Why we should care about maternal mental health

Empathic engagement with mothers

Image: Graeme Arendse

When I examined Johanna*, I noticed that Johanna was very quiet during the examination. Although everything was fine with the pregnancy, I knew that something was wrong. Johanna had filled in a mental health screening questionnaire, which is routinely offered in our clinic. She had a high score. When I approached Johanna to offer a referral to the PMHP counsellor, she started crying. When I asked what was wrong, Johanna said I can’t talk about it. She did, however, want to see a counsellor.

This is only one of many stories we hear from our nurses and midwifes at at one of our service sites. So why is it important that we train health and social workers and advocate for routine mental health screening in all maternity units in the country?

Read about Johanna’s way out of an abusive relationship and how the counselling empowered her to seek help here

What is perinatal mental health?

Some people may be confused about some of the words used in relation to maternal mental health, like ‘intrapartum’, post-partum’, ‘ante-natal’, ‘post-natal’. The time during pregnancy, may be called the ‘antenatal’ or ‘prenatal’ period. ‘Postnatal’ refers to the time after birth. In the mental health field, postnatal may refer to 6 months or 12 months after the birth. Intrapartum usually refers to the labour and delivery time. ‘Perinatal’ refers to the time from the beginning of pregnancy to the end of the first year after the birth.

It is important not to confuse the ‘baby blues’ with postnatal depression. The ‘baby blues’ occurs in about 60-70% of mothers. Feelings of being overwhelmed and tearfulness occur on the third or fourth day after the birth and these resolve usually within a week. Depression or anxiety are more serious conditions and usually require some form of treatment. Depression or anxiety may occur during pregnancy, after pregnancy or in both time periods. The symptoms of these conditions may be confused with the usual physical symptoms of pregnancy such as sleep and appetite changes, aches and pains, tiredness or changing emotions. However, depression and anxiety affects a person’s mood, thoughts and how they function in most areas of their lives.

‘Psychosis’ is when a person becomes out of touch with reality. Postpartum psychosis is actually rare. It occurs in about 1 in every 1000 women (0.1%) who have a baby. This illness, if rapidly and effectively managed, usually resolves completely so that mothers may return to being well and fully functional.

Find more definitions on perinatal mood disorder here

Why should we care about it?

Perinatal depression and anxiety are significant mental and public health problems with well-documented consequences for mothers, children, and families. In developed countries, suicide is a leading cause of maternal death.

Because of the stigma of mental illness and a lack of understanding, many women who suffer from depression and anxiety, and their families, are not aware that these conditions require treatment (like any other health condition) and that they can be managed (often with relatively simple methods) so that they can recover fully.

Mental health care usually starts with some form of ‘talking therapy’. This can provide the necessary support to empower a women to identify resources and personal capabilities. A therapeutic relationship can enhance a woman’s resilience to difficult life circumstances and support her to nurture her children optimally. Caring for mothers is thus a positive intervention for long-term social development. Many women may also safely benefit from antidepressant medication which effectively treat both depression and anxiety.

How many are affected?

According to the World Health Organisation, worldwide about 10% of pregnant women and 13% of women who have just given birth, experience a mental disorder, mainly depression. In developing countries this is even higher, i.e. 16% during pregnancy and 20% after child birth.

In South Africa, studies show that at least one in every five women suffering during or after pregnancy.

1 in 5 women suffering from depression

Why is mental illness during and after pregnancy so common in South Africa?

Pregnancy and the postnatal period is a psychologically distressing time for many women, particularly for those living in poverty, or with violence, abuse, HIV/AIDS or an unintended pregnancy. Many women in South Africa live in these circumstances.

Several studies on prevalence of common perinatal mental disorders in low and middle income countries are collated on our website.

Who is at risk?

Infographic: Anisha Gururaj and Ashley Pople

Perinatal mental health is connected to a wide range of issues faced by women and although many of the risk factors are common for all women, they can vary from country to country. See the infographic below for comparative risk factors between India and South Africa.

Women in South Africa are particularly at risk when faced by:

  • Domestic violence – violence contributes to poor mental health, and poor mental health makes it more difficult for women to negotiate relationships where there is conflict
  • HIV/AIDS– HIV puts people at greater risk of mental health difficulties, while poor mental health makes it less likely that those who are HIV positive to adhere to treatment
  • Refugee issues– women who are refugees are more likely to suffer mental health difficulties due to their past experiences and to a current lack of support
  • Substance abuse – poor mental health makes women more likely to use substances such as alcohol in an attempt to feel better, but in turn, these substances and the circumstances around using them, lead to worse mental health
  • Teen pregnancy – teenagers with poor mental health are more likely to engage in risky behavior and become pregnant, while pregnancy brings increased social and emotional pressures which then affect mental health

What can we do about it?

Education is key and it is important that mothers and families are sensitized. Informing mothers about perinatal mental health will go a long way in helping them manage depression, anxiety and related illnesses. This education must include information about how to get help and support.

The support may be emotional, practical or financial. Partners should pay attention to the needs of the mothers as well as their own mental health. Seeking help when it is necessary for either or both parents, is a useful way to cope with difficult circumstances. This may be from family, community, health or social workers or faith-based organisations.

Find out where you can receive help in South Africa here

*The PMHP is committed to client confidentiality in keeping with the ethical requirements of professional mental health practice. The client stories reflect common scenarios or sets of circumstances faced by many of our clients. Pseudonyms are used and details are changed. The stories are not based on any one particular woman’s experience, unless an individual explicitly chooses to share her story with or without her name attached.  

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Posted on September 14, 2016, in Campaign blogs and tagged , , . Bookmark the permalink. 1 Comment.

  1. Healthy growth and brain development in the first 1000 is very critical. This means the first 270 days pregnancy produces lifetime of benefits.

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