Birth Plans

In April 2020, Chi Yin was forty weeks pregnant. When she woke up at two o’clock in the morning and realised she was bleeding, she went to the nearest hospital in South London. Her waters hadn’t broken and labour hadn’t started, but Covid restrictions meant that once she’d been admitted to hospital she wasn’t allowed to leave: ‘I was put in an induction bay and told that the doctors would induce the birth.’ Her husband wouldn’t be permitted to join her till later.

She was on an understaffed ward with seven other pregnant people, separated by hospital curtains. None had a partner to hold their hand, massage their back, or keep them company through the initial phase of labour. ‘Basically, the first ten hours, I was alone, and that did me in,’ Chi Yin told me.

Once she reached four centimetres cervical dilation, her husband was able to join her. After thirty hours of contractions her son’s head was still stuck, so they gave her an episiotomy and used forceps to deliver him. She had lost 1.6 litres of blood. After the delivery, she had to spend another forty-eight hours in hospital without her husband. Unable to breastfeed, she asked for baby formula. The nurses provided it but told her she ought to be breastfeeding.

The past five years have felt like a century, but more time is needed to understand the long-term effects on parents, children and families of the Covid pandemic and associated lockdowns.

Danielle gave birth to twins in February 2020. ‘I remember being nervous about the virus while I was in the hospital,’ she told me, ‘and it felt like a different experience than with my first child.’ She thought that hospital staff visited her room less frequently after her twins were born. I asked her about the lockdown. ‘It’s so funny because after I gave birth,’ she said, ‘I got on social media, and everyone complained about being on lockdown. But going through the postpartum process, you feel so isolated.’

Preliminary data published in 2021 strongly suggested that testing positive for Covid was linked to a traumatic stress response during pregnancy and childbirth. According to a study from 2022, ‘pregnant mothers reported fear of infection, fear of vertical transmission, fear of poor birth and child outcomes, social isolation, uncertainty about their partner’s presence during medical appointments and delivery, increased domestic abuse, and other collateral damage, including vaccine hesitancy.’ During the first two years of the pandemic, maternal mortality rose in the United States (especially among Black and Hispanic communities), Japan, Australia and the Netherlands.

At one of my antenatal classes in Berlin last spring, many people expressed their intention to have a ‘natural’ birth, without any pain relief, at home or in a bath tub surrounded by lavender-scented candles. The choices felt endless. It doesn’t always go according to plan even at the best of times, but in the spring of 2020, when hospitals were under intense pressure from Covid and lockdowns were at their most restrictive, everyone’s birth plans crumbled like sand.

When countries have a well-funded public healthcare system with universal access to maternity care, maternal and infant mortality rates are notably reduced: the maternal death rate in Norway in 2022 was zero. State support is also necessary in the months following birth: relying solely on the unpaid labour of extended family for help in caring for a newborn is insufficient. Paid family leave, psychological care and social support can also help prevent postnatal depression, which affects more than one in ten people in the UK within a year of giving birth.

We cannot predict when disruption on the scale of the Covid pandemic will next hit, but we should be better prepared to help people through pregnancy and childbirth during disasters. Health policies shouldn’t be a matter of improvisation, especially in an underfunded and fragmented system. They should focus on ensuring that the infrastructure is robust enough to support the physical and mental well-being of some of the most vulnerable members of society.

Five years on, Chi Yin is living in Berlin, and able to talk about her experience of giving birth. She laughed when I asked how her son is now. ‘We have an amazing child. He’s very precious and already an art critic.’