Pregnancy and Motherhood 

 

The joys of motherhood may be true for some, yet for many women pregnancy and motherhood present conflicting emotions of good and bad, a dichotomy of positive and negative thoughts and feelings concerning the changes that are about to take place to the women’s body, relationships, career and life as  a whole. Women have to make huge physical, emotional and psychological adaptions to prepare for motherhood.  Sometimes women may experience an overwhelming sense of shock or fear, anger or resentment amongst other emotions about the changes that are to occur and the need for huge adaption in order to successfully transition into a new phase and cycle of life. Society often presents a false image of motherhood, reinforcing unrealistic images and expectations, reinforcing self-imposed pressures and demands. Women may be reluctant to openly express their fears or concerns which may result in depression/anxiety/stress. 

Types of depression in pregnancy and the postnatal period:

 

Distinguishing between the ‘baby blues’, antenatal and postnatal depression. 

 

Short episodes of tiredness, nausea, aches and pains, irritability, sleep disturbance and loss of interest in sex are relatively common as part of the normal adjustment process in the perinatal period and will not require treatment. 

 

The ‘baby blues’ 

 

The term ‘baby blues’ refers to a brief episode of mood swings, tearfulness, anxiety and difficulty in sleeping that is very common in the first week after the birth of a baby. It requires no special treatment, unless the symptoms are severe. 

 

Antenatal depression 

 

Antenatal depression means depression that starts during pregnancy. Between 10‐15 % of pregnant women experience mood swings during pregnancy that last more than two weeks at a time and interfere with normal day‐to‐day functioning. Medical assessment is necessary in such circumstances. 

 

Postnatal depression (PND) 

 

PND describes the more severe or prolonged symptoms of depression (clinical depression) that last more than a week or two and interfere with the ability to function with normal routines on a daily basis, including caring for a baby. Around one in seven women experience PND and for around 40 % of these women the symptoms begin in pregnancy. 

 

Different types of PND: 

 

It can be helpful to know that there are different types of PND. Why? Because not only can the symptoms vary between different types of depression, but they tend to respond best to different treatments. Two main types are outlined below: 

 

Melancholic depression 

 

Melancholic depression is relatively uncommon and affects only 1‐ 2 % of adults. This is usually a more severe type of depression than the other type (non-melancholic depression) and has a more distinct genetic and biological basis. 

 

Someone who is pre‐disposed to melancholic depression might have an episode of depression triggered by a stressful life‐event (e.g. a death in the family) but this is not usually the primary cause of their depression. 

 

Non‐melancholic depression 

 

Non‐melancholic depression is the most common form of PND and is linked more to psychosocial risk factors than to genetic and biological causes. 

 

Any form of prenatal stress felt by the mother can have negative effects on various aspects of foetal development, which can cause harm to the mother and child. Antenatal depression is often caused by the stress and worry that pregnancy can bring, only at a more severe level. 

 

Other factors that can put a person at risk for antenatal depression is an unplanned pregnancy, difficulty becoming pregnant, history of abuse, and economic or family situations. Commonly, symptoms involve how a woman views herself, how she feels about going through such a life changing event, the restrictions on the mother's lifestyle that motherhood will place, or how the partner or family feel about the baby. Pregnancy puts a lot of strain on a woman's body, so some stress, mood swings, sadness, irritability, pain, and memory changes are to be expected. Antenatal depression can be extremely dangerous for the health of the mother, and the baby, if not properly treated.

Signs & Symptoms 

 

Antenatal depression:

 

During pregnancy, a lot of changes to mood, memory, eating habits, and sleep is common. When these common traits become severe, and begin to alter one's day-to-day life, that is when it is considered to be antenatal depression.

 

Symptoms of Antenatal depression are: 

  • Inability to concentrate. 

  • Difficulty remembering. 

  • Feeling emotionally numb. 

  • Extreme irritability. 

  • Sleep problems that aren't related to pregnancy. 

  • Extreme or unending fatigue 

  • Desire to over eat, or not eat at all. 

  • Weight loss/gain unrelated to pregnancy. 

  • Loss of interest in sex. 

  • A sense of dread about everything, including the pregnancy. 

  • Feelings of failure, or guilt. 

  • Persistent sadness. 

