Study examines postpartum women’s experiences during the third wave of COVID-19

In a recent study published in the journal Pharmacoepidemiology, researchers investigated postpartum women’s birth-associated experiences during the third wave of the coronavirus disease 2019 (COVID-19) pandemic in Europe.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has significantly affected perinatal mental health and other outcomes, with increased cesarean section deliveries and a lack of partner support at the time of delivery. However, data on perinatal experiences and mental well-being of European women during the third COVID-19 wave are limited. Moreover, existing data are primarily focussed on the period of pregnancy, and the period during the first two COVID-19 waves, often with limited sample size, of single country residents.

Study: Pregnancy- and Birth-Related Experiences among Postpartum Women during the Third Wave of the COVID-19 Pandemic—A Multinational European Study. Image Credit: christinarosepix / Shutterstock

About the study

In the present cross-sectional, web-based study, researchers investigated postpartum women’s birth experiences during the third COVID-19 wave.

The multinational study was conducted across Switzerland, the United Kingdom, Norway, Belgium, and the Netherlands. Data were collected between June 10 and August 22, 2021, using web-based surveys adapted from a previous study. The survey was translated from English into Dutch, French, German, Italian, and Norwegian languages.

The study included expecting women and postpartum women who delivered in the previous 3.0 months, were aged ≥18.0 years and responded to the questions on changes in birth experiences, and filled out questionnaires querying the location of birth location, allocated health professionals, delivery type, changed delivery settings, or prenatal appointment cancellations.

The EDS was utilized to assess depression symptoms, and the EDS-3A subscale was used for evaluating perinatal anxiety levels. Univariable and multivariable logistic regression was performed to determine the relationship between anxiety (EDS-3A scores ≥ 5.0) and the major symptoms (EDS scores ≥ 13.0) and (i) pregnancy and birth-associated changes and (ii) partner support at the time of delivery.

Socio-demographic data on the residential country, age of the mother, educational and professional status, work type, and smoking habits were obtained. In addition, data on the SARS-CoV-2 infection status, COVID-19 severity, test reports, and the number of SARS-CoV-2-infected family members were analyzed. Partner support during delivery was also inquired.

Further, data on reproductive and health variables, including the history of chronic somatic (such as cardiovascular illness, allergies, asthma, epilepsy, diabetes, and hypothyroidism) and mental (such as depression and anxiety) diseases, lactation status, and prior experience of breastfeeding, were obtained.


A total of 1,799 postpartum women participated in the survey, of which 69 women were excluded due to missing responses to questions on birth experiences. Of the 1,730 remaining participants, 1,522 women reported ≤4.0 changes in birth experiences, whereas 208 women reported ≥4.0 changes in birth experiences.

Among the participants, >95.0% of postpartum women experienced ≥1.0 birth-associated change during pregnancy. The most commonly observed change was the lack of partner support during pregnancy-related appointments (such as ultrasound imaging), documented by >80.0% of women. However, the change did not significantly affect perinatal mental well-being.

Less commonly observed changes were altered C-section delivery schedules (four percent), delivery center changes (three percent), and changed delivery settings from homes to hospitals (one percent) showed stronger associations with postpartum anxiety and depression symptoms. However, delivery-associated changes could have occurred due to obstetrical limitations. Of interest, birth-associated changes showed positive associations with the nationality, status of SARS-CoV-2 infection, and previous breastfeeding experiences.

Among postpartum women documenting >4.0 birth-associated changes, 25% of them scored exceeding the cut-off values for depression, in comparison to 16% of the participants reporting fewer changes. In addition, 41% of participants documenting >4.0 birth-associated changes documented greater anxiety scores than 32% of the participants who reported ≤4.0 changes, indicating that COVID-19 was a key stressor for pregnant women.

The team observed a significant relationship between postpartum women documenting >4.0 birth-associated changes and significant symptoms of anxiety and depression, with adjusted odds ratios of 1.6 and 1.8, respectively. Pregnancy and delivery-associated changes were linked to >2.0-fold elevation in the chances of postpartum depression. Reductions and cancellations of prenatal care appointments doubled the chances of experiencing major depression symptoms and increased the chances of experiencing high anxiety levels by nearly 70.0%.

Despite more than 80.0% of women lacking partner support at pregnancy care appointments, >88.0% of them had their partner’s presence at the time of delivery, showing that the time of birth was prioritized. In addition, compared to the national pregnant population, a greater fraction of the study sample had attained higher education, worked in the healthcare sector, and were professionally active.

Overall, the study findings highlighted the birth-associated changes experienced by postpartum women in Europe during the third COVID-19 wave. Experiencing >4.0 pregnancy- and delivery-associated changes enhanced the chances of postpartum anxiety and depression. The study findings underscored the importance of extending care and support to pregnant women during the third COVID-19 wave to ensure postpartum health and well-being.

Journal reference:

  • Araya, R.A.; Tauqeer, F.; Ceulemans, M.; Gerbier, E.; Maisonneuve, E.; Passier, A.; Oliver, A.; Panchaud, A.; Lupattelli, A.; Nordeng, H. Pregnancy- and Birth-Related Experiences among Postpartum Women during the Third Wave of the COVID-19 Pandemic—A Multinational European Study. Pharmacoepidemiology 2023, 2, 54–67. DOI: pharma2010006,
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