The impact of COVID-19 lockdown on postpartum mothers in London, England: An online focus group study.

Aims: This study examines the impact of COVID-19 lockdown on postpartum mothers in England, with the aim of identifying opportunities to improve maternal experience and wellbeing. The postpartum/postnatal period is widely acknowledged as a time when mothers require greater levels of support from multiple sources. However, stay-at-home orders, commonly known as "lockdown," deployed in some countries to limit COVID-19 transmission reduced access to support. In England, many postpartum mothers navigated household isolation within an intensive mothering and expert parenting culture. Examining the impact of lockdown may reveal strengths and weaknesses in current policy and practice. Subject and methods: We conducted online focus groups involving 20 mothers living in London, England, with "lockdown babies," following up on our earlier online survey on social support and maternal wellbeing. We thematically analysed focus group transcripts, and identified key themes around Lockdown Experience and Determinants of Lockdown Experience. Results: Participants raised some positives of lockdown, including fostering connections and protection from external expectations, but also raised many negatives, including social isolation, institutional abandonment, and intense relationships within the household. Potential reasons behind variations in lockdown experience include physical environments, timing of birth, and number of children. Our findings reflect how current systems may be "trapping" some families into the male-breadwinner/female-caregiver family model, while intensive mothering and expert parenting culture may be increasing maternal stress and undermining responsive mothering. Conclusions: Facilitating partners to stay at home during the postpartum period (e.g., increasing paternity leave and flexible working) and establishing peer/community support to decentre reliance on professional parenting experts may promote positive postpartum maternal experience and wellbeing. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-023-01922-4.

Communication across maternal social networks during the UK’s national lockdown and its association with postnatal depressive symptoms

BackgroundPostnatal depression (PND) is highly detrimental for both mother and baby, with a pre-COVID-19 estimated prevalence of up to 23% in Europe. Low social support is a key risk factor for developing PND. Social distancing measures designed to limit COVID-19 transmission likely created unprecedented barriers for mothers to access social support. We explore how social support networks existed during the UK’s first national lockdown amongst London mothers with infants, and their associations with postnatal depressive symptoms.MethodsUsing self-reported social network data from 162 London-based mothers with infants aged ≤6 months collected in May-June 2020 (during the first lockdown), we conduct a concurrent design mixed-method study. We quantitatively describe communication within maternal support networks, using quasi-Poisson regression models to analyse associations with postnatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). In parallel, we thematically analyse open-text data to explore and understand the experiences of mothers with infants during England’s lockdown.ResultsQuantitative findings: Levels of depressive symptoms were high in our sample, with 47.5% of participants meeting the >=11EPDS cut-off for potential postnatal depression.On average, women kept in contact with 10–11 people remotely (via WhatsApp, Zoom etc), and saw one family member other than their partner, suggesting high compliance with lockdown rules. The number of seen in person, and remote communication with a higher proportion of those not seen, negatively predicted depressive symptoms (RRR = 0.950 – 0.996 across models). However, a higher proportion of relatives seen in person was associated with increased depressive symptoms (RRR=1.003;95% CI 1.001–1.006), suggesting family members may have broken lockdown rules to support mums in need. Qualitative findings: We identified four themes. Some mothers in our sample felt lockdown ‘protected’ family time which led to better bonding, often facilitated by high levels of support from the partner (theme 1). However, many experienced the ‘burden of constant mothering’ without anyone around to help (theme 2). Mothers felt remote contact was ‘not as good’ and led to reduced or inadequate support (theme 3). Mothers grieved for lost opportunities for them and their baby, and worried about the developmental impact on their baby (theme 4). Overall, these experiences coexisted with feelings of isolation, exhaustion, worry, inadequacy, guilt, and increased stress.ConclusionResults suggest the strict lockdown in the UK may have increased the risk of postnatal depression, reflected in the high levels of PND symptoms and poor maternal experiences in our sample.

Implantable Cardiac Defibrillator Deactivation During End-of-Life Care in the COVID-19 Pandemic.

