Maternal mental health matters

It's important to raise awareness of maternal mental health, and to mind our mental health during and after pregnancy.

Advocacy Manager here in St Patrick's Mental Health Services, Louise O'Leary, discusses ways we can look after mothers' mental health and shares resources which can open up pathways to support. 

What we mean by maternal mental health

More than one in ten women worldwide experience mental health difficulties during and after pregnancy.

Pregnancy is recognised as a complex time of life change, with, by its nature, both physically and emotionally demanding impacts by for expectant mothers. Pregnancy can also pose particular challenges where mental health is concerned, but research indicates that both our awareness and responsiveness to mental health needs during this important time need to improve considerably.

Maternal mental health issues generally refer to mental health difficulties that occur during pregnancy, or up to a year after birth; this is also sometimes referred to as perinatal mental health.

Women might experience a mental health difficulty for the first time during or after pregnancy, or they may have an existing or previous mental health difficulty that needs special consideration around this time. On a more general level, it’s very important for all women to mind their mental health during a time that creates such physical and emotional demands. If you’re pregnant, taking time to think about what’s going to be important for your mental and emotional wellbeing can be helpful – you may find the ‘Wellbeing Plan’ linked below of some help.

Depression and anxiety are the most common perinatal mental health difficulties experienced, but particular challenges can also arise for women living with existing mental health difficulties, such as eating disorders, bipolar disorder or psychosis. More recently, there has been increased attention on the impact of trauma on a person’s mental health during this time, whether this concerns a past trauma or trauma associated with the process of childbirth.

Why it's important to focus on maternal mental health

As with mental health difficulties experienced at other times of life, maternal mental health difficulties are treatable; the sooner help and support can be accessed, the better the outcomes.

Stigma

Frustratingly,  stigma remains associated with maternal mental health difficulties, which can impact both a person’s likeliness to seek help, and a health professional’s readiness to inquire about mental health needs. Women need to be able to talk openly about their mental health needs during and after pregnancy to get timely support when it's needed and to prevent or limit development of serious mental health issues.

For women with existing or previous experience of a mental health difficulty, it’s essential that they feel able to preempt and plan for potential associated challenges and to get the right support to do this. This might include feeling able to have an open discussion about any anxieties and concerns they might have, and to feel informed about their health needs and choices. It may also concern more specific issues, such as addressing medication needs, planning for sleep and rest, and considering whether breastfeeding is best for them. Accessing additional supports, such as psychotherapy, might also be an important component of healthcare needs around this time.

Family health

Improving our awareness and responsiveness to maternal mental health matters is also important for family health and future generations. For example, where mental health difficulties such as prenatal or postnatal depression go untreated, this can have an impact on aspects of child development, such as cognitive development or bonding between mother and child. Recent research based in the United Kingdom (UK) also indicated an increasing prevalence of depression and anxiety symptoms among young mothers today, compared with their own mothers’ generation.

Global and public health 

It’s important to recognise that, as with the nature of mental health globally, a higher risk of developing perinatal mental health difficulties is associated with experience of adversity, including poverty and migration. This is reflected in the fact that rates of depression of perinatal and postnatal depression are significantly higher in developing countries.

Focussing on maternal mental health can help shed a spotlight on how socioeconomic inequalities and human rights abuses also result in health inequality. A particularly disturbing illustration of this is that domestic violence can often start for the first time when a woman is pregnant. Not surprisingly, experience of domestic violence increases the risk of mental health difficulties such as postnatal depression and anxiety.

Maternal mental health difficulties have been described as a major public health challenge. Increasing health professionals’ abilities to meet the mental health needs of pregnant women across various settings, improving integration and continuity of care for women, and having specialist perinatal mental health services in place, ready and able to support women when needed, is crucial.

How to mind your mental health during pregnancy

The Royal College of Psychiatrists recommends several steps you can take to mind your mental health during a pregnancy. These include common mental wellbeing approaches, such as:

• Eating a healthy, balanced diet
• Finding time to do something enjoyable or relaxing every week
• Practicing mindfulness or meditation
• Getting regular sleep
• Discussing any worries you might have your family, GP or midwife.

More specific suggestions include:

• Making a ‘Wellbeing Plan’ to include support you might need during and after your birth. You can get a sample wellbeing plan here; this has been endorsed by the National Institute of Clinical Excellence (NICE)
• Attending pregnancy exercise classes
• Reducing demanding daily tasks like housework or shopping, and letting family and friends help with these things.

Where to seek support for maternal mental health

If you are concerned about your mental health, you should seek support. The most helpful first step may be making an appointment with your GP.

There are a number of support organisations and helplines available who can help with maternal mental health issues; their links or contact details are below.

• Cuidiu (a parent-to-parent voluntary support charity)
• Parentline | LoCall 1890 927 277 or 01 873 3500
• Postnatal Depression Ireland | Call 021 492 2083 | Email support@pnd.ie                     
• Samaritans 24 Hour Helpline | Call 116 123
• Women’s Aid | Call 1800 341 900.

There are also a number of sources of good information on mental health and pregnancy online, including:

• The Rotunda Hospital's information on mental health during pregnancy
• The National Maternity Hospital's information on mental health during pregnancy
• The Royal College of Psychiatrists' public mental health information website, including information for women with current or previous experience of mental health difficulties
• The Health Service Executive's information on postnatal depression.

Tags:   mental health   anxiety   depression   perinatal mental health   women's mental health  

References

Articles and organisations used to inform this article are available below.

1. Aher. A and O’Connell, R; Midwifery Matters: Domestic Abuse in Pregnancy. 
2. Gilbert, H., Gurvich, C. and Kulkarni, J. (2015) Special Issues for Pregnant Women with Mental Illness. Journal of Nursing and Care 4: 280. 
3. Griffiths, S. (2019) The effect of childbirth no one talks about.
4. Higgins, A. et al (2017) Perinatal mental health: an exploration of practices, policies, processes and education needs of midvives and nurses within maternity and primary care services in Ireland. Dublin: HSE
5. Muzik, M. et al (2016) PTSD symptoms across pregnancy and early postpartum among women with lifetime ptsd diagnosis. Depression and Anxiety 33 (7). 
6. NICE; Mental health in pregnancy and the year after giving birth.  
7. Pearson, M. et al (2018) Prevalence of Prenatal Depression Symptoms Among 2 Generations of Pregnant Mothers. The Avon Longitudinal Study of Parents and Children. JAMA Network Open 1 (3): e180725 
8. Royal College of Psychiatry: Mental Health in Pregnancy leaflet; November 2018. 
9. World Health Organisation (WHO); Maternal mental health factsheet.