​Part 2: Tips for Coping with Anxiety While Pregnant during COVID-19
by Drs. Katie Lawlor and Jamie Kent 
​
Anxiety during pregnancy is common and maintaining peace of mind during the COVID-19 pandemic can feel particularly challenging. Each time you turn on the TV or go online, there is a barrage of new information, with countless reports on how to best protect yourself and the health of your baby.
 
There is often an inclination to engage in behaviors that seem protective, however sometimes they can actually increase anxiety levels. For example, googling the latest statistics to stay informed may cause you to become overwhelmed. You may also feel compelled to act on these worries by excessively cleaning your home or stockpiling groceries and supplies.
 
Or perhaps you are living in a community under shelter-in-place orders and feel isolated from your support system. Maybe the maternity classes you had planned to attend have been postponed or cancelled and you are unsure of where to look for guidance.
 
Below is a list of ideas and resources aimed at improving your mood and sense of well-being as you prepare to welcome your baby. All of these can be done in the comfort of your home. 
 
Self-Care Activities: Making time to engage in comforting and calming activities can provide relief from stress. Ideas include reading a book or magazine, drinking a cup of tea, listening to classical music, watching the sunset or looking at the stars at night, gardening or planting flowers, baking, or watching a favorite show or movie.
 
Stay Physically Active: Exercise releases endorphins, which are chemicals secreted in the brain and nervous system that help relieve pain and anxiety while improving our moods. Research has shown that just 5 minutes of movement has positive benefits for both our physical and mental health. Suggested activities for women who are expecting include yoga, walking, and dancing. It is recommended that you always consult with your physician before beginning a new exercise routine during pregnancy.
 
Be Mindful: Mindfulness activities have been shown to reduce physical feelings of tension and pain, as well as negative thoughts. Jon Kabat-Zinn, one of the founders of mindfulness-based stress reduction, describes the concept as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” There are several ways to practice mindfulness in your daily life, and these free online resources can help you begin:
 
UCLA Mindful Awareness Research Center
San Francisco Center for Acceptance and Commitment Therapy
Harvard Health Publishing – Benefits of Mindfulness
Mayo Clinic Mindfulness Exercises
 
Reduce Worry through (Online) Education: It’s entirely natural to feel nervous when thinking ahead to labor, delivery, breastfeeding, and infant care. Learning what to expect during each stage can help reduce uncertainty and provide clarification. This information may also help you better articulate your intentions, act with agency, and advocate for yourself. You can prepare by signing up for online classes that cover a variety of relevant topics:
 
Stanford Health Care Maternity Classes
UCSF Women’s Health Pregnancy and Postpartum Classes
Sutter Health Pregnancy Classes and Events
BabyCenter’s Pregnancy and Baby Videos (Free)
 
Nest: While you may not be able to shop at your favorite baby store or boutique, you can begin to prepare your home for baby’s arrival. Activities you can do without leaving the house include deep cleaning the room you will use for the nursery, assembling furniture such as the crib or changing table, purchasing items you need such as diapers and wipes online, washing and folding new and gifted clothes, and arranging beloved books, art, and stuffed animals. You may also want to pack your hospital bag, including items such as a warm robe/nightgown, socks/slippers, a nursing bra, toiletries, and comfortable outfits for both you and the baby to go home in.
 
Journal: Journaling is a great way to release worry and stress. Writing about stressors can increase understanding, which in turn clarifies what is both within and outside your control. Expectant mothers often enjoy documenting the journey of pregnancy itself in a designated pregnancy journal. With pregnancy comes a seesaw of emotion, from the wonder of each time the baby kicks, to the excitement of meeting him or her, to the moments of fear and apprehension, and the meaning behind becoming a mother. There is so much to process and no wrong way to journal.

​Talk to Someone: Confiding in a trusted friend or family member can provide you with a safe, compassionate space to process issues you are particularly apprehensive about. Feeling heard and understood may relieve some of your related anxiety. Please keep in mind that your loved ones may not recognize when you could benefit from their support, so you may need to ask them.
 
Consult your Doctor: If you or your loved ones become concerned that anxiety is beginning to impact your daily life, or if you are experiencing recurrent panic attacks and/or having difficulty sleeping, we would strongly encourage you to contact your OB-GYN. The sooner you seek help, the sooner an intervention could improve your symptoms. Furthermore, it may be particularly helpful to speak to a mental health professional, such as a psychologist or therapist, who is specially trained in providing evidence-based treatment and care for pregnant women experiencing anxiety.
 