People with implantable cardiac defibrillators (ICDs) who are nearing the end of life are at risk for arrhythmias, which activate the ICD and may cause unnecessary shocks and suffering. Because ICDs have enabled more patients to live longer, they often succumb to noncardiac diseases and may be cared for by primary care physicians. Despite published recommendations 10 years ago regarding the management of ICDs during the end of life, over half of patients with ICDs who are dying still have not been offered the choice of deactivation. The Coronavirus disease 2019 (COVID-19) pandemic has complicated this issue and the need to discuss it because of practices that separate patients from loved ones and that modify the usual interactions of patients with doctors and nurses. We offer the following recommendations: (1) the management of ICDs at the end-of-life needs to be understood by all physicians who care for patients with ICDs; (2) discussions about deactivating the ICD should occur while patients have decision-making capacity and are clinically stable, beginning at the time of ICD implantation, then periodically at follow-up appointments, and certainly when a change in the patient's clinical status warrants a reconsideration of the goals of care; and (3) clinicians should compensate for the impediments to communication with patients and families associated with the COVID-19 pandemic, which includes patient isolation and restrictive visitor policies, by using devices that permit visual communication to reexamine goals of care, including defibrillator deactivation, in patients with ICDs who are expected to die.

Communication Across Maternal Social Networks During England's First National Lockdown and Its Association With Postnatal Depressive Symptoms.

Postnatal/postpartum depression (PND/PPD) had a pre-COVID-19 estimated prevalence ranging up to 23% in Europe, 33% in Australia, and 64% in America, and is detrimental to both mothers and their infants. Low social support is a key risk factor for developing PND. From an evolutionary perspective this is perhaps unsurprising, as humans evolved as cooperative childrearers, inherently reliant on social support to raise children. The coronavirus pandemic has created a situation in which support from social networks beyond the nuclear family is likely to be even more important to new mothers, as it poses risks and stresses for mothers to contend with; whilst at the same time, social distancing measures designed to limit transmission create unprecedented alterations to their access to such support. Using data from 162 mothers living in London with infants aged ≤6 months, we explore how communication with members of a mother's social network related to her experience of postnatal depressive symptoms during the first "lockdown" in England. Levels of depressive symptoms, as assessed via the Edinburgh Postnatal Depression Scale, were high, with 47.5% of the participants meeting a ≥11 cut-off for PND. Quasi-Poisson regression modelling found that the number of network members seen in-person, and remote communication with a higher proportion of those not seen, was negatively associated with depressive symptoms; however, contact with a higher proportion of relatives was positively associated with symptoms, suggesting kin risked seeing mothers in need. Thematic qualitative analysis of open text responses found that mothers experienced a burden of constant mothering, inadequacy of virtual contact, and sadness and worries about lost social opportunities, while support from partners facilitated family bonding. While Western childrearing norms focus on intensive parenting, and fathers are key caregivers, our results highlight that it still "takes a village" to raise children in high-income populations and mothers are struggling in its absence.

Parental perceptions of the impact of neonatal unit visitation policies during COVID-19 pandemic.

OBJECTIVES: To ascertain parental perceptions of the impact of restricted visiting policies to neonatal intensive care units during the current COVID-19 pandemic. DESIGN: Cross-sectional survey of parents impacted by visitation policies. SETTING: Six tertiary level neonatal units, four from the UK and two from the USA, participated in the study. PARTICIPANTS: Parents and families of infants hospitalised in the participating centres between 1 May 2020 and 21 August 2020. METHODS: Online-based and/or paper-based survey, querying the visitation policies and their impact on parents' ability to visit, care for and bond with their infants. RESULTS: A total of 231 responses were received. Visitation limited to a single visitor with no restrictions on duration was the most frequently reported policy; 140/217 (63%). Visitation policies were perceived as being restrictive by 62% (138/219) of the respondents with 37% (80/216) reporting being able to visit less often than desired, 41% (78/191) reporting being unable to bond enough and 27% (51/191) reporting not being able to participate in their baby's daily care. Mild to severe impact on breast feeding was reported by 36% (75/209) of respondents. Stricter policies had a higher impact on families and were significantly associated with a lack of bonding time, inability to participate in care and an adverse impact on breast feeding. CONCLUSIONS: Visitation policies during the COVID-19 pandemic varied between centres and over time with stricter restrictions implemented earlier on in the pandemic. Parents reported significant impacts on their ability to visit, care for and bond with their infants with perceived severity of impact worse with stricter restrictions.