Background
Understanding postpartum emotional distress in the context of the COVID-19 pandemic is important from both theoretical and practical clinical perspectives as it can inform future support for women experiencing PPED during a pandemic. Considering this, the purpose of the present inquiry was to explore women’s experiences of postpartum emotional distress (PPED) after giving birth during the COVID-19 pandemic in the UK.
Methods
The first study is a systematic scoping review of studies that investigated various forms of PPED during the COVID-19 pandemic. The aim was to explore which forms of PPED were researched, the range of methodological approaches used, the limitations of these studies as well as suggested future direction for further research. The methodology for evidence search, synthesis, and reporting of findings was guided by a framework developed by Arksey and O'Malley (2005) and The Joanna Briggs Institute’s guidelines (Aromataris, 2020) for scoping reviews.
The second study was a qualitative exploration of women’s experiences of PPED during the Covid-19 pandemic in the UK. In this study, PPED was defined as “an unpleasant emotional state which is more intense than is usual for the new mother and lasts most of the day nearly every day for at least a couple of weeks and starts within the first few months after childbirth.” A critical realist approach guided the research process. The data was collected using semi-structured interviews. Purposeful sampling was used to select participants for the study following criteria which included: women over the age of 18 years, who delivered a full-term, healthy, and singleton baby during the COVID-19 pandemic in the UK, experienced PPED, now in a state of recovery residing in UK and are fluent in speaking English. The data was analysed using Reflexive Thematic Analysis (RTA) to explore the women’s perspective of PPED after giving birth during the COVID-19 pandemic to understand the essence of their experience.
Findings
The scoping review provided an overview of 29 papers that were used to explore postpartum emotional distress (PPED) during COVID-19 in the UK. In particular, it highlighted the trend to focus on exploring depression and anxiety and ignoring other forms of PPED. It also shows the tendency of researchers to use a quantitative approach to study PPED during the COVID-19 pandemic which in terms of numbers was almost double the studies that used qualitative or mixed-method approaches and hence dominate the research field. The findings of this review helped to identify a gap in the literature and provided a context within which the strengths and limitations of the second study were evaluated.
The qualitative study revealed 12 sub-themes which were organised into 4 over-arching themes which were: 1. The emotional range of PPED, 2. The Missing Village, 3. Relying on the online virtual village, and 4. PPED changes you as a person. The findings indicate that women’s lived experience of PPED is not limited to the experience of anxiety and mood disorder for the reason that postpartum women experience a broad range of emotional states and their responses to these emotional states are also varied and wide-ranging. The impact of the COVID-19 pandemic on the emotional state of postpartum women as well as on their response to their emotional state is evident. Moreover, the findings demonstrate that women would have experienced PPED irrespective of the pandemic but dealing with the postpartum stressors and their emotional state of distress would likely have been less complicated and more manageable.
Conclusion
PPED needs to be explored and understood as a multifaceted phenomenon that involves wide-ranging emotional states and the reaction to these emotional states which are varied. Moreover, the impact of the COVID-19 pandemic on postpartum mental health is significant and such contextual factors need to be understood to better support women.