Pregnancy and birth
Pregnancy and having a baby can be an exciting time. But, it can also be a time of immense pressure. There are so many changes happening to your body and the very nature of bringing life into the world places demands on you to adjust your lifestyle.
All of these factors cause a woman’s hormones to work overtime. Not only does this lead to a range of physical symptoms (including morning sickness), it can also lead to the amplification of certain emotions. It's not uncommon for women to feel more anxious and 'down' at this time. Some develop a mental health problem during pregnancy or within a year of giving birth - this is referred to as the ‘perinatal period’.
Examples of perinatal mental illness include antenatal depression, postnatal depression, anxiety, tokophobia (extreme fear of childbirth), perinatal obsessive-compulsive disorder (OCD), postpartum psychosis and postpartum post-traumatic stress disorder (PTSD). These illnesses can be mild, moderate or severe, requiring different kinds of care or treatment.
On this page, we will explore these issues in more detail, including how support from a counsellor can help.
What is perinatal mental health?
The terms ‘maternal’ and ‘perinatal’ are often used interchangeably when discussing topics surrounding pregnancy and childbirth. However, particularly when talking about mental health, ‘perinatal’ refers to a woman’s mental health during pregnancy and the first year after birth. This includes mental illness existing before pregnancy, as well as illnesses that develop for the first time or are greatly exacerbated in the perinatal period.
Some women who have a mental health problem stop taking their medication when they find out they are pregnant. This can make their problem come back or get worse. For some women who have had a mental health problem in the past, being pregnant, giving birth and caring for their baby can bring the problem back.
According to the Mental Health Foundation, around 50% of perinatal mental health problems are untreated or undetected. This can have a devastating impact on women and their families, and this time in your life is, perhaps, when you need help the most. Getting support and developing coping mechanisms can help transform a time of stress and anxiety into one of excitement and joy.
Causes of perinatal mental illness
The causes of mental health problems differ from person to person - there is rarely one single cause. The following list contains some of the more common causes of perinatal mental illness:
- Hormonal changes - sometimes the simple upset of your body's hormone balance is enough to trigger a mental health problem.
- Relationship issues - perhaps your partner isn't as supportive as you hoped, or maybe you're going through this alone. Either way, relationship problems can often spark feelings of depression or anxiety.
- Financial worries - concerns over the amount of money you'll need to raise a baby are a common worry among expectant parents.
- Despair over morning sickness - for some, this symptom of pregnancy is debilitating and can even lead to hospitalisation. This can lead to feelings of hopelessness.
- Lack of sleep - pregnancy-related insomnia and general exhaustion could lead you to overthink situations and magnify negative emotions.
- Family issues - when you become pregnant a spotlight is shone on your own family life and previous rifts and tensions can become exaggerated.
Psychosynthesis counsellor Adriana Gordon (PGDip Reg MBACP) discusses the changes that happen in a parent’s life after having a baby - and the implications of these on our mental health.
Most of us are well aware of postnatal depression and the associated symptoms, but a lot of people are still unaware of the effects that antenatal depression can have - that is, before the baby is born.
Currently, it is thought that around 10% of women are affected by it. Studies also show that if antenatal depression is not acknowledged and treated, around 50% of sufferers will go on to develop postnatal depression.
In the following video from BBC Three’s Body Language series, we hear one woman’s experience of antenatal depression. Please bear in mind, due to the sensitivity of the topic, you may find the story upsetting.
Symptoms of antenatal depression
There are likely to be times during your pregnancy when you feel down and unable to cope. While this may be common, it doesn’t mean you need to suffer in silence. For some, these feelings pass but for others, it is really severe.
The following symptoms are common in those suffering from depression during pregnancy. If you are experiencing similar feelings it may be worth speaking to your GP who can advise you what to do next.
- Feeling tearful - your emotions will be running high due to your hormones during pregnancy. But if you are feeling more tearful than expected, it may be a sign that you're not coping.
- Feeling numb or empty - for some, the implications of pregnancy are overwhelming. This may lead you to feel a numbness or emptiness at a time when you are expected to be overcome with joy.
- Guilt and shame - there are a lot of expectations associated with pregnancy and, when you don't feel what you are expected to feel, it can lead to intense feelings of guilt and even shame for having negative thoughts.
- Isolation - this can be especially true if your friends have not had children or if you come from an emotionally-closed family. Feeling alone in your pregnancy often evokes feelings of panic and depression.
- Insomnia - many women find it hard to sleep during pregnancy due to bodily changes but for some, it is a busy mind keeping them awake. This feeling of not being able to switch off and rest can lead to exhaustion, exaggerating negative emotions.
Feeling anxious about your baby's health, the birth and your ability as a parent are all perfectly natural. However, if feelings of anxiety begin to get in the way of your happiness, it may be time to take action.
Common symptoms of anxiety include:
- feeling on-edge all the time (feeling anxious constantly or about non-specific things)
- panic attacks
- avoiding people or certain situations
- difficulty concentrating
I began second-guessing myself and feeling utterly overwhelmed by the responsibility of keeping another human alive. My feelings of inadequacy morphed into anxiety. I was consumed by a foggy cloud of despair. I felt so guilty that my selfish emotions were getting in the way. I was terrified that I was messing him up by being a mess myself.