Catherine Lawlor, Psy.D., and Jamie Kent, Ph.D.
Women’s Mental Health Team at Peninsula Behavioral Health
 
 
 
 

Pregnancy is a time of anticipation and change, and some degree of anxiety is natural and expected. The recent outbreak of COVID-19 however has added an element of uncertainty and concern to this experience, especially with regard to the potential effects of the virus on how expectant women and their babies can stay healthy.
 
How does the virus spread?
The virus spreads primarily from person to person, through respiratory droplets emitted through the air when an infected individual coughs or sneezes. It may also spread when someone touches a surface or object that has the virus on it, then touches their nose, mouth or eyes. It’s also possible that someone may be infected but not have any symptoms and spread the virus.
 
What do we know about risk to expectant mothers and their infants?
According to the latest information provided by the Centers for Disease Control and Prevention (CDC), there is not enough data yet to know if pregnant women are at greater risk for contracting COVID-19, as compared to the general population. It also remains unclear whether they are more likely to become symptomatic if they do become infected.
 
To date, there is no definitive evidence that a woman infected with the virus can pass it on to her baby, either in utero or during delivery. While there have been a small number of reports citing complications with pregnancy and delivery, in these cases – for example preterm birth – it is uncertain if the outcomes were related to COVID-19. In a limited number of case studies of infants born to mothers with COVID-19, none of the infants tested positive for the virus. The virus has also yet to be found in samples of amniotic fluid or breastmilk.
 
As pregnant women experience changes in their bodies that may make them more susceptible to certain infections, it is recommended that they engage in protective actions to minimize their risk of exposure.
 
The CDC’s information page for pregnant and postpartum women has the most up-to-date information about risk.
 
What can I do to protect myself from getting the virus?

• Engage in social distancing by remaining six feet away from other people and adhere to the shelter-in-place order by leaving the home only for essential needs. Enjoy walks outside, but maintain distance from others not living with you. Reschedule (or consider a virtual option) for social gatherings such as baby showers.
• Avoid contact with individuals who are sick, including your partner, especially if they are exhibiting symptoms of COVID-19 (fever, cough, shortness of breath) or have been diagnosed.
• Frequently wash your hands with soap and water for at least 20 seconds, especially after visiting a public space such as a grocery store, gas station, or doctor’s office.
• If soap and water are not immediately available, use a hand sanitizer that contains at least 60% alcohol. Make sure to cover all of the skin on your hands and rub them together until they feel dry.  
• Avoid touching your face (especially your eyes, nose, and mouth) with unwashed hands.
• Clean frequently-touched surfaces every day, such as your cell phone, doorknobs, countertops, laptops and computers, remotes, sinks and faucets, and toilets, using an alcohol or bleached-based disinfectant.
• Hydrate and get adequate rest to maintain the health of your immune system.
• If you exhibit symptoms suggestive of COVID-19 (fever, cough, shortness of breath) call your doctor to determine next steps.

 
Will my prenatal visits be cancelled? How safe is the medical system for my visits / delivery?
Prenatal visits are routine care critical for ensuring maternal and fetal health. While many elective medical procedures and visits have been rescheduled to a later date, prenatal care continues. Some obstetricians may increase the interval between visits or may encourage telehealth visits. Expectant mothers should discuss with their doctor any concerns about their prenatal care.
Medical care systems take many precautions to minimize the risk of exposure to their patients. They follow strict rules to make sure that anyone who needs to be evaluated for COVID-19 is isolated from other patients. We recommend you talk to your doctor about any concerns you have about the precautions your medical system is taking with regard to the risk of exposure during your routine visits or during your hospital stay. You may also have questions about the number of people you can have with you in the delivery room, which your doctor can address.
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What can I do if I feel anxious or overwhelmed?
If you are finding yourself overwhelmed by concerns related to COVID-19, and especially if these thoughts and feelings are interfering with your ability to complete daily tasks, sleep well, or engage in self-care activities, reach out to a mental health professional for support.
 
For tips on coping with anxiety while expecting during COVID-19, read Part 2 to this blog post.
 
Catherine Lawlor, Psy.D., and Jamie Kent, Ph.D.
Women’s Mental Health Team at Peninsula Behavioral Health