Five messages for women and those who care for them
Reprinted from the "Having a Baby" issue of Visions Journal, 2012, 7 (3), pp. 5-6
Carrying a healthy baby to term and developing a strong attachment with the newborn is our primary goal. The journey of motherhood, however, may be fraught with uncertainty and emotional turmoil from the moment of conception.
Research shows that pregnancy doesn’t protect women from mental illness. The occurrence of depression in pregnancy is reported to be around 10%, while after birth it’s about 13%.1 More frequently than not, mood disorders or depressive symptoms are accompanied by anxiety.
Nobody knows why some women are more predisposed to perinatal and postpartum mental illness compared to others. Many factors can be involved, including prior personal or family history of mental illness and stressful life events. Hormones and changes in brain chemistry appear to play a role in the onset of mood and anxiety disorders in vulnerable women.
The effects of untreated psychiatric illness on the mother and baby are a growing concern to clinicians and researchers alike. Untreated depression in the mother can lead to poor prenatal care, increased substance use, medical complications, and thoughts of harming oneself. For the child, there can be bonding issues, excessive anxiety or behavioral problems, etc. Exposure to a mother with ongoing untreated mental illness can result in emotional upheaval in the growing child.
A message for women who are pregnant or planning to be and who have a history of mental health problems
If you are pregnant, it is in your best interest to share any recurrent emotional changes—however unimportant they may seem—with your health care providers. The rationale for sharing such information is to minimize the reoccurrence of depression and anxiety in pregnancy and the postpartum if you have a prior history of such illness. In addition, those women who are planning a pregnancy should also share their history of previous episodes with health care providers, as the chance of the disease reappearing during pregnancy or postpartum is likely.2-3 And, needless to say, those women currently receiving psychiatric treatment should disclose this information to their maternity doctor so their course can be monitored through the different stages of pregnancy and childbirth.
Most women are hesitant, apprehensive, and at times, frankly embarrassed when it comes to disclosing present or prior psychiatric history and that of our family members. We are fearful of being judged and labelled. But we have to make a concerted effort to overcome this barrier and share pertinent information of any illness, be it diabetes, high blood pressure or depression.
A message for women who don’t have a psychiatric history but unexpectedly face mental health challenges in pregnancy or postpartum
Unexpected onset of psychiatric symptoms with no prior warning can evoke a sense of shock, disbelief and skepticism. Without previous notice, it is not easy to accept this emotional upheaval at a time when we least expect it. In fact, it is extremely challenging.
Once the realization sinks in, treatment should be sought immediately to lessen the impact of the disease. This illness, if left untreated, can disrupt our lives. We should be our own best advocates in seeking help when necessary.
A message for partners, family members and other loved ones
More often than not, dealing with a mother-to-be or mother with mental illness is a taxing and overwhelming experience. Acceptance of this illness is daunting—time and time again partners want an explanation as to why their loved one is suffering. Partners and family members need to be reassured that with proper treatment this illness can be controlled. They can be guided to look for early signs in order to help prevent further worsening of the symptoms.
Ideally, one’s partner will be an ally throughout this tough course. Once educated about the illness, partners can be engaged in the treatment—a process that will alleviate their own fears and anxieties. Research reveals that the recovery from postpartum depression is accelerated by partner support.4 For those who are lucky enough to have a partner by their side, this battle becomes easier. And it’s very important that partners and loved ones take good care of themselves as well.
A message for health care providers who work with this population, but may not intimately work with them on the mental health side
In Canada, we are fortunate to have a diversity of health care providers involved in the treatment of pregnant and postpartum mothers. However, not all may be familiar with the psychological aspects of maternal well-being. And sometimes, the health care providers’ personal biases can interfere with early recognition and treatment intervention. Doctors who specialize in the field of perinatal mental health should shoulder the responsibility of educating their colleagues such as midwives, obstetricians, family physicians or nurse practitioners.
After thirty-odd years of clinical experience, my message to fellow clinicians is, "Look for psychological signs during pregnancy and the postpartum. Don’t ignore the symptoms, because they don’t go away!"
A last message to all
There are many effective resources available for women and their families. If a family doctor is providing the prenatal care, make sure you are carefully monitored for your mood. Midwives in BC are very efficient in recognizing the emotional changes and are prompt in finding resources—so talk to them. The obstetricians are tuned in to your overall well-being; make sure you take them into confidence. In addition, don’t be shy to talk to the public health nurses or the health care providers at your local health unit.
Self-care is an important tool for you!
About the authorShaila is a Clinical Professor of Psychiatry/Obstetrics & Gynaecology at UBC and the Founder/former Medical Director of the Reproductive Mental Health Program at BC Women’s and St. Paul’s Hospitals in Vancouver. She is the author of Pregnancy Blues and Shouldn’t I Be Happy? Shaila is the mother of two sons
Misri, S.K. (2005). Pregnancy blues: What every woman needs to know about depression during pregnancy. NY: Delacorte Press.
Altshuler, L.L.,Hendrick, V. & Cohen, L.S. (1998). Course of mood and anxiety disorders during pregnancy and the postpartum period. Journal of Clinical Psychiatry, 59(Suppl 2), 29-33.
Banti, S., Mauri, M., Oppo, A. et al. (2011). From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the perinatal depression - research & screening unit study. Comprehensive Psychiatry, 52(4), 343-351.
Misri, S., Kostaras, X., Fox, D. et al. (2000a). The impact of partner support in the treatment of postpartum depression. Canadian Journal of Psychiatry, 45(6), 554-558.