Maternal Mental Health in Pregnancy and Beyond During pregnancy and after birth, women may experience a range of mental health difficulties, such as anxiety disorders, depression, post-traumatic stress disorder or postnatal psychotic disorders. Perinatal illnesses occur during pregnancy and the first year following the birth. They include conditions that were present before pregnancy and which continue, worsen or re-appear with pregnancy and the perinatal period, and also conditions arising for the first time. Perinatal mental health illnesses affect more than 1 in 10 women. 7 in 10 women will hide or underplay the severity of their perinatal illness. Pregnancy and childbirth increases women’s risk of developing a serious mental illness (postpartum psychosis or severe depressive illness), and are associated with increased risk of recurrence of, or deterioration in pre-existing serious mental health illness (bipolar and severe depressive illnesses). Less severe but debilitating mental illness, particularly anxiety and depression are common during pregnancy and afterwards. Many more mothers will not quite meet the criteria for a diagnosis of mental illness but will nevertheless experience significant distress. It is important to remember that this a treatable illness and that mums should seek medical help. Who is at greatest risk of developing a perinatal mental illness? The presence of risk factors does not inevitably lead to perinatal mental illness. Many women are resilient in the face of extraordinary stressors, or with support and early help will not become unwell. Early identification is important in supporting mothers and babies to get off to the best start possible. Having some understanding and knowledge of risk factors can help us all to be mindful of possible difficulties. So who is at greater risk? Perinatal mental illness can affect anyone Despite the increased risks amongst some groups of women, it is important to note that anyone, from any walk of life, may be affected by mental illness. Suicide is a leading cause of death for women during pregnancy and for 1 year after birth Will there be an impact on baby? Perinatal mental illness causes a great deal of distress for individuals and families and can have particular significance at this important time of life. Whilst not at all inevitable, parental mental illness can impact on the developing bond, when a parents’ feelings, low mood, or state of mind affects their responding to their baby. Mum’s might feel overwhelmed by the babies’ needs, unable to enjoy the interactions with their baby, or struggle with some of the tasks of parenting when the cognitive symptoms of depression may impact on their ability to plan or to establish routines of feeding or sleeping. Unidentified and untreated perinatal mental illness not only can have long effects on maternal self-esteem and family relationships, but also on the development of the child. Getting the right treatment at the right time makes a big difference, whether that is in treating the illness in the Mum or in supporting the parent-infant relationship where this is needed. Perinatal mental health services and specialist parent-infant relationship services exist to offer treatment in different ways. Crisis support If you, or someone you are concerned about, are in crisis, despairing or suicidal, please contact a health professional e.g your own GP, midwife or health visitor, go to A&E at your local hospital or call emergency services on 999. You can also call Samaritans on 116 123 (free to call and will not appear on your phone bill - Welsh language option is 0808 164 0123) or email [email protected] Spotlight on Maternal Mental Health illnesses: Depressive Disorders About 50% of all new mothers will get the ‘baby blues’. This will typically have an onset a few days after the birth and women may feel irritable, tearful, easily upset, and sad. It usually eases by 10 days or so and does not require treatment. It can help mothers to know that this is not unusual. Postnatal Depression (PND) is a depressive illness affecting between 10 – 15 in every 100 women having a baby. Sometimes there is a clear trigger, but not always. Postnatal depression most often occurs within one or two months of having a baby but can be many months later. About 1/3 of women have symptoms which began during their pregnancy. 1 in 4 mothers are still depressed when their baby is 1 year old. Early identification and appropriate treatment (talking therapies and/or medication) will help to address this. Many different things may contribute to a woman developing PND, however it is known that certain things make a woman more likely to suffer from PND: Sources of further information and help for PND: APNI - Association for Postnatal Illness Pandas - PND Awareness and Support Postpartum Psychosis This illness affects about 1 in 1000 women in the UK each year. It is an illness with a rapid onset in the days or weeks following the birth of the baby. Most commonly onset is within the first 2 weeks after the birth, with symptoms emerging in the first few days. Symptoms can fluctuate and vary from person to person. Postpartum Psychosis is a psychiatric emergency. It can occur