Sheila Lee was nursing her newborn daughter Aubree last April when she glanced at the devastating text message.
A woman in her 50s, a colleague at the nursing home where she worked, had died of COVID-19.
“And I just remember completely breaking down,” Lee recalled nearly a year later. “It was that moment where I knew I’m not going back to work. I was so scared for my family and my baby.”
Lee, 35, gave birth just weeks before New Jersey was propelled into the throes of the coronavirus pandemic that would drastically alter her expectations as a first-time mother.
There was no stream of visitors at their front door. No infant swim classes. No grandparents to come snuggle baby Aubree at their Stanhope home.
Lee was diagnosed with postpartum anxiety, but offered few resources, she said. Despite monthly therapy sessions, she was overwhelmed during a time she always dreamed would be filled with joy.
And she wasn’t alone.
Lee’s experience with mental health during the pandemic is a common thread shared by so many women, including those who lost jobs or had children suddenly learning from home. COVID-19 has spared no one in its unrelenting flood of destruction, isolation, and grief. But experts and researchers suggest mothers have shouldered the brunt of the psychological toll.
Nearly half of U.S. mothers reported at least mild symptoms of psychological distress—combining feelings of anxiety and depression—in early April 2020, compared to 32.5% of men with kids, according to a working paper from researchers at the University of Southern California.
Often the primary caregivers and emotional anchors of their families, mothers are at a unique mental health risk during the pandemic, experts say, because of the stress and expectation to manage it all.
“I think moms are the, you know, in many ways, the real heroes of this epidemic, because they are oftentimes the primary caregivers for the children,” said Ramon Solhkhah, the chair of psychiatry and behavioral health at Hackensack Meridian School of Medicine at Seton Hall.
Women still spend more time on household labor and caregiving compared to men, with almost 75% of mothers saying they do more to manage their children’s schedules, according to data released in January from Pew Research Center.
On top of normal parenting duties, the pandemic has multiplied the pressure on mothers: shouldering the burden of remote learning help, sidelining their careers and losing finances, and being forced to reshape their expectations as parents.
COVID-19 has largely, although temporarily, reshaped parenting into a solitary experience for many caregivers. Gone are the after-school playdates and catching up with other moms. Now, many parents weather the stress alone, without the solace of community support.
“Fostering community is really important in parenting,” said Jill Wodnick, a childbirth educator and doula. “We are not supposed to do this alone.”
Remote learning has taken a toll on Chrissie Robertshaw, a single mom of two kids in elementary school. Joe Warner | For NJ Advance Media
Isolated from community
Remote learning has taken its toll on Chrissie Robertshaw’s kids—and her.
A 42-year-old single mom, Robertshaw adopted her two kids when they were young. Her son, a sweet, sensitive 8-year-old with a learning disability, struggled during remote school, but is making progress now that he’s back in person.
But she’s worried about her daughter.
From the time she was three, she was acting out, throwing extreme tantrums and hitting and kicking her mom and brother.
Around age 5, she was diagnosed with oppositional defiant disorder and severe ADHD. She began therapy, started managing her anger, and stopped inciting physical conflicts, her mom said.
By age 9, Robertshaw’s daughter was excelling in school and her teachers even floated the idea of having her skip a grade.
Now, she’s struggling to pass and the progress they’ve made in the last few years has been erased: her tantrums have returned, along with the physical altercations. She instigates fights with her brother with emotionally cutting remarks. And instead of hitting her mom, she verbally berates her.
“I was very confident that I could give these kids a good life and I could handle whatever would come my way,” Robertshaw of Brooklawn said. “(And) I’m not. And I feel like I’ve failed them.”
Over the summer, Robertshaw recalled, there was a point where she couldn’t talk without crying.
“I feel like I have so many full-time jobs that I can’t give any of them my full attention,” Robertshaw said. “So I feel like everything is being neglected and not one thing is getting done properly.”
Building a community of mothers to provide support, encouragement, and relief is a crucial part of parenting, experts say. Social rituals like mom groups, family help, and group advocacy are part of those community actions.
When those community needs are not met, women may experience an increase in depression, anxiety, and PTSD, Marcello said.
“Those little things aren’t so little, they’re actually huge,” she said. “And they’re really what allow women, and mothers, and fathers, to create that balance in our lives.”
Robertshaw works minimal hours at a salon as a nail technician because the pandemic has decimated her business. She estimates roughly 25% of her clients have returned, with some awaiting their vaccines before going back to the salon.
