Maternal Mental Health  

As a man, one feels compelled to approach any discussion about perinatal mental health with great humility. I will thus unashamedly admit that my thoughts in this area are heavily shaped by the women I have spoken to personally and professionally.  This is an area of great hope in mental health provision in the NHS, as funding is going in to develop perinatal services nationwide.

What is ‘perinatal mental health’?

So-called perinatal disorders affect women during pregnancy and following childbirth. I will briefly outline some off the major conditions shortly, but it is important to consider more broadly what happens in the lead up to and after childbirth.
Lately in my work as a Consultant Psychiatrist, I have been struck by the extent to which marital difficulties appear to be the catalyst for or lie at the heart of mental health difficulties that bring female patients to my attention.  Of particular note, when I explore what has happened, it often becomes apparent that the relationship challenges began after the arrival of a child.
Childbirth and child rearing have always been and for the foreseeable future are likely to remain significant life events, with both physiological and psychological consequences for women.  It was only when I had my first child that I got a true sense of the extent to which these events rather unhelpfully romanticised in modern society, with minimal acknowledgment of how difficult and anxiety-provoking they can be.
This is only exacerbated by a social media driven culture, in which we as parents are in danger of being drawn into a belief that we must present to the world images of ‘perfect’ children who bring overwhelming and neverending joy to us.  Little consideration is given to the unique and often difficult journeys many women (and their partners) may have faced along the way, leaving some women feeling vulnerable and unsure of themselves.
In addition to the physical challenges pregnancy, childbirth and the postnatal period may bring, mothers of today face enormous pressure from a gender identity perspective.  Many prospering careers face an unheralded period of uncertainty, heaping financial pressure on the family unit when these careers grind to an abrupt halt. 
There is an obligation for new mothers to attend to the needs of both their partner and the baby, whilst coping with the near ubiquitous sleep deprivation and exhaustion they are contending with.  A thankless and precarious juggling act ensues. 
Thus a man’s relief that “date night” has been arranged – a long overdue night away from the child – runs the risk of ignoring the internal struggle a woman may face during those excruiciating few hours away from her child.  Disappointment may be experienced on both sides when the penny drops that the new mother lacks superhuman powers and cannot serve both masters to the expected level. 
None of this is helped by the limited (or in some countries non-existent) paternity leave new fathers are given, time that could be invested in supporting the new family unit.  In this respect the Scandinavian countries are the envy of the world.  Resentment can easily build around the father’s perceived unwillingness to be more present. 
On top of this, women may feel judged by husbands, parents, in-laws and others in the decisions they make e.g. critical (even if well intentioned) comments about what they feed the weaning infant.  Breastfeeding on its own can bring significant pressure and the impact of peer pressure from groups of like-minded mothers can be devastating.  For those already short on confidence, this can lead to isolation from others at a time when closer connection is really needed.    
All of these factors can impact negatively on self-esteem and clarity of thought. The fear of being perceived as a failure by others on matters both large and small can be crippling.  Many of the women I see speak of their sense of shame and guilt; the stigma associated with maternal mental ill-health should not be underestimated. 

What problems arise?

In the days, after giving birth, more than 1 in 2 mothers may find themselves feeling weepy and irritable. This has been termed the ‘baby blues’ and is most likely due to changes in hormone levels post-delivery.
Approximately 10% of mothers are thought to experience postnatal depression, in which they are persistently low mood, fatigued and unable to enjoying previously pleasurable activities.  This usually happens in the first few months postpartum.
A much smaller proportion of women experience psychotic symptoms postnatally.  Very marked anxiety may manifest in Generalised Anxiety Disorder or Obsessive Compulsive Disorder (OCD).  A very difficult birth may also result in Post Traumatic Stress Disorder.  Less commonly, some women develop tokophobia, a fear of giving birth; the good news is that this is a very treatable condition. 
As a Psychiatrist, one of my pressing concerns is the impact of untreated maternal mental health problems on the mother-infant bonding. ‘Attachment theory’, in which the mother is able to meet the emotional needs of the baby and create a safe, nurturing environment, is one of the most profound concepts in all of psychiatry.  Secure and insecure attachments play equally big roles in shaping and nuturing our personalities throughout our life span.
Supporting women to fulfil this role as caregiver therefore lies at the heart of approaches to perinatal mental health difficulties.  Whilst in some instances there may be a need to seek specialist support, a first step in my practice is to explore what informal support networks – within the extended family and the local community – a woman can tap into e.g. antenatal classes, mother-and-baby groups. 

Where to seek help?

The first port of call for any suspected problems should be the GP or health visitor.  A range of talking therapies are available in the NHS, often based in GP practices, and many hospital antenatal departments offer additional support for women with established mental health problems.  Input from a psychiatrist may be required where there are complex decisions to be made e.g. considering of medication or a specialist therapy. 
The church is uniquely positioned to support new mothers by providing a safe space where they can experience a true sense of community, get practical support from peers without judgement and feel unburdened.

Dr Chi-Chi Obuaya Consultant Psychiatrist working in the NHS and in independent practice

Chi-Chi Obuaya, 12/05/2018
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