It’s supposed to be one of the happiest times in a woman’s life, but for some becoming a mum, even if it’s not for the first time, can be one of the most challenging, and sometimes frightening times of their life. It’s certainly a time of great change – physically and in terms of lifestyle too – but also mentally. Suddenly you have a new role to play, someone’s mum, with the expectations of your child, your partner and of yourself sky high. Whilst everyone coos over your sweet bundle of joy and tells you how happy and lucky you must feel, if you are a mother struggling with your mental health, inside you may not feel that way at all.
One in five mothers in the UK suffers from a mental health condition such as postnatal depression, anxiety or post traumatic stress disorder (PTSD) linked to childbirth. There are just 15 mother and baby mental health units or 115 beds in England, so many mothers do not have sufficient access to maternal mental health facilities and therefore do not receive the support they need. This lack of specialist support can sometimes have tragic consequences.
The medical profession takes great pains to look after the physical well-being of someone who is due to or has just given birth, but it is just as, if not more important, for them to look after the mental health of their patient too. Afterall, a mother who is not healthy mentally can affect not only their own life, but also that of their newborn, their partner, their other children and their wider family.
The most common of antenatal mental health condition, depression can be mild, moderate or severe and with or without psychotic symptoms. Symptoms include lethargy, apathy, inability to experience pleasure, disinterest, poor concentration, weepiness and sleep disturbance with early morning wakening. At its worse, depression can lead to suicidal intent, self-harming behaviour or alcohol or illegal drug misuse. Clearly the potential risk to the foetus is high in these cases and it is important that the symptoms are diagnosed early.
In bipolar disorder the patient suffers from mood swings between depressive episodes and hypomania which is recognised by rapid speech, insomnia, marked elation, ideas of grandeur and financial extravagance.
Symptoms of schizophrenia include delusions, auditory hallucinations, thought disorders and ideas of passivity (very controlled by some outside force or influence).
Specific postnatal illnesses include the postpartum blues which affect 50% of mothers, puerperal depression which affects 10% of mothers and less common, puerperal psychosis which affects 0.2% of mothers.
Puerperal or postnatal depression has the same symptoms as antenatal depression but with the additional risk, if suicidal, of infanticide. If mum is not adequately treated, the risk of depression following childbirth increases by tenfold and poor bonding to the baby becomes more likely.
Puerperal psychosis is a rare but serious illness which has the same symptoms as antenatal psychosis and often symptoms of schizo-affective disorder. The patient suffers from a loss of insight and usually needs inpatient treatment in a psychiatric unit. Emergency caesarean section can sometimes be a risk factor in a woman developing this illness.
Treatment for these illnesses can include the use of medications such as antidepressants, mood stabilisers, anti-psychotic drugs, beta-blockers and benzodiazepines. Of course, during pregnancy and breast feeding, the use of medication must be carefully considered and monitored, and in some cases stopped altogether in case the it harms the foetus or adversely affects a child who is being breastfed. In all cases, it is important to seek the advice and guidance of a GP or mental health professional before ceasing or reducing any prescribed medication.
To be safe, therapeutic treatments should be considered as an alternative to medication wherever possible. Supportive counselling, Cognitive Behavioural Therapy (CBT), relaxation therapy, anxiety management, mindfulness and psychodynamic psychotherapy can all be used effectively and without risk to the foetus or to a child who is being breastfed.
Consultant psychiatrists, Dr Adrian Winbow and Prof Tony Hale both have many years’ experience in helping expectant and new mothers who may be suffering from a mental health condition. If you or someone close to you is struggling with their mental health, please get in touch to make an appointment.