When not in their school a few hours four days a week, her son never wants to leave the house. Her daughter doesn’t want to be home. And so Robertshaw feels pulled in different directions, with guilt automatically included in either decision.
She regularly drops the kids off at their grandparents’ houses after school, so she can go to work, but all four grandparents work as well. The kids also need more help, whether through therapy or academic support, but as their sole provider, Robertshaw doesn’t have the time.
“And so it breaks my heart that I feel like I’ve disappointed them, I’ve let them down, because I can’t give them the time to get them the help that they need,” Robertshaw said.
Life is difficult and exhausting for her. She no longer has the desire to do her work. Regular healthcare appointments for herself—doctor visits, dentist checkups, the eye doctor—are neglected.
“Every aspect of my life is just slowly falling apart,” she said. “And I’m sitting here in the middle, just waiting, just watching.”
She’s also found herself forgetting things, walking around in a fog-like state of mind. Nothing is given her full attention, and the stress compounds.
“It’s almost like every kind of psychosocial stressor you can have in one pot, but like let’s through them all together and each person has a few of them,” said Stephanie Marcello, chief psychologist at Rutgers University Behavioral Health Care.
Kimberly Khalil was struggling with her mental health while balancing her full-time job and caring for her son. Aristide Economopoulos | NJ Advance Media
Career and financial stress
Kimberly Khalil was overwhelmed.
Between working her call-heavy full-time job that had now become remote and caring for her infant son, Khalil remembers a point last year where she told her husband she couldn’t do it any more.
“I don’t know how we’re going to swing this, but if you want me to be me, and mom, and the woman you fell in love with, I need to tend to our kid, until I find (another job) that works,” she recalled telling him before she left the workforce.
Khalil, 33, then became a stay at home mom in their Mount Arlington apartment for eight months. It was a relief because of the stress, she said, but it also brought on a flood of new feelings.
Her identity as a working mom, one she always wanted, vanished overnight.
She was one of 10 million mothers of school-age children who were not working in January — up 1.4 million compared to the same month last year, according to the U.S. Census Bureau data.
In addition to the career loss, financial worries exacerbate the stress many mothers have felt throughout the year.
Khalil wasn’t used to relying on her husband’s income, which diminished her confidence. She found herself tiptoeing around questions she normally would’ve asked him, like whether to get takeout, because she felt guilty over spending the couple’s money.
“….which is ridiculous because it’s our money,” she said, adding her husband never made her feel guilty about it, “but there’s still that individuality that I think everybody wants to have.”
The stress of everything combined—the remote job, nursing an infant, figuring out new routines amid a pandemic—threw her for a loop, on top of already existing mental health challenges she dealt with.
Khalil was diagnosed with anxiety before starting fertility treatments in 2018. She took antidepressants, and regularly went to therapy. She asked her doctor to increase her dosage and she adapted to her new normal.
“I felt like I was doing a disservice to my son, and then to my mental health, in trying to make it all work,” she said.
And although some women have returned to the workforce, with Khalil included, the long-term damage has still been done. The labor force participation rate for women has not been this low since 1988, according to an analysis from the National Women’s Law Center.
The expectation to continue managing a household plus working professionally is forcing women to extremes, Marcello said.
“We’ve really pushed women into a corner,” she said.
Rosanna Rodriquez said she sometimes forgets about herself as a mom, often putting her two younger kids first. Aristide Economopoulos | NJ Advance Media
Kids come first and mom comes last
Rosanna Rodriquez’s days are often draining.
As the co-director of the Laundry Workers Center, an immigrant advocacy group, Rodriquez is often more therapist than activist. She hears from undocumented members, provides resources and encouragement, and strategizes on organizing campaigns.
It’s a lot of pressure. But the Orange mom of a 7 year old and 9 year old also has to support her kids’ online schooling, while working her job.
Her husband also works for an advocacy group and her mother, who moved in with the family a few years ago from the Dominican Republic, helps with the cooking. But Rodriquez, 34, has still felt overwhelmed, especially when the pandemic first hit.
“Especially if you have little kids, you are not thinking about yourself, you’re thinking about your kids, and you put them first,” she said, “but it’s also like you forgot about you. You forget about yourself.”
Moms in particular focus on putting their child’s needs first, experts say, creating anxiety in the face of the unknown. Questions on everything from how much you should be going out to how many family members you can see is playing out in parents’ minds.
