Impact of COVID-19 lockdown-associated visitor restrictions on mother-child interaction and emotional state of women in the puerperium - a retrospective cohort study.

Introduction: The aim of this study was to analyse the impact of maternal isolation during the COVID-19 lockdown. Two main aspects were examined: (1) What impact do these social restrictions have on maternal depressive symptoms? and (2) Is there an influence on mother-child interaction? As secondary endpoints, we defined the influence of the restrictions on breastfeeding, the length of hospital stay, patient satisfaction during the inpatient stay due to the reduced number of visitors, and postpartum complications after discharge.

Materials and methods: The study was conducted at a university-affiliated teaching hospital in Switzerland. Women who delivered in the first phase of the COVID-19 pandemic and who were not allowed to have any visitors including the child's father (group "total ban", n = 53; 20 March 2020 to 10 May 2020) and women who were only allowed to have a visit from the child's father (group "partial ban", n = 49; 11 May 2020 to 20 June 2020) were compared to a reference group of women who delivered prior to the restrictions (n = 61; 1 January 2020 to 16 February 2020). Participants completed a questionnaire one year after delivery to assess their situation one week and one year after giving birth. The primary outcomes were the state of mental health (measured by the Edinburgh Postnatal Depression Scale) and maternal bonding (measured by the Mother-to-Infant-Bonding Scale). Secondary outcome measures were breastfeeding status, postpartum complications and length of hospital stay.

Results: Of 404 women eligible for participation, 241 declined to participate or could not be reached. Obstetric baseline characteristics were similar across all three groups. Analysis of signs of depression showed a 2-fold higher risk of postpartum depression after one week and one year in both isolation groups compared to the reference group (23% and 20% vs 9% at one week; 11% and 11% vs 5% at one year). However, this did not reach statistical significance (p = 0.158; p = 0.471). Analysis of the Mother-to-Infant-Bonding Scale revealed similar scores in all groups in the first week and after 12 months. There were no significant differences in the rates of breastfeeding and postpartum complications. Hospital stays were clearly shorter during the partial and total visitor bans (3.06 days and 2.55 days vs 3.51 days in the reference group [p <0.001]). 45% of patients in the reference group would have been dissatisfied with a limitation to the number of visitors as compared to only 18% in the total and 9% in the partial visitor ban groups (p <0.001).

Conclusions: We found an increased albeit non-statistically significant risk of postpartum depression one week and one year after delivery under different forms of isolation on the postpartum ward. We hypothesise that this is unlikely caused solely by isolation, as both groups were equally affected independently of the possibility of partner support. Maternal bonding and breastfeeding rates were unaffected. Hospital stays were significantly shorter during the partial and total visitor ban, but postpartum complications were unaffected. Only a minority of women in the isolation groups were dissatisfied with the visiting restrictions. The SARS-CoV-2-associated protective isolation measures applied in maternity wards appear not to have had a major negative impact on maternal wellbeing in this population.