Pandemic-related prenatal maternal stress, model of maternity care and postpartum mental health: The Australian BITTOC study

Problem: Women pregnant during the COVID-19 pandemic may be at risk of elevated postpartum mental health problems. Background: Social support protects maternal mental health during a pandemic. It is possible that formal supports, such as continuity maternity models of care, may also support maternal wellbeing. Aim: To investigate whether model of care moderates the association between prenatal maternal stress from the COVID-19 pandemic, and postpartum (a) depression and (b) anxiety. Methods: Women in Australia, pregnant during the COVID-19 pandemic (n n = 3048), completed a survey detailing their COVID-19-related objective hardship and subjective distress during pregnancy and completed depression and anxiety measures at birth to six weeks ("Early"), seven to 21 weeks ("Moderate"), and/or 22-30 weeks ("Late") postpartum. Findings: Higher subjective distress was associated with elevated depression and anxiety at all timepoints. Model of care did not moderate the association of objective hardship or subjective distress and depression or anxiety at any timepoint. Compared with Standard Care, women receiving private midwifery care had a 74 % reduction in the odds of elevated anxiety in early postpartum. Discussion: Women receiving private midwifery may have experienced lower anxiety due to a greater duration of postpartum in-home care, fewer changes to service delivery, and the option of homebirth. Women pregnant during a pandemic should be screened for higher subjective distress about the event. Conclusion: These results suggest that continuity of private midwifery care may be beneficial for supporting postpartum mental health during a pandemic, with implications for practice and policy for the current and future pandemics.