Perinatal Mental Health- An Overview
By Sammi Carson,
Registered Mental Health Nurse (BSc) and Developing Clinical Nurse Specialist.
Motherhood: one of life’s most precious experiences for a woman. For most, the journey of motherhood begins the very moment that faint second line appears on a little strip held by a shaky hand and viewed by watering eyes. We expect this nine month journey to be filled with excitement and joy, including several days of being lovingly informed how much you’re glowing, enthusiastically browsing baby names and patiently folding away an endless variety of babygrows and blankets. In summary, a warm ray of sunshine so strong that even the clouds of forbidden food groups, swollen feet and morning sickness appear fluffy and light, until the day your baby is safely in your arms and you are handed the long-awaited task of caring for them as only a mother knows how.
But what if it doesn’t happen this way? What if the sunshine is replaced by rain clouds when your long-awaited miracle is finally here? Or perhaps even before this? Phrases such as “antenatal depression” or “postnatal depression” and even “baby blues” can be a huge taboo and source of great fear for new and expecting mothers; however, it couldn’t be more important to talk about them and understand them, so that we may support all women in relishing the joys of motherhood.
The first thing to note is that these phrases are not as scary as they sound, or at least, they shouldn’t be. Sadly, women are still led to believe that these phrases should only ever be whispered and that any thought of experiencing the symptoms of these stigmatised conditions should be frantically pushed away and denied, thoughts which are often laden with the weight of fear, embarrassment and guilt. If there is one point which continuously needs reiterating when it comes to this topic it is this: when having a baby causes one of the most drastic physical changes to the human body possible, is it not entirely acceptable to believe this change may also affect the brain, arguably the body’s most vital organ which is responsible for controlling all physical bodily functions?
Let’s discuss the facts: there is a big difference between the “baby blues” and “postnatal depression,” although the terms are often wrongly used interchangeably. The baby blues usually occur within the first week or so following the birth of a baby and are experienced by a large number of women after childbirth. Approximately 85% of new mums experience symptoms of the baby blues, including feeling emotionally overwhelmed, irritable, sad and anxious. Considering the monumental adjustment to the demands of a newborn baby, these feelings are thought of as entirely natural, as well as a result of the significant hormonal changes that occur birth.
However, these symptoms should only last for a few days (up to around a week) and should feel manageable. Postnatal depression on the other hand, occurs when these symptoms do not go away shortly, worsen or begin a few weeks or months following the birth of a baby. Postnatal depression is characterised by symptoms such as feeling hopeless, unable to cope, unable to feel enjoyment and feeling indifferent or hostile towards your baby. These symptoms can occur with physical signs of depression, such as a loss of appetite, aches and pains or anxiety. Postnatal depression affects between 10-15% of new mums and is considered a serious mental health problem which must not be left untreated. New mum’s can fear being thought of as selfish, or unfit to be a mother by reporting these concerns, when they are in fact through no fault of their own: seeking support is the best thing a mum can do to protect the health and wellbeing of both herself and her baby if any of these warning signs are experienced.
It is also important to note that these symptoms are not limited to after the birth of a baby and some women may experience them during pregnancy. While conversations and information available around postnatal depression have generally improved, antenatal depression is often less publicised. Many women may feel more emotional and more anxious during pregnancy, but experiencing symptoms of depression or distressing, anxious thoughts is a sign to seek support from your midwife or GP. Just as expressing problems with mood or anxiety can be incredibly difficult following the birth of a baby, it can be equally hard for pregnant women. Pregnancy is largely viewed as a blessing and women may feel guilty for not bursting with feelings of luck and happiness, when pregnancy is actually also full of huge emotional, physical and hormonal changes that may understandably lead to these symptoms.
Although there is much more to do in the way of campaigning for open and honest discussions around antenatal and postnatal depression, understanding of these birth-related mental health difficulties have generally improved. On the other hand, there is another condition that is less well understood and discussed much less: postnatal psychosis (also known as puerperal psychosis). Just the word “psychosis” is enough to fill people with images of asylums from the early 1900’s and bring words like “mental” and “crazy” to mind, an incredibly damaging reaction when it is estimated that 1 in 1000 women will experience the condition, characterised by symptoms of psychosis. These include experiencing auditory or visual hallucinations, feeling paranoid, having strong delusional beliefs, as well as feelings of restlessness and elation. This condition should be treated as a medical emergency, one which women tend to recover from very quickly if help is sought straight away.
Again, lack of sleep and hormonal imbalances are often thought to be the cause, but those who already have existing mental health problems prior to pregnancy may be more at risk to developing these symptoms. Postnatal psychosis is heavily stigmatised, but it is so important to again stress that these symptoms can happen to any woman through no fault of her own and it can be an incredibly scary and isolating experience. Immediate support is therefore vital.
So what do we do about this? Well, the above has emphasised just how important it is for pregnant women and new mum’s to monitor their mental health and to have a supportive network of family and friends around them, as the most exciting, joyful time of their life can also be their most vulnerable. Treatment for the above conditions may include a combination of medication, self-help or talking therapy, all of which can be specifically tailored to suit individual needs and wishes. It is essential that midwives, health visitors and GP’s are alerted of any concerns as soon as they arise. As well as health professionals, there are several useful websites and helplines that women can use for information and advice (some are listed below) but above all, the most important thing for us to do is to continue to talk openly and honestly about these experiences, spreading the message that they should not be “taboo”.
Together, we can work to ensure that all women are given the best possible chance of a fast recovery from any birth-related mental health difficulties and are given their rightful opportunity to experience the joys of motherhood.
Useful links and websites:
Royal College of Psychiatrists:
The Pre and Post Natal Depression Advice (PANDA’S) Foundation:
Mind helpline: 0300 123 3393
Pandas Foundation Helpline: 0843 28 98 401
Samaritans: 08457 90 90 90
The National Childbirth Trust Postnatal Line: 0300 330 0773