Not every mum-to-be “glows” or “blooms”, just as not every new mother basks in the glory of their new role.
Caring for a new baby is associated with fatigue, greater responsibility and hard work. The demands of pregnancy, both physical and emotional, are not always easily managed either. Add to this society’s expectations that you will manage all of this with a smile on your face, and mental health issues can be the result.
Perinatal Mental Health Issues: When the Joy of Motherhood Isn’t There
There is an increased incidence of mental health disorders in the perinatal period, including:
- Anxiety and Stress;
- Bipolar Disorder;
- Postpartum (Puerpal) Psychosis;
Note: The term “Perinatal” covers the period of pregnancy (antenatal), the birth/labour, as well as 12 months postnatally.
Distress during Pregnancy
Many women experience distress during pregnancy but fail to recognise it as a problem – eg “crying during pregnancy was ‘perfectly normal’ – how could I be depressed when I was so happy to be pregnant?”
It is important not just to dismiss your own genuine struggles to cope with the challenging reality of caring for a new baby. Depression and other mental health issues in pregnancy are related to the rates of mortality and morbidity for infants as well as mothers, so seeking help is not just good for the mother, but also for the health and wellbeing of the child/ren as well.
Following is some basic information about the mental health issues that can arise during the perinatal period:
Anxiety and Stress
There is growing evidence that anxiety and stress have a negative effect on the growing foetus, with a strong correlation between cortisol (stress hormone) levels of the mother and her foetus in-utero.
Therefore any intervention that reduces the mother’s anxiety and stress during pregnancy will have a positive effect on the infant, and should reduce problems with the infant’s cognitive, behavioural and emotional development due to raised cortisol levels.
Pregnancy and Bipolar Disorder
Pre-conception counselling is recommended for women with pre-existing Bipolar Disorder, Personality Disorders, previous diagnoses of Psychotic Post-Partum Depression. This provides a valuable opportunity to determine the risks versus the benefits of medication, to evaluate all the treatment options, and to set up ongoing counselling and support throughout the pregnancy and postnatal period.
This is important because pregnant women with bipolar disorder are at risk of:
- Greater incidence of gestational diabetes;
- More instrumental deliveries (eg forceps deliveries);
- Increased number of caesarean deliveries;
- Higher risk of pre-term births;
- Lower APGAR scores at 5 minutes.
Tokophobia is a disorder often overlooked by medical professionals. Whilst some anxiety or fear regarding pregnancy and birth is normal, Tokophobic women have an all-consuming anxiety regarding labour and childbirth. It can manifest as nightmares, panic attacks, psychosomatic complaints, or difficulty concentrating on work/family activities.
Tokophobia may affect as many as one in ten women, and some women see pregnancy and childbirth as so horrifying they decide never to have children, or elect to have a Caesar, or even terminate what was actually a much-wanted pregnancy. It can be the result of a past traumatic birth/pregnancy experience, or through being influenced by the negative experiences of others.
If you, or someone you know, might be experiencing this intense fear and/or anxiety regarding pregnancy and birth, it is important to look for positive and empowering information and books, and to seek out positive birth stories from other women.
It can also be beneficial to attend counselling with a Psychologist or experienced midwife, to work through the fears and learn to manage them, rather than avoid the experiences involved in pregnancy and birth.
Postpartum (puerpal) Psychosis
Postpartum psychosis is rare but very severe, and it affects around 1 or 2 in 1000 women. It involves a risk of self-harm or harm to the baby or other children. Research has not been able to identify the cause of postpartum psychosis, however it has been suggested that women with bipolar and women with previous postnatal psychosis are at greater risk of experiencing postpartum psychosis.
Whereas once the focus was on just depression in the postnatal period, symptoms of depression have now found to be not any more common or severe after childbirth than during pregnancy – ie they are just as common during pregnancy. This has meant that more GP’s, midwives and obstetricians are on the lookout for signs and symptoms of depression in pregnant women, which has meant more women who may previously have suffered alone, are now accessing support and treatment.
The symptoms of perinatal depression include:
- Profound and consistent lowering of the mood;
- Alteration in clear thinking;
- Slowing down of psychomotor functions;
- Catatonia may occur in severe cases;
- plus anxiety about the baby, and/or their mothering ability.
The effects of perinatal depression are great, and can include the following:
- Mother’s distress and feelings of guilt;
- Loss of bonding/attachment with infant;
- Deciding not to have more children;
- Marital strain or loss;
- A third of untreated cases last over one year;
- And a third will recur with the next pregnancy
Given the significance of these effects for not just the mother, but for her family and others around her, seeking treatment can have huge benefits. Treatment of perinatal depression falls into four main areas:
- Biological eg Electro Convulsive Therapy (ECT), medication;
- Psychotherapy eg Cognitive Behaviour Therapy, Acceptance and Commitment Therapy, supportive counselling, relaxation, psycho-education;
- Helping families eg discussions about safety, investigating childcare during the day, “Circle of Security” to improve mother/child attachment quality, and improving the quality and quantity of sleep;
- Encouraging the use of supports eg from families, friends, use of babysitters, engaging professionals such as sleep specialists.
What about the Father?
But it’s not just women who suffer from perinatal depression …
Research shows that one in 20 fathers are now diagnosed with postnatal depression each year in Australia (Deloitte 2012). The total number may actually be higher, with many more men struggling without seeking a diagnosis or support.
Some of the signs/symptoms of perinatal depression in men are:
- Tiredness, headaches and pain (so they might attend their GP for a seemingly unrelated somatic concern);
- Irritability, anxiety and anger;
- Loss of libido;
- Changes in appetite;
- Feelings of being overwhelmed, out of control and unable to cope;
- Engaging in risk taking behaviour;
- Feelings of isolation and disconnection from partner, friends or family;
- Withdrawal from intimate relationships and from family, friends and community life;
- Increased hours of work as a part of the withdrawal from family;
- Increased use of drugs or alcohol instead of seeking treatment for depression.
If you think you – or someone you care about – might be experiencing symptoms of any of the perinatal mental health issues outlined above, it is important for both their wellbeing as well as that of the baby’s that professional help is sought. This might be through formal psychological counselling, pharmaceutical interventions through a GP or Psychiatrist, or just looking at some of the available resources (listed below) as a starting point.
Author: Lauren Burrow, B Psych (Hons), Grad Cert Health Promotion.
Lauren Burrow is a Brisbane Psychologist, endeavouring to provide her clients with a welcoming, reassuring and non-judgmental experience. She assists her clients to identify helpful strategies to overcome their issues, to broaden their existing skills in coping and functioning, and provides them with psycho-education to assist with understanding and managing the symptoms they are struggling with.
To make an appointment with Brisbane Psychologist Lauren Burrow, freecall 1800 877 924 or book online today.
- Beyond Blue: includes fact sheets/information booklets on Perinatal Depression (Beyond Baby Blues), and looking out for the mental health of fathers
- Black Dog Institute: has a section titled “Depression in pregnancy and postnatal”
- PANDA: Post and Antenatal Depression Association 1300 726 306
- “How is Dad Going”: PANDA’s new website for fathers.