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Christine Forte May 19, 2020

Counseling During COVID-19: Special Considerations for Clients who are Pregnant or Recently Delivered

Approximately 300,000 women give birth each month in the United States, which means that since the beginning of stay at home orders in the US, more than 600,000 women have delivered a child. As this is a significant portion of the population, it stands to reason that many of us as counselors have clients who either became a parent for the first time in the last couple of months or added a new member to their family. The transition to parenthood has been broadly recognized as one of the most significant developmental changes that adults go through, and even for those who are not new parents, adding a member to the family is no small matter, particularly during a pandemic.

The mental health of both mothers and fathers is so important not only to their own well-being and happiness but to that of the new baby and entire family. Mental health issues in new parents are often overlooked because they may not follow the typical pattern of what moms assume depression look like, instead featuring a strong component of anxiety. There can also be a tendency to blame emotional struggles on a lack of sleep or hormones. While these certainly play a strong role and need to be acknowledged, it does not mean that the emotional impacts don’t also need to be addressed.

While we certainly don’t play an active role in the physical process of delivery, we are charged with advocating and supporting our clients whenever possible, and so however we can be prepared to support clients who are going through pregnancy and delivery is worth planning for.  

In order to make recommendations for therapists on how to best support their clients who were anticipating delivery or having just delivered, I spoke with several women who had either delivered in the next couple months or are due within the next few months about their experiences. I asked about what they were experiencing and also what they might hope for from their therapists. Here are some themes that they shared about.

  • First and foremost, being able to trust healthcare providers is fundamental to a healthy delivery. Encourage expectant parents to have frank discussions with their doctors or midwives prior to the delivery so that is much as possible they can know what to expect about how the medical teams are operating right now. In particular, due to COVID-19, many hospitals have changed their policies about who is allowed to be present in the delivery room. One of the mothers I spoke with told me of how there was a week this spring, just prior to her due date, where partners were not allowed in the room during delivery due to contamination concerns. Fortunately, enough advocates appealed to Governor Cuomo and he issued an order that women be allowed to have a support person or partner with them, however, couples should be prepared that this may not be the case for all localities. As a counselor, if you have a client in this situation, you can help them to mentally prepare and deal with any anxieties they may have. Or conversely, if you have a client that this happened to, it may be important to help in processing not getting to have the birth experience that she expected.
  • In tandem with the previous point is that many women may hesitate now about going to a hospital to deliver but consider changing plans to a birthing center or a home birth. While as counselors it isn’t our role to advise on this decision, we can encourage parents to have conversations with their healthcare provider to make sure it is truly the right decision for them. A high risk pregnancy may still be better off taking the chance of encountering COVID-19 by entering the hospital than having a situation where mother and baby end up in danger in a birthing center. Counselors can then help with processing any anxieties around whatever decision is made.
  • Likewise, it can be important to help processing any feelings of frustration or grief over feeling that some of the happiness and celebration around pregnancy and delivery has been taken from them by COVID-19 restrictions. One mother who had been trying for a long time to get pregnant was disappointed that her husband would not be allowed into the facility to go to prenatal appointments with her. She felt that sharing these moments, and in particular the ultrasounds, were something that would normally be such joyful times and found it unfair that they had been taken from her.
  • Another mother that I spoke with said that she thought it was important to express gratitude to healthcare workers and staff, as they are also under a lot of stress. She found that because she had mostly been gracious, the couple of times when she did really need to draw a boundary about something that was happening, they really listened. She encouraged being prepared to ask for space if you feel that someone in the hospital isn’t respecting your boundaries.
  • A further support that clinicians can provide is to help clients in learning some relaxation tools, doing some guided meditation or hypnosis to practice being able to cope with changing circumstances or uncertainty. This is always useful in preparing for childbirth, but even more so now when there could be elements of the birthing environment that can’t be anticipated.
  • Prior to the due date, therapists might also encourage scheduling a follow up visit for after delivery, and encouraging parents to also do this with family and friends. As noted before, it can be challenging for new parents to have the bandwidth to plan out seeking  help or support, so having it already lined up is likely a good idea, even if it might be changed later. One mother that I spoke to said she had felt even more isolated during this time as friends, family and neighbors weren’t able to just stop by, so having planned online meeting times was really helpful.
  • Helping clients to reframe the conversation going on in their heads can also be an important contribution that therapists can make. It’s important to keep in mind that whatever is happening will be temporary, to be prepared to be flexible or make changes in birth plan, and to not catastrophize about this. One mother pointed out that there can be even be some positives to the whole family staying at home together right now, as it gives them extra time to bond with the new baby.
  • And finally, it may be worthwhile for clinicians to consider offering some flexibility on session length or time of day. Particularly for mothers who also have an older child or toddler, finding 50 quiet minutes during the day to have a session online may be near impossible, especially if they don’t have childcare help at the moment. Offering half sessions of 25 minutes could make it more possible for them to schedule, or being willing to meet in the evenings after children have gone to bed.
It is never possible to anticipate every eventuality of becoming new parents, and this is part of what can make the transition so challenging. Helping our clients to tolerate and deal with uncertainty is an important part of what we do, and in this case it is also an important contribution to the well-being of the next generation who are being born during this crisis.
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Christine Forte is a counselor working in private practice online with the globally mobile community. She has recently repatriated to the US with her family after ten years of living and working in Shanghai, China. You can contact her at Christine(at)forteklotz.com or read more about her practice at www.forteklotz.com
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