out of the blue. It can be very frightening for mothers, partners & families. Mothers experiencing postpartum psychosis may not realise that they are unwell. Many factors are likely to contribute to a woman suffering from postpartum psychosis. Having close family members (mother or sister) who have suffered from it increases a woman’s risk. A history of severe mental illness also increases risk. For some women though it can occur out of the blue. Further information & help: Action on Postpartum Psychosis APNI - Association for Postnatal Illness Pandas - PND Awareness and Support Post Traumatic Stress Disorder The majority of women in the UK have birthing experiences which are not traumatic. However for some women, subjective feelings of intense fear about their own death, the death of their baby or of physical injury, perhaps accompanied by high levels of feelings of helplessness, terror, and fear result in these women suffering traumatic experiences, and developing symptoms of post-traumatic stress disorder (PTSD). Women can become very isolated by these experiences, as they necessarily distance themselves from the experience that has overwhelmed their minds. Difficulties in breast-feeding, problems in the couple relationship, and difficulties in bonding with the baby may follow on from a traumatic birth. Sources of further information & help: www.birthtraumaassociation.org.uk Obsessive Compulsive Disorder Obsessive Compulsive Disorder (OCD) is a relatively common mental illness affecting men and women at any time of life. Some women may have OCD prior to pregnancy & birth, however for some women pregnancy can be a trigger. For many women there is a normal and adaptive rise in levels of anxiety around the birth related to feelings of responsibility and worries about a baby’s wellbeing. OCD affects around 1 in 100 women in the perinatal period. It is usual to feel protective and to check that all is well. Thoughts about harms coming to your baby may be fleeting and linked to this ordinary maternal worries. However these typical worries can become more problematic for some and trigger, or worsen, symptoms of OCD. In Perinatal OCD symptoms are often focused on the baby, but not always. Sources of further information & help: Maternal OCD: A charity set up by mothers recovered from OCD who can provide advice and support. OCD Action: A charity providing a dedicated helpline, email support and advocacy. Eating Disorders For a woman, having a baby involves significant emotional, physiological and physical challenges. A woman’s body nourishes the developing baby, and so if her reserves of fats, minerals and carbohydrates are low she will become further depleted if she does not eat well. This can lead to feelings of exhaustion and depression as well as to other issues of malnourishment. Symptoms related to early pregnancy such as nausea and vomiting may mask symptoms of an eating disorder. Women with eating disorders and their babies are at risk during pregnancy. Research in the UK has highlighted that around 7% of pregnant women were experiencing an eating disorder, although it is believed the number is likely to be higher as some women either hide or deny their disorder. What are the risks? Pregnancy can amplify some of the symptoms of an eating disorder, such that if women have existing bulimia nervosa, they are at increased risk of dehydration and an increased level of chemical imbalances in their digestive system. Women suffering from bulimia often have increased rates of postnatal depression. Use of laxatives and diuretics are not safe in pregnancy as these could cause harm to the baby, depriving them of necessary fluids and nutrients. If a woman has anorexia nervosa she may struggle emotionally and psychologically with putting on weight while pregnant. She may also conceive her baby with an extremely low BMI. This presents significant challenges for women trying to conceive in the first place also as most anorexic women do not have regular periods Since the growing baby gets all its nourishment from the mother, it’s all the more important for pregnant women to eat well and sustain a healthy body weight before her pregnancy, during and after giving birth. The average woman gains between 25-35 pounds during pregnancy. Further information & resources: Eating Disorders UK Beat Eating Disorders Bipolar Disorder Many women with bipolar disorder have healthy pregnancies and babies, but there are some risks around having a baby with the condition. Women with a diagnosis of Bipolar Disorder are at risk of becoming ill during and especially after pregnancy. If they have planned their pregnancy it is likely that they will have discussed this with their treating psychiatrist, and made decisions about things such as medication in consultation with those involved in their psychiatric care. It is important that mother, her family and all professionals involved (psychiatric, obstetric, midwifery and primary care) work together to monitor and support mothers. Sources of further information & help: Bipolar UK For more information on any of these conditions and for and sources of support the Royal College of Psychiatrists produces detailed and up to date leaflets.