Families delay pregnancy during pandemic

New Hampshire families are adjusting their plans for more children, or opting not to expand their family at all

By Kelly Burch via Granite State News Collaborative

Billijean Martiello, of Warner, and her husband Christopher both work as nurses, so the past eight months have been stressful for their family.

“We have been right on the front lines, knowing that for us, one wrong move during this pandemic could be detrimental not only to our family, but our patients as well,” Martiello said.

Even before the coronavirus, the Martiellos were considering only having one kid. But the pandemic solidified that choice. Luna, nearly 3, will be their only child; Christopher had a vasectomy this summer.

“In the midst of the chaos of the world, we realized that our small triangle family was perfect for us,” said Martiello, 31. “The three of us could weather the storm together, and we didn’t need, or want, another child.”

The Martiellos aren’t alone. For families around the country and through the state, the pandemic is throwing family planning into question. A national survey of 2,000 women ages 18-48 conducted in early May by the Guttmacher Institute found that more than 40% of them had changed their plans for if and when to have children, or, like Martiello, about how many children to have. One third of women said that the pandemic made them want to delay pregnancy or have fewer children.

Dr. Amy Paris, an OB/GYN and director of Family Planning at Dartmouth-Hitchcock Medical Center in Lebanon, said that the pandemic is on patients’ minds as they consider trying to conceive.

“Patients have been talking about the impact of the pandemic on their plans for pregnancy,” she said. “Especially at the beginning of the pandemic, when we knew much less about COVID-19 and especially risks to pregnant women and babies, many patients were talking about whether and how to postpone getting pregnant.”

Paris saw some patients delaying assisted reproduction, while others opted to stay on birth control like IUDs for longer than they initially anticipated.

Dalia Vidunas, executive director of Equality Health Center in Concord, said it’s hard to say whether more patients are seeking out birth control, since visitation to the clinic has been down  since the pandemic. However, she has seen more patients seeking out long-acting reversible contraception (LARC) options during the past year, she said. LARC, which includes IUDs and implants, are considered more effective than oral contraceptives like the pill, since users don’t have to take any action once they’re in place, she said. Vidunas generally asks new patients when and if they plan to start a family — if they don’t want to do so in the next year, she recommends an LARC.

Laura Thielker, 34, of Chester, has a LARC, so she’ll need to see a doctor when she decides it’s time to expand her family beyond just her three-year-old. She was planning to start trying for a second baby this summer. Her mother, who lives in England, was planning to come over in the spring of 2021 to help care for the new addition.

“All that went out the window with the pandemic,” Thielker said.

Thielker and her husband can’t afford two children in daycare, and they don’t know when her mother will be able to travel again from England. They’re also concerned more broadly about having a baby during COVID.

“I don’t like the idea of a pregnancy or brand new infant in a pandemic… solitary doctor appointments, changing hospital policies, an isolating [postpartum experience] when I’ll need all the support I can get,” Thielker said, referring to the three months after a baby is born.

At the same time, Thielker is worried about increased complications with conception and pregnancy as she ages.

“We may end up throwing caution to the wind if this pandemic drags on for too long,” she said. “I don’t want to miss my chance and the age gap between kids is already bigger than I’d pictured my life looking like. There’s a lot of moving parts involved in these decisions.”

Paris said that as scientists and healthcare providers learn more about the novel coronavirus, some women are becoming more comfortable conceiving.

“For women who either do not want to delay or are in a situation where they are running up against the ‘biological clock’ in terms of expanding their family, I do feel that there is some good news,” she said.

Providers, including Dartmouth, are now conducting some prenatal visits via telehealth to help limit exposure. The virus doesn’t seem to be passed to fetuses or infants via the placenta or breast milk, Paris said.

“Even though it may be a scary time to contemplate pregnancy for many, I do feel like we can safely support women who do choose to become parents during this pandemic,” she said.

However, Derek Edry, spokesperson for Planned Parenthood of Northern New England, said that the pandemic has made access to family planning options more important than ever, especially since pregnant people are classified as having increased risk for severe symptoms of COVID.

“Our clinicians work with people every day who are navigating the challenges of the pandemic and incorporating these new issues into their plans to start a family, grow a family, prevent a pregnancy, or end a pregnancy,” Edry said. “Each person’s decision-making has more factors to consider than ever before.”

Thielker understands that well.

“Worry is my expertise,” she said. “I know it’s hard for everyone. I know there are other ways to add more kids to your family besides pregnancy. It doesn’t make me less frustrated that this wrench was thrown into my plans.”

She added, “I know I’m not alone struggling with these choices, and that’s equally comforting and depressing.”

For couples who are feeling similarly frustrated, both Edry and Paris recommend focusing on preconception health. That can include practicing healthy eating, getting up to date on vaccinations, taking a prenatal vitamin and quitting smoking, Edry said.

“Good health before someone becomes pregnant helps them to have a healthier pregnancy and reduces the chances of some birth defects and pregnancy complications,” Edry said.

Yet, not everyone is delaying pregnancy — some, like Martiello, are scrapping plans for additional children entirely. The Brookings Institute estimates that there will be 300,000 to 500,000 fewer babies born in 2021 because of the pandemic: in addition to health concerns, recessions are linked to lower fertility rates.

While some might find that sad, Martiello is completely confident with her choice — she’s not worried about making a permanent decision during a temporary crisis.

“Our family’s resources — time, money, emotional energy — are enough to sustain the three of us. Our daughter is happy and healthy, and importantly, so are her parents,” Martiello said. “It isn’t a loss of a hypothetical child that might have been, but an educated and informed decision that took into account our collective needs and desires as a family.”

These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.

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