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This week is Maternal Mental Health Awareness Week, which aims to shed light on the commonplace and complex difficulties associated with pregnancy and early motherhood.
Perinatal Mental Health refers to the mental health of women during their pregnancy or in the first year following the birth of a child ('peri' meaning around and 'natal' meaning birth). This post contains information on the different types of maternal mental health difficulties, symptoms of perinatal mental health difficulties, support for partners of women suffering from perinatal mental health difficulties and guidance on seeking support. The truth is, although some women may have more of a predisposition towards developing perinatal mental health difficulties (this is most commonly the case with perinatal psychosis), it just happens.
How common are perinatal mental health difficulties?
Suicide is the number one cause of deaths for women after giving birth.
Prevalence rates of perinatal mental health difficulties vary, as it is difficult to get a precise figure.
Meta-analytic estimates (research which takes into account multiple studies) suggest that 10-15% of women experience difficulties with depression or anxiety during pregnancy (Bennett et al 2004; Heron et al 2004).
Prevalence estimates for postpartum depression (PPD) range from 3-25% of women in the first year post birth (Dennis 2003).
Prevalence rates of other mental health difficulties vary, with postpartum psychosis estimated to affect around 1% of mothers (Sit et al 2006).
Any woman of any age, ethnicity or background can be affected by perinatal mental health difficulties.
Maternal OCD (Obsessive Compulsive Disorder)
Maternal OCD is an anxiety disorder which involves obsessions and compulsions which will usually revolve around your baby and being a parent. Some people develop symptoms of OCD for the first time during pregnancy or after giving birth; for others, it can exacerbate previous symptoms. It's completely normal to worry about your child and their wellbeing. If it becomes so severe that it is affecting your daily life and your wellbeing, then it might be a good time to speak to someone about it. Please note that although symptoms can be very distressing, there has been no reported case of a mother acting on her thoughts (as reported by https://maternalocd.org/about-perinatal-ocd/).
Symptoms of maternal OCD:
Obsessions: unwelcome, intrusive and recurring thoughts, beliefs, images or doubts (e.g. that harm will come to your baby)
Compulsions: to carry out certain tasks, whether mentally or physically, to prevent an undesirable outcome or to neutralise or suppress the feelings of anxiety and distress (e.g. sterilise the baby's bottle three times)
Perinatal Psychosis
Postpartum psychosis occurs after a woman has had a baby. It most commonly begins to manifest in the first few days or weeks after childbirth. It is a severe mental illness and can get worse very rapidly but it is treatable. Most women require medication and are admitted at hospital for treatment. Some groups of women will be in the higher risk category, for example women with a history of bipolar disorder. It can also happen to women who have no previous experience of mental ill-health.
Risk factors for postpartum psychosis:
Previous experience of postpartum psychosis
A difficult or traumatic pregnancy or birth
A diagnosis of bipolar disorder (previously known as manic depression) or schizophrenia
A family history of mental ill-health, particularly if this includes postpartum psychosis, bipolar disorder or schizophrenia
Symptoms of perinatal psychosis:
High mood & low mood
Hallucinations
Delusions
Mania
Depression
Confusion
Ante-natal and Post-natal Depression
Mothers can experience symptoms of depression when trying for a baby, during pregnancy or after birth. Post-natal depression is much more long-lasting severe than the 'baby blues' which refers to very common feelings of low mood and overwhelm in the first few days after a child is born. It can come on suddenly, or be more gradual in its on-set.
Symptoms of ante-natal and post-natal depression:
Difficulty bonding, for instance with holding or looking at your new baby
Anxious surrounding your own health, pain, wellbeing of family, having visitors
Sleeping difficulties
Obsessional and/ or intrusive thoughts - fears about harming someone (like the baby)
Poor concentration and memory
Panic
Hopelessness
Sadness
Tearful
Lack of interest in looking after yourself
Feelings of worthlessness
Loss of interest in sex
Trauma
Birth can be difficult and upsetting, which could lead to some symptoms of trauma for either you or your birth partner.
Symptoms of birth trauma:
Distressing memories, nightmares or thoughts about the birth
Not wanting to think or talk about the birth
Feeling upset and anxious when reminded about the birth
Who can I talk to?
Your Health Visitor is responsible for providing you with support and guidance on caring for your new baby. They can offer listening visits if you have Postnatal Depression.
Your Midwife is there to support you with your emotional health as well as your physical health.
Your GP can help with providing the correct diagnosis, which is fundamental in being able to access the correct perinatal mental health support, such as talking therapies and medication.
Peer support can differ from service to service, but it generally includes support from individuals who have shared life experiences with those utilising the peer support service. It is for women who are suffering the same or similar issues, or who have done in the past. The shared experience can provide a safe, non-judgemental environment for opening-up. It can provide an avenue for acceptance, learning, advice and solidarity.
If you feel like a member of your healthcare team isn't listening to you, you can ask to see another member of the team, for example you can contact the community midwife manager.
Please remember it is completely understandable and normal for us all to need help from time to time, especially when such a big life change is involved. If you're worried, talk to someone you can trust. It takes a village to raise a child. If you're finding it hard to care for your baby, they'll still be able to receive love and safety from another adult, while you take care of yourself. It does not mean you are, or ever will be a failure as a mother or parent. You are enough.
With the right treatment and support, women do make a full recovery and are able to regain the mothering role they expected and hoped for. It can be difficult reaching out for help, especially when it seems other new mums and babies are flourishing, and when there are expectations that the early days of motherhood are supposed to be filled with wonder and joy. Recovery takes time and can be a difficult process, but it is possible to go back to your usual self.
Take Care,
Hannah
Resources
Action on Postpartum Psychosis: a national charity for women and families affected by Postpartum Psychosis who provide peer support services, patient information, training and promote public awareness and conduct research. https://www.app-network.org/
Bluebell Care: provides innovative services to help families manage their emotional wellbeing during pregnancy and after birth. www.bluebellcare.org
Maternal OCD: information and support for new mums, mums-to-be and healthcare professionals about perinatal OCD. https://maternalocd.org/
NHS Inform: further information on symptoms. https://www.nhsinform.scot/ready-steady-baby/early-parenthood/your-wellbeing-after-the-birth/mental-health-issues-after-the-birth
Royal College of Psychiatrists: information on accessing perinatal mental health services. https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/what-are-perinatal-mental-health-services
Tommy's: provide information on making pregnancy safer and support parents before pregnancy, during pregnancy after loss. https://www.tommys.org/
References
Bennett, A., Heather, Einarson, R., Adrienne, Taddio, R., Anna, Koren, R., Gideon, & Einarson, R., Thomas. (2004). Prevalence of Depression During Pregnancy: Systematic Review. Obstetrics & Gynecology, 103(4), 698-709.
Heron, J., O'Connor, Evans, Golding, Glover, & The Alspac Study Team. (2004). The course of anxiety and depression through pregnancy and the postpartum in a community sample. Journal of Affective Disorders, 80(1), 65-73.
Sit, D., Rothschild, A., & Wisner, K. (2006). A review of postpartum psychosis. Journal of Women's Health (2002), 15(4), 352-368.
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