- Rebecca shares her experience of perinatal mental ill health with Happiful.
Anxiety, stress and depression often go hand in hand, with one leading to another if not treated. For your best chance of avoiding this, it is advised that you seek professional help from a qualified professional such as your GP or a counsellor.
Of course, if you are pregnant with your first child, it is normal to have some anxiety about the birth. It is something you will have never experienced before and, understandably, you will be unsure of what to expect. Even if you have had children before, worrying about things going wrong in the delivery room is still common. This could be due to previous experiences, friends’ experiences or reading about long, painful births in the media.
Whatever your reasons may be, for some, the thought of giving birth becomes a phobia. Tokophobia is the extreme fear of childbirth.
To cope with this type of anxiety, it is recommended that you arm yourself with information. Speak to a medical professional with experience, they will be able to tell you about possible complications, how likely it is that they will happen and exactly what the midwife or doctors will do in that situation.
Reading up about labour and listening to other peoples' experiences should also help to give you a good idea of what to expect. The important thing to remember is that every birth is different and just because someone you know had a difficult labour, it doesn’t mean you will too.
Many pregnant women and new mothers will experience a rise in feelings of worry, as well as some obsessive or compulsive-like symptoms. It’s normal to worry about your child's wellbeing and to want to protect your baby; you may be more careful about avoiding risks in pregnancy or after birth.
For some women, however, these normal worries can trigger or worsen symptoms of OCD. The symptoms can interfere with life. These thoughts can be very upsetting and frightening, but it's important to remember that having an intrusive thought doesn't mean that you'll act on it. It can be very hard to open up and talk to someone about these types of thoughts, but you can get treatment and support.
In this video from Mind, we meet Sara, Holly and Kate. They talk about their experiences of mental health problems after pregnancy and becoming mothers - including intrusive thoughts.
Postpartum psychosis is a rare but serious mental health illness that can affect a woman soon after she has a baby. Symptoms (such as confusion or behaving out of character) usually start suddenly within the first two weeks after giving birth. More rarely, they can develop several weeks after the baby is born.
Other symptoms can include:
- delusions - thoughts or beliefs that are unlikely to be true
- a manic mood - feeling restless, talking and thinking too much or too quickly, feeling "high" or "on top of the world"
- a low mood - showing signs of depression, being withdrawn or tearful, lacking energy, having a loss of appetite, anxiety or trouble sleeping
- loss of inhibitions
- feeling suspicious or fearful
Postpartum psychosis should be treated as a medical emergency. Most women with postpartum psychosis need to be treated in hospital. Ideally, you will be offered a bed in a Mother and Baby Unit (MBU) - a specialist psychiatric unit where mothers with mental illness are admitted with their babies. You will be supported in caring for your baby whilst you have the care and treatment you need.
For the majority of people, childbirth is an extraordinary event. For others, it can feel traumatic due to complications during labour, or unexpected deviations from the birthing plan. Sometimes, even when everything goes according to plan, the experience can be such an overwhelming one that mothers are left feeling traumatised. This can lead some women to experience postpartum PTSD, or birth trauma.
Birth trauma can happen for many different reasons. The important thing is that you don’t compare yourself to others and their experience; it’s about how you feel about your experience. Acknowledging how you feel about what happened to you and giving yourself permission to feel that way is an important part of releasing those feelings.
- Read ‘Understanding birth trauma’.
The impact of a traumatic birth can often be underestimated. Some people may feel that the baby is adequate compensation for the trauma and that, as a new mother, you will soon forget it in the joys of motherhood.
However, traumatic childbirth and developing PTSD can impair your relationship with both your baby and your partner. You may feel a range of emotions; disappointed, angry and upset that childbirth was not the experience you were hoping for. You may also experience flashbacks or unwanted memories of the traumatic birth.
How can a counsellor help with perinatal mental health issues?
If you feel you are suffering from a perinatal mental health issue, it is essential that you seek help. Although the feelings you are experiencing can be frightening, you won’t feel this way forever.
A qualified counsellor can provide space for you to vent your concerns or frustrations in a safe, non-judgmental environment. They will be able to explain some of the panic-based reactions and, over time, desensitise the trauma you have experienced. They will be able to talk you through your feelings so you better understand why they are occurring, as well as offering coping mechanisms and relaxation techniques.
Additionally, gaining support from other mothers who have had similar experiences often helps - knowing you are not alone and hearing how others coped can be incredibly reassuring.
What should I be looking for in a counsellor or psychotherapist?
There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat mental health issues during pregnancy. However, the National Institute for Health and Care Excellence (NICE) have developed a set of guidelines that provide advice about the recommended treatments regarding various mental health problems during pregnancy and after giving birth including:
- obsessive-compulsive disorder
- post-traumatic stress disorder
- eating disorders
- bipolar disorder
Read the NICE guidelines here:
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