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Journal Pre-proof

Giving birth under lockdown during the COVID-19 epidemic

Viaux S, Maurice P, Cohen D, Jouannic JM

PII: S2468-7847(20)30128-8
DOI: https://doi.org/10.1016/j.jogoh.2020.101785
Reference: JOGOH 101785

To appear in: Journal of Gynecology Obstetrics and Human Reproduction

Received Date: 2 May 2020

Please cite this article as: Viaux S, Maurice P, Cohen D, Jouannic J, Giving birth under
lockdown during the COVID-19 epidemic, Journal of Gynecology Obstetrics and Human
Reproduction (2020), doi: https://doi.org/10.1016/j.jogoh.2020.101785

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© 2020 Published by Elsevier.

Giving birth under lockdown during the COVID-19 epidemic

Viaux S1, Maurice P2,3, Cohen D1,2, Jouannic JM2,3*jean-marie.jouannic@aphp.fr

1
- APHP.Sorbonne, Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière

Hospital, Paris, France.

2
- Sorbonne Université, INSERM, UMRS 1142 LIMICS, Paris, France
3
- APHP.Sorbonne, Fetal Medicine Department, Armand Trousseau Hospital, Paris,

France

*Corresponding author : Pr JM jouannic, Service de Médecine Foetale, Hôpital

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Armand Trousseau, APHP, Paris 6, 26 Avenue A. Netter, 75012 Paris, France

Tel: +33-14473-5228

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Fax: +33-14473-5222

Email:
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Key words: COVID-19, maternal isolation, psychological vulnerability, post-partum
re
depression
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The COVID-19 epidemic has greatly impacted hospital organization in all

affected countries, where visits to hospitalized patients have been restricted or even

banned. These measures, which were dictated to limit the risk of spread of the
na

epidemic, have also been applied to maternity wards in Europe and the USA. Most

maternity wards have therefore decided to allow the presence solely of the pregnant
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woman's partner in the delivery room and to prohibit visits during postpartum hospital
Jo

stay. Such an arrangement exposes mothers who have been given birth in isolation

and the effect is amplified once they return home. Indeed, the lockdown measures

implemented in most countries prevent visits by family members and limit face-to-

face management by caregivers. This places mothers in a situation of greater

psychological vulnerability and heightens the risk of postpartum depression and of

disrupted mother-infant bonding, which may be weighted or worsened by the balance

of the couple. We expect this impact to be even greater in vulnerable mothers in the

context of dysfunctioning social services.

Following implementation from 20 March 2020 of measures to restrict visits at

the three maternity units of APHP.Sorbonne University in Paris, a new arrangement

was put in place and offered women giving birth in these units the possibility of a

telephone interview with a psychologist at days 10-12 postpartum, plus another one

6-8 weeks later. These standardized interviews of approximately 30 minutes

of
comprise a free exchange followed by a psychological assessment using

questionnaires validated during the perinatal period. In the first interview, the

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conditions of discharge home are discussed and the mother's experience of childbirth
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is discussed ant the mother's experience of childbirth is evaluated by means of the

perinatal post-traumatic stress disorder (PTSD) questionnaire1. The following are

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also evaluated during the two interviews: the Mother-Infant Bonding Scale2, the
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Dyadic Adjustment Scale3, and the Edinburgh Postnatal Depression Scale4, using a

score >12 as the threshold defining increased risk of postpartum depression, so as to

propose suitable psychological or psychiatric support. Eighty percent of women

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adhered to this follow-up in the first three weeks after lockdown in our units.

The rate of postpartum depression in the general population is about 15%4

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and it would not be surprising if this figure is increased by lockdown measures during
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the COVID-19 epidemic5. We feel that the organization implemented to reduce the

risk of psychological vulnerability should be extended to personnel who provide care

at childbirth. The results of this organization will be important for other parts of the

world, notably in adapting necessary care to the management of these situations of

psychological vulnerability at a time critical for mother-infant bonding and the

development of family functioning.

References

1 Quinnell FA, Hynan MT. Convergent and discriminant validity of the Perinatal

PTSD Questionnaire (PPQ). J Trauma Stress 1999;12:193–9.

2.Taylor A, Atkins R, Kumar R, Adams D, Glover V. A new Mother-to-

of
Infant Bonding Scale: links with early maternal mood. Arch Womens Ment Health.

2005 May;8(1):45-51.

ro
3.Antoine P, Christophe V, Nandrino JL.Dyadic Adjustment Scale: clinical interest

of a revision and validation of an abbreviated form.Encephale. 2008 Jan;34(1):38-

-p
46.
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4.Teissedre F, Chabrol H. A Study of the Edinburgh Postnatal Depression Scale

(EPDS) on 859 Mothers: Detection of Mothers at Risk for Postpartum Depression.

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Encephale. Jul-Aug 2004;30(4):376-81.

5.Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N,

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Rubin GJ. The psychological impact of quarantine and how to reduce it: rapid

review of the evidence. Lancet. 2020; 395(10227):912-920.

ur
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