Challenges faced by new moms due to perinatal mental health disorders
Perinatal mental health illness includes a spectrum of disorders such as anxiety, stress and depression. It can cause serious consequences for both the mother and the baby. It is, in fact, the most common complication of the childbearing and post-delivery period. Untold and rarely discussed, this issue is one that most pregnant women and new mothers face on a daily basis. For further understanding, let us look at the challenges of two moms and discuss the medical aspects.
24-year-old Mrs X was in the fifth month of her second pregnancy. She had previously miscarried in her first pregnancy at a very early stage. While we were discussing her fifth month scan results in the clinic, she was very quiet. Even in her previous reviews in the clinic, she was often seen withdrawn from her surroundings, avoiding eye contact and rarely asking questions. Her family took good care of her. Yet, she continued to remain less engaged even after the fifth month scan where all seemed to be completely normal.
Surprised at her behaviour, we explored the situation further in private. She opened up and told us about how her family believed that travelling to her place of work was the reason behind her first miscarriage. She was forbidden from working and was left feeling lonely and depressed at home. After giving up her career, she was now mostly bed-bound. She feared that she would be blamed for any problems relating to her second pregnancy. This fear and loneliness made pregnancy a totally negative experience for her.
Mrs Y, who had given birth two days ago, was found to be staring motionless at her crying baby during a postnatal ward round. When we offered to help, she broke down and disclosed what was bothering her. She told us about the difficulties she faced during her pregnancy, managing her toddler and continuing to work due to her financial situation. Her husband was of very little help. Mrs Y kept going, holding in her stress and now with her breastfeeding issues had fallen into postnatal depression. She felt very detached from the baby. Her family was unable to understand the situation and blamed her for being irresponsible.
We did an anonymous survey of around 100 pregnant women along with those who had given birth less than four weeks before. We noted that more than 50% of the women felt more stressful and anxious closer to their delivery date and during the first two weeks of breastfeeding. Of these, more than 50% kept their difficulties to themselves, without seeking help, somehow managing to keep going.
There is enough evidence from recent studies that a mother’s prenatal stress and mental health status can influence the amount of stress hormones and metabolites entering the baby’s bloodstream, having a strong impact on the development of the infant brain and physiology. Clinically, antenatal depression has been associated with childhood cognitive and behavioural problems, attention deficit hyperactivity disorder and autism.
Most of the time, the factors leading to anxiety or depression are well-known beforehand but unfortunately dismissed by either the mother herself or the family. In traditional family set-ups, women have little to no opportunity to voice out their problems. In many circumstances, the mother is blamed and shamed for the outcome of her pregnancy. Comments such as “You don’t eat well”, “Your breast milk is not enough” and “Your post-delivery belly is still big” worsens the pre-existing triggers and can even affect the bonding between mother and baby.
In our hospital, during antenatal visits, we observe and pay attention to the clues given by pregnant women. We give time for the expression of all their concerns and offer our help. Counselling sessions, listening visits, exercise and yoga are organised as first line management. For severe cases, we offer the combined care of a perinatal psychologist.
Perinatal mental health disorders are looked down upon as shameful conditions, even by close family members. This leaves most women in a pit of dark emotions, as they believe that they are on their own. It is high time that we have the awareness necessary to help them talk about their issues and get out of that pit.
Dr. VIDHYA MOORTHY,MBBS, MRCOG, DIPLOMA IN FETAL MEDICINE
Senior Consultant – Obstetrics and Gynecology, Fetal Medicine