“I mean there’s a lot of unknowns, we tend to err on the side of caution,” said Meghan Rattigan, an obstetrician gynecologist at Jersey Shore University Medical Center. “I think that it’s creating anxiety for a lot of my new moms, because they want to do the right thing.”
Last September, Rodriquez noticed her older son was showing some signs of depression: he was sleeping more than usual, spending most of his time alone, and only wanting to go on his computer.
So she started taking him out with her more, going on walks together, and keeping him engaged in other activities. It’s mostly worked and he seems to be doing better now, she said, but his mental health played a role in her own worries as a mom.
“You don’t want to see your kid in that situation,” Rodriquez said.
Mental health-related emergency department visits among children ages 5 to 11 increased 24% from last mid-March to October, and was even higher in adolescents, compared with the same period in 2019, according to data from the CDC.
Seeing your child’s mental health suffer in turn affects your own mental health as a parent, experts say. Feelings of guilt, anxiety, and a sense of loss come together, spurring a sense of fatigue over a long period of time, with the pandemic stretching beyond a year now.
“So I think women really internalize that,” Rattigan said, “and hold themselves accountable for something that is under no one’s control.”
Before her daughter Aubree was even born, Lee envisioned throwing her a huge first birthday party. They would host it at the same restaurant Lee’s baby shower was thrown, buy a large cake, and invite family and friends.
But when the milestone came around, things were different than what she pictured. The cozy Italian restaurant had gone out of business. The pandemic, somehow, was still affecting every aspect of her life.
Lee instead held a simple celebration with her immediate family. She stuck to her original pastel pink floral party theme, and decorated the kitchen with a festive balloon backdrop. It felt good to surrender her expectations, she said.
Sheila had to adjust her expectations when it came to Aubree’s first birthday, but it freed her from some of the pressures of motherhood. Sheila Lee
She had experienced an entire year of disappointments and setbacks. Readjusting her expectations was a new normal for her, but it also provided a blank road map moving forward.
“Because I’m not held to all of these standards and I don’t feel so pressured to be a certain way, she said, “which I feel like a lot of mothers deal with.”
Lee also got her yoga certification to teach adults and is working on another one to teach kids. She plans to open her own business and offer “mommy and me” type classes.
As restrictions loosen up and more people get vaccinated, many mothers are hopeful and looking toward a fresh start for the coming school year.
“Human beings are resilient by nature,” Marcello said. “It’s not anything extraordinary—resiliency is like in our biology, and so how do we support kind of the stress we’re looking at right now?”
Long-term repercussions of the current mental health impacts are dependent on the individual person, experts say. People with a family history of mental health diagnoses or previous episodes are at a greater risk of experiencing psychological distress in the future.
One way to help mothers—pandemic or not—is by expanding behavioral health services, so psychologists can conduct mental health screenings and evaluations alongside OB/GYNs, experts say.
Having clinicians working with women on site and offering referral services after giving birth would be crucial, Marcello said. Sending them home without that information could diminish the chances of women seeking help and accessing resources.
“Even the chances of them being able to make another appointment, go see a therapist, to find a therapist, to get them to call them back, to know who to call,” she said, “I mean, it’s a lot for someone who is struggling or could be struggling and who’s also caretaking for an infant.”
According to survey data the Kaiser Family Foundation released in April, nearly three in ten mothers needed but were unable to receive mental health services over the past year. The most common reason for the barrier was an inability to find a provider.
Friends and family can also offer support by checking in, and noticing if someone they know is indicating sleep and eating changes or seems more isolated and disconnected. For new moms in particular, there’s a false notion that they have to do it all as a “super mom.”
“…it’s a fallacy,” said Solhkhah, “and it’s compounded by social media, where everyone only paints the best portrait of themselves.”
Stigma surrounding maternal mental health continues to exist, but experts are optimistic that people are more open to seeking help and resources when needed. Simply talking about it with other people helps open up the door.
It allows “for more honest conversations about where women really are and the struggles that we really do face as moms, as stay at home moms, as working moms,” Marcello said.
As she reflected on the past year and the whirlwind experience of being a new mom, Lee said she was grateful for the time she had with her daughter. She didn’t miss a single milestone—every first roll over, sit up, and step, Lee was there for it.
“She was a blessing, you know?” Lee said. “I had her every day to wake up to and take care of and she’s my reason to keep going. So we just, we did it.”
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