Minding Women’s Mental Health in Pregnancy and early Motherhood

Pregnancy and early motherhood are idealized as a wonderful and joyous time. However, for some, it may not be the joyous and happy experience they expected. It can be a physically difficult and emotionally demanding time. It is a time of great transition and of shifting identities. Parents may start to re-think what is important in their lives, or reflect on their relationship with their own parents. Pregnancy may also bring up unresolved issues from the past, including one’s own experience of being parented. It may raise concerns about the kind of parent one will be and how one will cope. Whether the pregnancy was planned or unplanned, it’s normal to have mixed emotions during this time.

While depression and anxiety are the most common mental health issues seen here, women will also be referred because of other mental health issues, including, Puerperal Psychosis , Bi-Polar Disorder, Obsessive Compulsive Disorder (OCD), Eating Disorders and Post-Traumatic Stress Disorders (PTSD) and complicated bereavement.

There is a recognition of the importance of mental well-being throughout pregnancy. Early detection of mental health issues is key. Two-thirds of women who have suffered with depression or severe anxiety antenatally, will experience depression post-partum. Postnatal depression and anxiety can impact negatively on mother/infant bonding which is vital for the long-term emotional and cognitive development of the child. Also, mental health issues can impact the whole family, and are associated with a higher incidence of relationship breakdown.

So what factors affect women’s mental health during pregnancy and postnatally?

 At no time in a woman’s life are supportive relationships more important than in pregnancy and for the first few months after birth. Poor social support or lack of a confiding relationship, or a difficult marital/partner relationship will impact negatively on a woman’s mental health, as will issues such as additional stressful life events, e.g. bereavement and relationship break-up. If the pregnancy is unplanned, the woman may be worried about finances, or not feel ready for motherhood. A difficult pregnancy may also lead to depression/anxiety. Further, women who have suffered a previous miscarriage or stillbirth may be particularly at risk of developing symptoms of anxiety in later pregnancies.  However, the biggest risk factor is having a previous history of a mental health issue. If you have a history of depression, postnatal depression, anxiety, psychosis, bi-polar disorder or any history of mental illness, it is very important to mention this at time of booking, so that you can be offered the support of the Perinatal Mental Health Team.

When should I seek help?

The sooner a woman seeks treatment, the better. If a woman feels sad/depressed/anxious/worried for more than two weeks, and/or begins to feel that life is not worth living, and these feelings won’t go away, it is vital to reach out for help as soon as possible. Other symptoms of depression/anxiety include loss of interest in usual daily activities, decreased motivation, appetite changes , insomnia, crying a lot, feeling  worthless, anger or irritability, feeling afraid to be alone with the baby, having constant worrying thoughts, or experiencing panic attacks. Anxiety and depression can snowball. Feeling deeply sad or having panic attacks every day, can put you and your baby at risk.  It is important to discuss with your G.P. or Midwife about how you are feeling, or to your Obstetric Team if you are attending a hospital appointment.

How can women look after their mental health during pregnancy?

Begin to start developing a network of support during pregnancy, whether this is from family, friends or other women who are pregnant or have children of a similar age. Think about who may be able to support you if you need it. Support can be both emotional and practical. It could be someone you may call if you are feeling down or anxious, or someone to share your concerns with.  Practical support could be a family member or friend who could do some shopping for you, or mind your baby while you catch up on sleep. Talk to your partner about how you are feeling and the difference a baby will make to your lives, how your relationship may change and how you may adjust to this. Being prepared for the changes a new baby will bring, will ease your path to parenthood.  Post-birth, try to ensure that your partner is at home for the first week or two to provide you with extra support. If your partner has to go back to work early, perhaps a grandparent or sibling could help out, or agree to drop in daily.  Remember that you can’t do it all alone – don’t be afraid to ask for help; and don’t be hard on yourself or try to live up to unrealistic expectations.

It is also important to take time for yourself. Many mothers put their own needs last.  Tending to your own needs or self-care is about valuing yourself.  Self-care can make you a better caretaker – neglecting your own needs can lead to deeper unhappiness, low self-esteem, resentment and burnout. Self-care is about taking time out to doing things just for fun or doing activities that you enjoy.

Self-care activities are activities that can also help you relax and lift your mood.   Some of these may include – pregnancy yoga, mindfulness, tai chi, swimming, walking or other gentle exercise.  The relaxation and feel-good effect of these activities is cumulative, i.e. it builds up with regular practice.

Sometimes seeking professional help can be beneficial.   There are some organizations which provide support and counseling for women during pregnancy and postnatally. Cognitive Behavioural Therapy (CBT) also works well for mild to moderate depression and anxiety. It works on the basis that your thoughts affect your moods, and that changing your thoughts can change how you feel. CBT can help you identify anxious or negative thoughts and the situations trigger these thoughts. CBT is available both through private and some low-cost services.

Finally, medications can help to reduce depression and anxiety but non-pharmacological treatments are the first line of treatment in mild depression/anxiety.  Overall the risk of birth defects and other problems for babies of mothers who take antidepressants is low.  The decision to use antidepressants is based on the balance between risks and benefits. The decision will be made by your GP or Psychiatrist in consultation with you.

Do not neglect your mental health. Care is available to you.