  • Thoughts of suicide, or death 

 

Other symptoms can include the inability to get excited about the pregnancy, and/or baby, a feeling of disconnection with the baby, and an inability to form/feel a bond with the developing baby. This can drastically affect the relationship between the mother and the baby, and can drastically affect the mother's capacity for self-care.  

 

 Antenatal depression can be triggered and caused by various events within a woman's life. Some possible triggers can include relationship problems, family or personal history of depression, infertility, previous pregnancy loss, complications in pregnancy, and a history of abuse or trauma.

 

Postnatal depression 

 

There can be differences in the nature, severity and duration of the symptoms of depression seen in women who are pregnant or have recently given birth.    

 

Common symptoms of PND include: 

 

• loss of enjoyment in usual pursuits 

• loss of self‐esteem and confidence 

• loss of appetite and weight, or weight gain 

• difficulty with sleep (irrespective of the baby’s routine) 

• a sense of hopelessness and of being a failure 

• a wish not to be alive 

• frank suicidal thoughts or ideas - It is very important that any talk of suicide be taken seriously 

• panic attacks 

• loss of libido 

• fears for the baby’s or partners’ safety or wellbeing. 

 

There are a high percentage of women that do not seek support for this condition which may be due to stigma, fear of consequences of doing so, unhelpful beliefs and perceptions about motherhood and ability to cope.  

 

PND exerts a negative impact upon couple relationship; development of infants; development of psycho-social problems resulting in poor social skills, reluctance to seek support, excessive self-monitoring of negative events, insufficient self-reward and excessive self-punishment.  

 

Among men, in particular new fathers, the incidence of postpartum depression has been estimated to be between 1% and 25.5%. Symptoms include sadness, fatigue, changes in sleeping and eating patterns, reduced libido, crying episodes, anxiety, and irritability. A number of risk factors have been identified, and many women recover with a treatment consisting of a support group or counseling

Treatment 

 

Analysis of data shows a variety of outcomes in response to psycho-education group, CBT, other theoretical interventions, group vs. individual therapy. What is clear is that some intervention is better than none, or routine care, however, more research needs to be carried to assess which intervention is most effective (at time and follow up). Group based psycho-education, including CBT was superior to routine care (Bennett and Morgan, 2002). 

 

As a psychologist working within the NHS, in January 2013, I developed a pilot treatment group called  ‘Making the Most of Motherhood’ (see link) which offers a 10 week programme for mothers experiencing PND and anxiety which affects their maternal mood ante/post phase.  

 

This treatment group aims to improve the recognition of PND; providing psycho-education, support and Cognitive Behavioural Therapy (CBT) to improve maternal mood and treat/reduce symptoms.  Other aims include providing social support within the group, an opportunity to share experiences and normalise feelings, tackle unhelpful thoughts about motherhood, self, environment and the future, along with partner involvement and peer support for fathers, and working closely with community Health Visitors with regards to managing and monitoring mothers care. 

 

NICE Guidelines: 

 

http://www.nice.org.uk/guidance/cg192/chapter/1-Recommendations#providing-interventions-in-pregnancy-and-the-postnatal-period-2

 

Questions to identify possible depression: 

 

  • During the past month, have you often been bothered by feeling down, depressed or hopeless?  

  • During the past month, have you often been bothered by having little interest or pleasure in doing things?  

  • Is this something you feel you need or want help with?

 

Psychological treatments: 

 

Women requiring psychological treatment should be seen for treatment normally within 1 month of initial assessment, and no longer than 3 months afterwards. This is because of the lower threshold for access to psychological therapies during pregnancy and the postnatal period arising from the changing risk–benefit ratio for psychotropic medication at this time. 

 

For a woman who develop mild or moderate depression during pregnancy or the postnatal period, the following should be considered: 

 

  • self-help strategies (guided self-help, computerised cognitive behavioural therapy or exercise). 

  • non-directive counselling delivered at home (listening visits). 

  • brief cognitive behavioural therapy or interpersonal psychotherapy. 

 

If you are concerned about yourself or relative is showing signs of ante/postnatal depression, please seek medical advice from a GP, Health Visitor or Health Care professional as soon as possible. 

 

Early detection and intervention is very important due to the serious impact that this condition may have on the mother, infant and family if symptoms persist and left untreated. 

 

Of course, if you wish to make an appointment to see me individually or attend a group, please go to my contact page.

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