The key to a healthy mind is living in a supportive, nurturing environment – one that puts the mother’s well-being first.

From trying to conceive to getting pregnant, going through the pregnancy and then delivery and even after delivery, a woman goes through so many changes. These changes are closely related to, if not a direct outcome of, all the physical and hormonal changes occurring to her body. Some gain weight, some lose weight, some have mood swings, some develop diabetes even. All of these take as much of an emotional toll on the woman as it does physically.

Until recently, the fact that a woman can develop depression during pregnancy or soon after delivery, was not considered a serious affair – especially in the Indian context, this was unheard of. Having a baby must always be a happy occasion – and for the most part it is. However, there are times when even the prospect of being a mother or even holding the newborn in her arms, cannot wipe away her tears from depression. For her to enjoy motherhood she needs all the understanding, support and care she can get.

Maternal Mental Health issues arise in the perinatal period which includes the months of pregnancy and up to one year after delivery. Some of the most common Maternal Mental Health disorders are:

POSTPARTUM BLUES (PPB)

Most common psychological symptom in post-partum period. Common with >70% of mothers. May be associated with panic attacks. Associated with undue anxiety about health of new-born. Repeated doubts about feeding, bowel movements, sleep cycle of new-born. Improves after 1 – 2 months does not cause functional impairment. Mother with PPB require good physical, social support, reassurance from doctors and rest.

POSTPARTUM DEPRESSION (PPD)

Seen in 10 – 15% of mother in post-partum period. Associated with symptoms of feeling low, loneliness crying spells, less sleep and less appetite, poor interaction, suicidal ideas, fear of harming the child, inability to enjoy being with the child.

Patient with symptom suggestive of postpartum depression should get prompt consultation with psychiatrist as it is completely reversible in with psychotherapy, counselling, medication and social support system. Delay in treatment seeking may impair quality of life, mother infant bonding, acting upon the suicidal ideas, chronic depression, and failure of married relationships secondary to depression.

BIRTH RELATED POST TRAUMATIC STRESS DISORDER

Women who had a complicated birthing experience are at the risk of Birth Related PTSD especially if the mother’s response to the complication was of extreme horror and fear. In some cases, the delivery experience might bring back vivid memories of a past trauma, that can also lead to Birth Related PTSD. Symptoms of the condition include:

• – Feelings of panic when near the birth site
• – Fearful, obsessive thoughts about the delivery
• – Often feeling detached from the surroundings including the baby
• – Nightmares and disturbing memories of the delivery
• – Depression, anxiety, and irritability

POSTPARTUM PSYCHOSIS

This is extreme and quite rare. Nevertheless, one must watch out for symptoms which are essentially like general psychotic reactions such as delusions and hallucinations. PPP usually sets in with two weeks of delivery of the baby and quickly escalates. Symptoms include:

• – Refusal to eat
• – Hyperenergetic
• – Obsessing over trivial matters
• – Hearing voices/ sounds that are not there
• – Seeing things that are not real
• – Confusion and incoherence

Mothers diagnosed with PPP need to be hospitalized and treated. They should be allowed to manage the baby only in the presence of someone else, lest one of their symptoms take over leading to them harming the infant.

RISK FACTORS FOR PERINATAL DISORDERS

Some of the risk factors for maternal mental health issues are:

• – Complications during pregnancy or delivery
• – Strained relationship with partner
• – Unplanned pregnancy
• – Financial duress
• – Being away from family during pregnancy and post-delivery
• – Lack of family support through pregnancy and post-delivery
• – Family history of depression

HOW TO PREVENT MATERNAL MENTAL HEALTH PROBLEMS?

The key to a healthy mind is living in a supportive, nurturing environment – one that puts the mother’s well-being first. Stress and anxiety while pregnant can have a significant impact on the development of the foetus. In some women it can lead to pre-eclampsia (which is hypertension in pregnant women), preterm deliveries and long-term health issues in the newborn. Depression and anxiety after the birth could cause the mother to be negligent towards the needs of the child and it also causes developmental delays in the infant. Keeping these complications in mind, it is necessary to pay attention to maternal mental health.

To mothers-to-be and new moms:

• – Be available for yourself. Hand over the baby to a trusted caregiver preferably the father or the grandparents and relax. Stay home or go out. Enjoy yourself guilt-free.
• – Reach out to ‘mommy support groups’ online or in your society to share your troubles and learn from other mothers.
• – Understand that you do not have to be the kind of supermom everyone expects every mom to be. Do not hesitate to ask for help.
• – If you are feeling unreasonably low, get help immediately. Do not brush it aside as fatigue. Perinatal mental health disorders are real.

Reviewed By:

DR.VIDHYA MOHANDOSS

CONSULTANT – PSYCHIATRY

MBBS, DNB (PSYCHIATRY)