Pregnancy and childbirth are especially high-risk periods for mental ill-health. The mobile health program called Essential Coaching for Every Mother (ECEM) was designed to meet the needs of mothers during this critical time, but its introduction was delayed because of the onset of the pandemic. A recent preprint posted to the medRxiv* server describes the early results of the program relative to the self-efficacy of the mother and other important parameters, as well as its acceptability.
In the current coronavirus disease 2019 (COVID-19) pandemic, there is a possibility of an increase in mental ill-health because of various factors, such as anxiety about the possibility and consequences of infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the social isolation, uncertainty about employment, and lack of social support. During the postpartum period, women are still more vulnerable to the lack of access to up-to-date information and support, even without a pandemic.
For instance, many parts of Canada canceled public health classes, including new mother classes, while friends and family could no longer visit. The inevitable result was incre1ased postpartum depression and anxiety, with loss of self-efficacy on the new mother’s part.
The ECEM program
The ECEM mobile health application was designed to help meet this need. It is a texting program that sends daily messages for the six weeks of the postpartum period. With the onset of the pandemic, some messages were changed around and new ones added, for a total of 56 messages.
These texts concerned newborn care and the mother’s own mental wellbeing, with new messages being relevant to the pandemic, such as the safety of breastfeeding during this season. The program was designed in concert with new mothers and healthcare professionals and was intended to enhance “women’s psychosocial outcomes in the immediate postpartum period.”
As originally designed, the program would send two messages a day for the first 14 days, with one a day for the remaining four weeks. The modified program sends a third message on three days in the first 14 days. The women can choose if they want messages about breastfeeding or formula feeding, flexibly, throughout the six weeks.
The pilot study was carried out on 88 mothers, with a mean age of 31 years. Almost 88% were white, and over two-thirds were married, while over a quarter were in common-law relationships. Over half had a high income, with 10% having a low income. About 88% said this was a planned pregnancy, terminated normally in over two-thirds, by an unplanned C-section in about 28%, and planned C-section in 5%. A third had received a diagnosis of anxiety or depression.
Of these participants, only ~43% got all the messages. About 90% chose breastfeeding messages. However, this did not seem to affect the outcomes.
When asked about the outcomes, there was an improvement in self-efficacy between the first and second surveys, a mean of 5 weeks apart, from the moderate to mild clinical range. However, this could simply be the result of mothers getting used to managing the care of their babies.
There was also a marked reduction in anxiety over this period, as measured by the State-Trait Anxiety Inventory (STAI). Other measures, such as postpartum depression, COVID-19-specific anxiety, COVID-19-related stress, and social support, failed to show any change.
Strikingly, almost 90% of the women said the program was completely acceptable in terms of the number of messages, and ~85% approved of the information they received about newborn care. Areas with incomplete information, according to the participants, were breastfeeding and newborn sleep. Several commented that the time they received messages about a specific topic was just right.
Almost 99% said they would recommend it to other new mothers. Many appreciated the support they received from these texts, when in-person support was lacking. “Having the texts felt like we were being cared for and gave advice that we imagined our parents would give.”
Support and togetherness
Many said the program would have been helpful even without the pandemic, and several said they felt this information was more reliable than what they could have found out for themselves by Googling a topic. Moreover, the information reassured them that what they were experiencing was expected and normal for that period. The mothers felt that their babies were meeting their milestones as expected, and also experienced a feeling of community.
The daily texting gave the new mothers an anchor as well as important validation of what they already knew or were doing right. They liked the fact that it tied in with information from other healthcare sources, and was given freely from a reliable source, and without having to ask for it. Many women did wish they could reply or ask questions, possibly have a support person, and that the ECEM program would continue for a longer period.
Since Nova Scotia was a low-prevalence area for COVID-19, the participants sometimes felt the texts related to the infection fueled their anxiety.
“Preliminary findings suggest that Essential Coaching for Every Mother may play a role increasing maternal self-efficacy and decreasing generalized anxiety, although future work with a control group is needed to delineate the true effect of the program beyond changes that occur in the postpartum period generally.”
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.