Mental health care in pregnancy-be kind to your mind
By Dr Shelley Rowlands, East melbourne Obstetrics and Gynaecology
Pregnancy is a time of many challenging and well recognised physical changes, but it’s also important to consider and care for your mental health.
During pregnancy, there are many ways that your mood and mental health may be affected. The hormones of pregnancy have a steroid like effect on your body. While, they can impart feelings of wellbeing, and many women describe a kind of elation during the middle trimester especially, they can also make you feel emotionally labile, and equally many women describe crying for “no reason” or a heightened emotional response to things that would not normally have worried them.
These steroid hormones affect your sleep patterns. Good sleep is integral to good mental health. Commonly you will fall asleep easily only to wake in the early hours of the morning and feel wide awake. Interrupted sleep will make you tired and more emotional. In the later weeks of pregnancy, the discomfort of the growing baby, extra pregnancy weight, increased body fluid, needing to wee overnight and even heartburn all contribute to reducing the quality of your sleep.
Pregnancy is a time of change. Although approaching motherhood is exciting, leaving or changing work, rearranging the routine of your life and concern about finances, the possible impact on your relationships, worrying about how you will juggle a new baby with your other children is a lot of change and is very stressful. It’s not uncommon to meet pregnant women and their partners who are busy doing all this and then trying to shift house or renovate at the same time. A most stressful life event even outside of pregnancy! Then of course the biggest change is after you go home with your baby. It will be an exhilarating time but it will be stressful.
Pregnancy can be a precipitant for depression. Women who have a history of depression prior to pregnancy are at risk of developing depression during or after pregnancy. Postnatal depression is probably under diagnosed but may affect up to 1 in 8 women. It can last for up to a year after birth. Postnatal depression can affect bonding with your baby and can even lead to changes in your physical health. Tragically suicide remains a leading cause of maternal death today.
Women who have had mental health problems prior to pregnancy should speak to their doctors and psychologists about how they can be supported and protected during and after pregnancy. It is a good idea to continue counselling as this will likely be with someone who knows and understands you and will notice any changes early. If you are taking medication, you need to discuss this with your doctor. Understandably most women are reluctant to take medication for fear of adverse effects on the developing baby. However, many anti-depressants are actually safe to continue in pregnancy and during pregnancy is not the ideal time to change medication that has been working well for you. Depression is medical condition just as asthma or high blood pressure are and you would not want to stop medication for those conditions when you are pregnant! Ideally a pre-pregnancy consultation with a specialist obstetrician with an interest in mental health issues can help you make a plan for managing your depression in advance of pregnancy and will make you feel safer and more confident of remaining well during pregnancy.
Most women however will not be easily identified as at risk of mental health issues in pregnancy. There are many medical tools available that can help diagnose deteriorating mental health during and after pregnancy. The Edinburgh Postnatal Depression Score is an example- it uses 10 simple questions to determine if you are at risk of mental health problems- and has been shown to be useful in pregnancy. Many Obstetricians will check your mental health using this or a similar tool during and after your pregnancy to ensure you are not at risk. This can be also be accessed online.
There are many simple things you can do to protect your mental health. Talk to your partner, friends or doctor about how you are feeling. There is no reason to feel ashamed by your feelings. They may only be transient but it’s better to discuss your concerns early than to become over whelmed by them later.
Get as much rest, if not sleep, as you can. We all lead busy lives these days but simplifying what you fit into each day will allow you to get more rest. Plan ahead and don’t leave things to the last minute. Having said that, it doesn’t mean the nursery must be perfect before you get home- a new baby does not care about the colour of the walls, only that they have a loving mother and family, so prioritise things that really are important. The gestation at which you finish work and start maternity will depend upon many factors. Medically, there is no prescribed time beyond which you should not work, but reducing your work load or working from home in the last few weeks may help you cope better.
Anticipate and put support in place for after you have the baby. This may be your partner, friends or family but there are also many community support services available, for example community midwives, lactation consultants, community carers, that you can source through your doctor or local government.
Acknowledging there may be signs of deterioration in your mental health and recognising the effect of stressors will alert you to problems early. Simple interventions can help you cope and hopefully avoid significant problems during and after pregnancy. It is important to care for your mental health as you do your physical health and always tell someone if you think you need help.
Find out more about East Melbourne Obstetrics and Gynaecology at www.emog.com.au