Lost connection: The impact of COVID-19 restrictions on antenatal appointments

With the World Health Organisation (WHO) declaring COVID-19 a pandemic in March 2020, rapid and significant changes were implemented across various sectors, including obstetric and maternity care.

The recommendations for social distancing to reduce the spread of the virus led to restrictions placed on the presence of fathers and non-birth partners at antenatal, birth, and postnatal appointments.

Routine maternity and obstetric care appointments transitioned from face-to-face to telehealth. Where face-to-face ultrasound appointments were conducted to monitor fetal growth and development, the presence of fathers and non-birth partners was significantly limited, and in some instances, restricted.

Pregnancy and fatherhood

In the absence of major risk and complications for the mother or the foetus, fathers report a range of feelings about the pregnancy, from conception to birth and beyond, often in relation to their partner’s health.

If the pregnancy is progressing well, then fathers are more likely to report positive pregnancy experiences. Most tell of feeling excitement, a sense of accomplishment, nervousness and worry in the early stages of pregnancy, the latter two often relating to the health of the pregnant partner, and concerns for the developing baby.

During the early stages of the pregnancy, as their partners experience morning sickness, fatigue, and in some instances ambivalence about the baby’s presence, fathers can report feeling surreal and detached, possibly as a means to protect themselves from feelings of disappointment should there be an unplanned termination.

As the pregnancy progresses, and mothers feel body changes with the developing baby, the non-birth partners, often devoid of these experiences, rely on the mother to experience the pregnancy as “real”.

Research shows that antenatal appointments, particularly ultrasound appointments, provide a sense of reality and confirmation of the pregnancy, as the non-birth parents can see the baby, hear the heartbeat, and have the opportunity to ask questions and seek reassurance about their partner and baby’s health.

Physical attendance at these appointments is important to help fathers and non-birth partners feel connected to the pregnancy, their partner, and the growing baby.

Bonding during pregnancy

Research has shown that, like mothers, fathers bond with the baby during pregnancy. While mothers biologically gestate the baby, they also psychologically gestate the baby. In doing so, they’re able to navigate a range of psychological and biological changes as they prepare for motherhood.

However, recent research has indicated that fathers are able to psychologically prepare in a process that can be similar to mothers’.

Further, research has also shown that father-and-mother involvement during pregnancy steadily increases as the pregnancy progresses, but fathers’ involvement remains significantly less – possibly because they’re not biologically gestating the baby.

The more involved the father is during pregnancy, the better the outcomes postnatally for their own mental health.

In order to stay involved and make the psychological transition to fatherhood, it’s important for fathers to be involved and connected to the pregnancy.

Fathers’ involvement during pregnancy has proven impacts on involvement post- birth. In one study, researchers found that fathers were able to think about and form a bond with their baby during pregnancy, and the quality of this bond remained stable even after birth.

And, the more involved the father is during pregnancy, the better the outcomes postnatally for their own mental health, adaptation to fatherhood, maternal coping and mental health, breastfeeding, and bonding and attachment with baby.

Bonding after birth

While some parents feel an immediate connection with their baby, it’s not the case for all. Research has shown that some fathers (like mothers) take time to bond with their baby, and the development of this bond is also dependent on how much physical access he has to the newborn.

With feeding, especially breastfeeding, and mother-infant interactions dominating most of the baby’s initial days, it’s quite common for fathers to feel excluded.

There are, however, things fathers can do to foster a sense of connection with their partner and baby.

• Get involved with childcare tasks. Getting involved in tasks such as changing nappies, bathing the baby, taking the baby in a sling or carrier for a walk, and baby massage are great ways to stay close. Physical touch stimulates the release of hormones such as oxytocin and dopamine, which foster attachment.

• Engaging your baby. Playing with the baby during “tummy time” or reading to the baby is a great way to stay close and be involved. Engaging your baby will help you to get to know the cues they use to communicate their needs. Being responsive to your baby’s needs promotes a sense of connection and is the basis for developing a strong attachment.

• Avail paternity leave. Make use of parental leave, if this is an option. This is a great opportunity to support your partner, get to know your baby, and in general recover from the birth experience. Some studies have shown that men who spend more time with their babies feel more competent in their role as fathers, and are better able to adapt to fatherhood.

• Seek assistance. If you notice feelings of anger, anxiety or general lethargy that you feel may impact your ability to connect with your partner and baby, please seek support from a professional who specialises in understanding mental health in the perinatal period.

Our research team is seeking to better-understand fathers’ and non-birth partners’ perspectives on bonding and attachment in the context of restrictions to their presence during pregnancy and birth. Participation in the study can be via a survey, or interviews. If you’d like to participate in either of these studies, please contact Levita D’Souza on levita.dsouza@monash.edu