Perinatal Mental Health
Your First Meeting
Mental health during pregnancy and afterwards is being taken far more seriously by medical professionals. During your initial consultation with your midwife you will be asked about current and past mental health problems. The reason for this is that you are more likely to become ill during your pregnancy or during the first year of your baby’s life, more so than at any other time in your life, if you’ve had or have severe mental illness.
Those women experiencing less severe mental health problems may also find that their symptoms worsen during pregnancy and afterwards. If this is the case then by discussing these concerns with your midwife and GP will ensure that everyone providing your pregnancy and postnatal care can intervene early to ensure that you get the help you need quickly.
If you are currently taking medication please speak with your GP or midwife about its safety in pregnancy. Please do not stop taking your medication without consulting with your GP or psychiatrist, it can make your illness much worse.
There is now a much greater level of support for women with mental health problems in pregnancy and you midwife and GP can help you to access that care, and these include psychological therapies and medication. You will also be offered more frequent antenatal appointments with either your midwife or a midwife who specialises in mental health during pregnancy and postnatally.
Worries and Concerns
After any birth, but especially your first, you will undoubtedly have concerns. You might be concerned for your baby or yourself, but it is important that you act upon those concerns. There really is such a thing as a mother’s instinct, so if you are concerned at all about your baby ask you G.P. or midwife to visit. If after they have visited you still feel concerned or you feel they have not listened you should take you baby to your local emergency department. You will be reassured that there is nothing wrong or if a problem is found then you will have been justified in your anxiety.
Occasionally you will worry about yourself. You may have problems going to the toilet or you may have emotional worries. You would normally inform your midwife or G.P. if you suffer with physical problems and the same applies to your psychological wellbeing. There is no need to worry that they will judge you in any way. You should be enjoying this time with your baby and the sooner you can get help the quicker you will be able to enjoy him properly.
Maybe you had the birth you wanted and you were shown compassion and kindness whilst in labour. For the majority of women this is how childbirth will be. But a minority will look back at the birth with anger, sadness and possibly trauma. The birth might have been traumatic for you, despite the views of those around you. Just as many women who had a quick trouble-free labour are traumatised when compared to those who had an assisted labour and felt empowered. Much of your feelings are down to the perceived care you experienced during pregnancy and birth. Those who feel empowered are usually those who were prepared for an assisted birth and were cared for in a respectful and dignified manner allowing them control over their birth.
You can voice your feelings to the labour ward manager and ask for a meeting to review your birth. They will arrange for a midwife, obstetrician, or both, to go through your birth with you and answer all of your questions. They will make plans for your care in pregnancy, labour and birth should you wish to have another baby.
If you want to complain about the care you received your first contact should be the Head of Midwifery at your local hospital. Their contact information should be available on the hospital’s website.
Weeks or months after a birth debrief following an emergency, such as shoulder dystocia or postpartum haemorrhage, you may have many unanswered questions. You can either contact your consultant obstetrician’s secretary for an appointment or again the labour ward manager or Head of Midwifery. Each of these points of contact will be able to arrange a meeting to discuss your concerns. During that meeting you should take with you a list of all the questions you wish to ask and also your partner or a friend to offer support. Those providing this session will be open and honest with you and this should help you come to terms with your birth experience.
After a few days at home with your newborn you will begin to understand his routine and be able to anticipate when he will sleep and need feeding. After a few days you may become tearful and anxious and be overwhelmed by trivial matters. These emotions are a normal part of the transition to motherhood. It is known as the ‘baby blues’ and affects around eight out of ten women. The blues usually fade in a few weeks and the simplest and quickest way to resolve them is to treat the cause.
You will be sleep deprived, anxious over his wellbeing, being flooded by hormones and most likely attempting to be ‘supermum’. You will probably still be doing most of the housework you did before the birth and no matter how many times you are told to slow down and rest you will not listen. If you will not listen to your family, then listen to your body which is telling you to rest.
Midwives struggle to enforce rest on women and don’t wish to interfere by telling partners they need to relax. Pregnancy and childbirth are natural, not an illness, however motherhood, breastfeeding and sleep deprivation will take their toll if you do not get enough nourishment, fluids and rest. Conceding that you cannot do it all is difficult, but here’s what you need to do:
- Run a bath – Your partner can take your baby to you if he needs to be fed.
- Order a takeaway for dinner that night.
- Tell your partner that the washing, ironing and cooking for the next week will need to be done by him or be organised by friends of family.
- Once you have had dinner and your baby has had his evening feed, go to bed.
- Your partner needs to reassure you that your baby is fine and you are doing a brilliant job.
- Accept the compliments and the fact that you feel like this.
By doing this you are not admitting defeat, you are treating the physical and psychological impact of sleep deprivation and exhaustion and the symptoms of baby blues.
This is not ‘baby blues’ in that it will not pass after a few days. The symptoms of postnatal depression can persist for months and for some, if left untreated, can become a long-term problem. Postnatal depression can begin to develop in the first four to six weeks after childbirth, however some women may not develop symptoms for months later. The usual symptoms are:
- Symptoms of the baby blues that persist longer than expected.
- Persistent feelings of sadness and low mood
- Difficulty falling asleep
- Loss of interest in the world around you
- No longer enjoying the things you used to
- Feeling tired all the time
- Feelings of guilt or self-blame
- Poor or increased appetite
- Crying for no reason
- Lack of personal hygiene
- Withdrawing from friends and family
- Worried there is something wrong with your baby
The condition can interfere with daily life and the way you care for your baby. You might feel incapable of looking after him, or scared to leave your house to meet friends
It is common to have thoughts about harming your baby. At this point most women will seek advice. Your family will normally notice the condition before you do and they may ask you to seek help from your G.P. Some may even contact them on your behalf. Once contact has been made and you have opened up and received treatment you can begin to get well again as postnatal depression needs proper treatment, you will not just snap out of it.
It is important to remember you are not being punished for anything and you are most definitely not a bad mother. There is no rhyme or reason why you should suffer from postnatal depression. Given time and treatment you will get back to the way you were and the mother you want to be. You will enjoy spending time with him without always feeling anxious and you will have the energy to look after your family.