May is Maternal Mental Health Awareness Month. To raise awareness for mental health issues for new parents, we invited Marie Louise, The Modern Midwife, to provide an insight into a little recognised condition – ante-natal depression. ‘Post-natal depression gets a lot of press, and most parents and health professionals know what to look for. But ante natal depression can be just as debilitating and is becoming increasingly reported. This comes as a little surprise to me, given the fragility of people’s mental health in light of the Pandemic.’
Is there such thing as antenatal depression and if so, how do you know if you’re suffering from it?
There is absolutely such a thing as antenatal depression and it is perhaps more common than you realise. It is thought that around one in seven women have it but I suspect it is a lot more as some women may never get diagnosed or seek help.
Depression during pregnancy can be confused with, or passed off as ‘normal’ pregnancy symptoms. It is true that women can be more emotional or tearful during pregnancy and changes brought on by pregnancy can be overwhelming at times but it is important not to assume these feelings are part of pregnancy and you should just ‘get on with it.’ Sometimes depression can gradually get worse and other times it comes on fairly quickly or unexpectedly depending on personal circumstances. I often explain to women that if they are wondering whether or not they have depression they probably do – they know themselves better than anyone. Or if they are feeling down, tearful or upset more than they are feeling happy, excited or calm then it is time to seek support from a trusted person. A healthcare professional such as a midwife or GP are the ideal experts to turn to but really opening up to anyone they trust is an important, although sometimes difficult, first step. Always remember there are trained experts that are willing and able to help you without judgement.
Is it purely hormonal or does it tend to happen to those who are more anxious generally?
You are more likely to have mental health problems during pregnancy if you have a history of mental health illness (such as anxiety) but mental health problems can happen to any mum to be at any time during pregnancy. There are an array of hormones that fluctuate throughout pregnancy which can impact your emotions. A recent piece of research also linked hyperemesis to depression during and post pregnancy highlighting that those with severe sickness are around eight times more likely to suffer antenatal depression and four times more likely to have postnatal depression. If you have a difficult pregnancy, feel unwell or have severe sickness this may trigger depression or impact your emotional well-being, even if you have never had depression before. It is important not to group anxiety and depression together as they often are – although some people with anxiety get depression and vice versa they are separate problems requiring different treatments.
It is also worth noting that midwifery led continuity of carer can lead to a reduction of premature birth and miscarriage. This indicates that feeling safe, cared for and supported has an affect on physiological events during pregnancy. So a key message for pregnant women is to ensure they surround themselves with people that have a positive effect on their emotional state.
What are the recognisable symptoms?
The most recognisable symptoms of antenatal depression are:
- Feeling down the majority of the time
- Feeling tearful most days
- Irritable or frustrated and not wanting to be around other people
- Loss of confidence and or self-esteem
- Loss of interest or pleasure in doing things you would normally enjoy
- Feeling unworthy
- Regularly feeling guilty
- Thinking about self harming or suicide
Is it just women who experience antenatal depression, or could my partner get it too?
Partners can experience antenatal depression and some research even revealed how partners may also develop sympathy symptoms, or significant gain weight during their partners pregnancy. Partners reaction to and emotions surrounding pregnancy are rarely discussed and it is, of course, the pregnant woman who is the focus. This can lead to a partner’s depression or anxiety going undiagnosed. As with women early intervention and accessing support is important and can really help to aid bonding but also avoid long-term problems.
What can I do if I have symptoms?
The best way to alleviate symptoms is by accessing expert support. With the right treatment, counselling or medication it is absolutely possible to feel better, happier and excited. There is not one rule that fits all, we are all so different and understanding the cause of depression can really help manage symptoms. But ultimately getting help is the first step to managing symptoms.
That said there are a few things you can do that may help. Lowering your expectations and being kind to yourself are great places to start. Sometimes people feel down about themselves because they don’t meet their own expectations. Sometimes women expect to feel positive, glowing and confident but they feel none of these and then beat themselves up. In reality most people find pregnancy a bit worrying or overwhelming so please try not to put pressure on yourself to feel or be a certain way. Then create space and time just for you and your baby.
Mindfetalness can be a great daily practise to tune in with your baby and monitor their movement. Get as much rest as you can in and try not to panic buy – hand me downs are great! I know there’s always something to do, we live in a world where doing is more important than being. But during pregnancy it’s a good idea to not let small tasks prevent you from prioritising time for you. Lastly sleep, exercise. Learning breathing techniques and healthy eating are all really great ways of supporting your emotional wellbeing and helping you feel better about yourself and your situation.
What kind of support can I get from the NHS?
There is a range of support offered by the NHS such as:
More appointments, you may be offered regular appointments with a specialist to chat through how you are feeling, help you monitor your symptoms and learn about coping strategies that work for you.
Support groups, some trusts run local support groups where you can meet with other women going through similar difficulties. These may not have been available during Covid 19 but should start to open up again soon – if not already.
Counselling or therapy, there are specific psychological therapies such as cognitive behaviour therapy (CBT) as well as local counselling services.
Medication, depending on your personal circumstances and symptoms, your GP may suggest taking antidepressants or other medication. Nothing will be prescribed to you that isn’t thought to be safe to take but please do make sure you ask all the questions you need to feel comfortable.
What can a midwife do to help someone with antenatal depression?
Midwives will be able to help you recognise symptoms or difficulties that you may need further help with. They can refer you to specialists and there are also specialist midwives that work in perinatal mental health who are there to help you get a diagnosis and most importantly ensure you get access to the right support.
If I have antenatal depression, does it necessarily mean I will have post-natal depression?
Not necessarily although women who develop antenatal depression are at an increased risk of developing postnatal depression, this is not the case for everyone. Remember that this period of your life can be very stressful and have an affect on various aspects of your life but may settle once your baby arrives. Overall it is normal to feel some of the symptoms described some of the time. But if your symptoms are persisting or worsening it’s important to seek support as soon as possible at any time on your journey.