Sara Powell Art Psychotherapist HCPC, UK Reg
Being Pregnant is a major life event, and is often coupled with the notion that pregnancy will be an exciting time for the mother; however, expecting mothers can have an array of emotion ranging from positive to negative feelings. I will not add to the common mindset that ‘all emotions we have during pregnancy are positive’, as the reality of it is that pregnancy for some women can bring about serious distress, mental illness and trauma. It is due to the severity of these feelings and the frequency with which they occur that we need to talk about this. If a mother is feeling overly anxious, overly sad, is experiencing trauma, having suicidal ideation, psychosis or even a subtler reaction leading to even a minor disruption in daily life, then we cannot simply ignore this, we need to do something about it.
Pregnancy and Mental health Concerns
As many as 1 in 5 women have mental health challenges during pregnancy and following giving birth, as there are a multitude of mental health problems which can be experienced in pregnancy. All expecting mothers are susceptible and it can occur at any time, even in subsequent pregnancies and in mothers who have not experienced pregnancy connected mental illness during previous pregnancies. The most common disturbances are anxiety, in which research suggests it can occur across all three trimesters, with a global prevalence of approximately 15% to 20% during the antenatal period. In addition, depression has a prevalence of approximately 10% to 15% within the general population. Recent research suggests that depressive symptoms during pregnancy ought to also take into consideration contributing factors such as hormonal dysregulation, malformations in hypothalamic-pituitary-adrenal axis activity, genetics and epigenetics in the development of perinatal reproductive mood disorders in particular.
The term Perinatal encompasses the time a mother is pregnant and up to 12 months after giving birth. Perinatal Mental Illness (PMI), is estimated much higher within Middle Eastern mothers (Mishkin et al., 2021). As a mental health clinician residing and practicing in the Gulf, I have observed an overall lack of perinatal mental health focus and resources. This was further acknowledged during my own pregnancy three and a half years ago, and again now. With a lack of resources, conversations about mother’s mental health, even a quick “so how are you feeling?” by medical professionals was evident. In my experience both professionally and personally it is important that mothers have options and support within the community when appropriate / required. Perinatal Mental Illness is regarded as an important public health issue regionally (Doraiswamy et al., 2020). – and should be managed with this information in mind**
Common Symptoms of Perinatal Mental Illness (not limited to):
-Flashbacks, an experiencing of nightmares or feeling overwhelming distress, triggered or reminded of a past experience – this should be monitored to support potential for trauma and Post Traumatic Stress Disorder (PTSD), this can be rooted in abuse, experiencing a traumatic birth, IVF, previous pregnancy loss and complication etc.
-Experience an overwhelming and distressing fear of giving birth – this should be monitored to mitigate potential for Tokophobia, this can also be exacerbated by previous birth complications.
-When expecting mother find changes in their weight and body shape distressing– this should be monitored for eating disordered symptomology or and/or resurfacing/relapse of an eating disorder.
-Increase in sadness – should be monitored to mitigate depression.
-Sudden waves and attacks of panic and fear – should be monitored for potential panic disorder.
-Obsessive thoughts and compulsive behaviours – should be monitored for potential Obsessive-Compulsive Disorder (OCD).
-Prior diagnoses, such as an eating disorder, bipolar disorder, schizophrenia, schizoaffective disorder, severe anxiety and depression, postpartum psychosis, postnatal depression etc. in the form of prevention, a holistic perinatal mental health service ought to be provided during pregnancy.
Due to the nature and severity of symptoms, some mothers may be recommended medicine to treat mental illness during pregnancy. This will be carefully considered, typically by both psychiatrist and medical team, the risks and benefits, in order to decide what is the best course of treatment for mother and baby.
Community Resources
*A few resources which may be helpful.
-ATIC Psychological Counseling Center (Early Intervention and Child Development) wing of services in support of mother and also child
-Genesis Perinatal Care Clinic
-First Psychiatry Clinic
References
Doraiswamy, S., Jithesh, A., Chaabane, S., Abraham, A., Chaabna, K., & Cheema, S. (2020). Perinatal mental illness in the middle east and North Africa region—A systematic overview. International journal of environmental research and public health, 17(15), 5487.
Evans, K., Rennick-Egglestone, S., Cox, S., Kuipers, Y., & Spiby, H. (2022). Remotely delivered interventions to support women with symptoms of anxiety in pregnancy: mixed methods systematic review and meta-analysis. Journal of medical Internet research, 24(2), e28093.
Jones, I., Chandra, P. S., Dazzan, P., & Howard, L. M. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. The Lancet, 384(9956), 1789-1799.
Howard, L. M., Molyneaux, E., Dennis, C. L., Rochat, T., Stein, A., & Milgrom, J. (2014). Non-psychotic mental disorders in the perinatal period. The Lancet, 384(9956), 1775-1788.
Meltzer-Brody, S. (2022). New insights into perinatal depression: pathogenesis and treatment during pregnancy and postpartum. Dialogues in clinical neuroscience.
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