillips and colleagues found that the prevalence of probable depression in 63% of mothers and 29% of fathers. This is 33% higher than the usual numbers and much higher than global pre-Covid-19 estimates of 13%.

“Our study showed that mothers who had predominantly negative emotions about their birth were more likely to be depressed, and that having a preterm baby, not having the delivery method of your choice and Covid-19 affecting your birth experience led to more negative feelings about the birth. Parents need support to overcome these challenges. Digital methods of care provision during the post-partum period are effective,” said Phillips.”

Published in peer-reviewed journal, Women and Birth, the study explored the birth and new parenting experiences of South African parents during lockdown. The all-female research team - which included lactation consultant Emma Numanoglu, health systems researcher Amanda Edwards, Phillips, who is an epidemiologist, and Dr Elise Farley - conducted a cross-sectional online survey with consenting parents of babies born in 2020. Out of 520 respondents the majority (95%) were females who gave birth mostly at private hospitals.

Some of the difficulties reported by parents included changes in delivery plan, a lack of breastfeeding support, difficulty accessing maternal healthcare, mental health challenges and a lack of social support.

Phillips said mothers reported that lockdown restrictions made the new parenting phase more challenging.

“In particular there was the ban on the sale of baby products which was introduced with Level 5 lockdown and only overturned after the restriction was ruled unconstitutional in early April 2020. A further challenge was the registration of babies, which by law should happen within 30 days of their birth.”

While before lockdown, registrations took place within hospitals, this was cancelled during lockdown, including other services at Home Affairs, making registration difficult. According to the study, the ban on exercise, a feature of several lockdown levels, was noted by respondents as something that affected their post-partum quality of life.

Exercise in the post-partum period has been linked to several positive changes for the mother including improved psychosocial wellbeing in other settings. Future lockdown restriction implementers and policymakers should take these challenges into consideration. Baby products should always be included in essential items lists, and be available for sale in shops and online; plans should be made to assist new parents to register their babies in a timely manner and outdoor exercise, with precautions such as masks, should be allowed.

The study found a high caesarean section rate of about 63%. While undoubtedly lifesaving, it noted that C-section could also lead to severe and permanent physical complications, including increased post-traumatic stress, mental health issues and impairments in quality of life for the mother.

“Caesarean sections have also been reported to lead to challenges with infant-mother bonding, breastfeeding issues, an increased risk of non-communicable diseases and adverse effects on children’s sensory perception and neuropsychiatric development.

“Our findings show that most mothers wanted to have a natural birth, and that a change in delivery method was directly associated with a negative birth experience which was associated with probable depression. Due to these potential issues, caesarean sections should only be used when medically necessary.”

Phillips said the  high caesarean section rate in South African private healthcare is problematic and needs to be addressed.

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