We’ve all heard of post-natal depression; but that’s not the full story as ante-natal depression and anxiety can over over-shadow what should be a joyful time
Radhika Holmstrom reports
Pregnant and feeling low? A sleep- deprived new mother who’s anxious about her baby’s sniffle? They’re both totally understandable – and totally normal. But they can start eating into your life and in that case, it’s time to seek help.
“Everyone’s heard of post-natal depression but anxiety is just as common: and there are lots of other issues that don’t t into the expected categories,” says Rose Coates of the University of Sussex. “Often, the way you’re feeling doesn’t match the standard questions about depression – for instance, if you’re worried, or you’re getting intrusive thoughts about the birth, or you feel you just can’t go out of the house.” As a result, women can feel that they are making a fuss about nothing – or that they’re awful people. It’s also easy to think that worries are completely justified.
Before and after
The good thing is that ante-natal and post-natal mental health is on the mainstream radar and health professionals will take it seriously. If you’ve got a previous history of depression, anxiety or other mental health problems you may be particularly at risk; but mental distress can strike people who never thought it might happen to them. It’s estimated that one in 10 women will experience depression in pregnancy and one in five afterwards – but, as Coates says, these aren’t the only conditions that can develop.
It’s not surprising. During pregnancy, our systems are ooded with progesterone (in much larger doses than during premenstrual tension), which ramps up all the other stresses too. Relationships are under pressure; those of us planning to go back to work have to think about that; and on top of this is the bizarre feeling of one’s body first expanding
to previously unknown dimensions and then going through birth. Birth itself, or a baby who’s unwell and has to go into special care, can leave its own mental scars; while adjusting to the world of parenting, with its responsibility for a new, fragile person, is frequently not straightforward – especially since sleep is usually in pretty short supply.
Depression can manifest quite a while after the actual birth. In fact, some research has suggested that mothers are more likely to be depressed when their child is four, rather than in the first 12 months after childbirth.
Spotting the signs
However, when you’re actually going through the experience, it’s often surprisingly hard to identify that things have gone beyond the normal ‘baby blues’ which hit at around four days after giving birth. That’s particularly the case if you’re struggling during pregnancy – because though everyone has heard of postnatal depression, prenatal depression gets a lot less coverage.
“I think a lot of women struggle with being able to tell if something is wrong,” says Professor Susan Ayers, of the Centre for Maternal and Child Health Research at City University London. She describes a range of symptoms that should ring alarm bells. “The kinds of sign you should look out for is finding yourself in tears a lot and finding that you’re withdrawing from other people. One big indicator is if you’re not getting pleasure from the things you used to enjoy.”
Anxiety is different, she explains. “It feels very different and from the research we’ve done, women with anxiety were being told they didn’t have depression. If you’re feeling generally anxious, getting waves of panic, your anxiety is focused on the baby or the health of you or your baby , you need to talk about it.”
Depression isn’t always easy to diagnose. “In some studies, women told us they fell through the gaps of the usual definitions, so they thought they had something else,” says Coates. A difficult birth can leave some women with post-traumatic symptom disorder; the key symptoms are nightmares or ashbacks and going over the birth and what happened.
“Having problems during birth can compound other factors, once you’re sleep-deprived,” Ayers adds. “Women who have traumatic births report all kinds of things – guilt, shame, panic, anger – the whole range of negative feelings. There are problems associated with having a baby in special care too; women who have either premature babies or babies that have a problem have a much greater risk of struggling later on.”
Coates flags up a few other things to consider. “Bonding disorders are an important issue: feeling that you’re not forming that attachment with your baby, or feeling very angry. Anger and irritability are symptoms that are often overlooked. Some researchers suggest there could be a disorder where your anxiety and worry symptoms are all related to your baby, or your post- pregnancy body. If you’ve had a really traumatic birth and then the baby is ill, the birth gets forgotten because everything’s focused on the baby.”
At the most extreme end of the spectrum are suicidal thoughts, or thoughts of harming yourself or your baby – and the alarming thing is that while you’re experiencing them, they can seem reasonable ways to feel.
Please don’t let thoughts like this frighten you. There’s a lot that can be done to tackle them – and in fact, becoming aware of the warning signs is one of the most important first steps. If you’re already on medication for a mental health issue, don’t stop it till you’ve spoken to your doctor (but do make an urgent appointment).
It’s crucial to flag up concerns to your health professionals: both before and after you give birth. Alongside that, it’s a good idea to have advance prevention strategies in mind (even if you are feeling ne now). If you’re pregnant, think about your ‘support team’: not just the professionals and your partner but people you might be able to talk to honestly about how you are feeling. Build a new support network; whether or not you’re a ‘group’ sort of person, antenatal and baby groups can provide a lifeline of people with whom you can have frank conversations about how you’re feeling.
There’s a lot the professionals can offer, from talking therapies to medication. “There are really good online forums for women who are depressed, anxious or feel they’re not coping,” Ayers reports. “The internet is a great source of help; there are also self-help programmes, including a few for pregnant and postnatal women.” She’s a big advocate of cognitive behavioural therapy (CBT) for anxiety, depression and trauma. “It’s very effective and if you get it early enough it can prevent long-term problems.”
Finally, never forget that mental health problems can affect women of all kinds: from the high-achiever who’s used to running the show, to the laid-back earth mother who’s planning a low-tech birth. There’s no stigma – whatever you’re feeling or thinking, the professionals won’t be shocked. If you need help, it’s out there. All you have to do is ask.
“Our job is to be honest yet reassuring.”
Roshni Patel is a consultant in maternal medicine and obstetrics at the Chelsea and Westminster Hospital.
“I think it’s very important to listen to women’s anxieties and get to the bottom of them. Sometimes women start off by saying they’re terrified of labour but when you analyse it you realise they’re terrified of something specific, like tearing or being induced. It’s important to identify those fears and then address them. I think an obstetrician’s job is to be honest whilst being reassuring. We must listen to women and engage with them; they’re saying they’re anxious because they need support.
“Sometimes women are so anxious that we have to refer them for other care. Some women respond well to CBT, counselling or psychotherapy. A few need medication; I’m keen that an obstetrician should give them all the information about risks and bene ts and that they’re given medication that means they can breastfeed, so they can make their own choices.
“There are women who had a previous traumatic delivery; I can’t change what’s happened before but I can go through that labour with them, acknowledge what happened before, give them the time to debrief fully and understand what’s happened – and if I’m looking after them, helping to give them the confidence to believe in themselves.”