How Do Changes to Birth Plans During COVID-19 Impact Mental Health?

What you need to know

• Two-thirds of women experienced changes to their planned childbirth experience during COVID-19
• Having one change increased post-traumatic stress symptoms by 12%, while two or more changes led to a 38% increase
• First-time mothers were more vulnerable to stress from birth plan changes compared to experienced mothers

The Impact of Unexpected Changes

Having a baby is already an emotionally charged experience filled with hopes, expectations and careful planning. But what happens when those carefully laid plans have to change unexpectedly? This was the reality for many women giving birth during periods of healthcare restrictions. While changes to birth plans can happen under normal circumstances, understanding how multiple unexpected changes affect new mothers’ mental health is crucial for providing better support.

What the Research Found

In this large study spanning 11 countries, researchers surveyed over 3,500 women who had given birth. They found that 64% experienced at least one change to their planned birth experience. The most common change, reported by about 42% of women, was not being allowed to have their chosen support person present during delivery.

The researchers measured post-traumatic stress symptoms (PTSS) in these women. PTSS can include feeling constantly on guard, having trouble experiencing positive emotions, experiencing unwanted thoughts about the event, and having difficulty concentrating.

The Cumulative Effect

What made this study particularly interesting was how it showed that changes to birth plans had a “dose-response” effect - meaning more changes led to more stress symptoms. Women who experienced just one change showed 12% more stress symptoms compared to those whose births went as planned. For women who experienced two or more changes, stress symptoms increased by 38%.

First-Time Mothers More Vulnerable

The study revealed that first-time mothers (primigravidas) were more affected by changes to their birth plans than mothers who had given birth before (multigravidas). This makes intuitive sense - when experiencing something for the first time, we tend to rely more heavily on our plans and expectations to feel in control. When those plans change unexpectedly, it can be particularly destabilizing.

The Most Impactful Changes

Not all changes had equal impact. The changes that seemed to cause the most distress were:

• Not having access to preferred pain medication
• Having planned cesarean sections or inductions canceled
• Having vaginal births changed to inductions or C-sections
• Not having a support person present during delivery

What This Means for You

If you’re pregnant or planning to become pregnant, these findings highlight the importance of:

• Building flexibility into your birth plan while maintaining your core priorities
• Having open discussions with your healthcare providers about what changes might be necessary and why
• Seeking additional emotional support if you experience unexpected changes during birth
• Being particularly mindful of first-time mothers’ need for support when plans change
• Understanding that it’s normal to feel distressed by unexpected changes to your birth experience

Conclusions

• Unexpected changes to birth plans can significantly impact new mothers’ mental health
• The more changes experienced, the greater the potential for psychological distress
• Healthcare providers should prioritize maintaining essential elements of birth plans when possible
• Additional mental health support may be needed for women who experience multiple changes to their planned birth experience