According to the World Health Organization, about 10 per cent of pregnant women and 13 per cent of new mothers will experience a mental disorder, the main one being depression. Without appropriate intervention, poor maternal mental health can have long term and adverse implications for not just these women, but their children and families, too. In most cases, however, women simply aren’t aware of the help available or even that they might need it.
“Most of the time, they mistakenly think they are failing at parenting,” says Wendy Davis, executive director of Postpartum Support International (PSI). “They don’t realise they are going through a temporary, treatable experience that many others have gone through.”
So, what are the signs to look out for and what kind of support is available? To find out more and mark World Mental Health Awareness Month, Vogue speaks to a range of global mental health experts and women who have experienced perinatal depression.
What is perinatal depression?
“Perinatal depression is the experience of depression that begins during pregnancy [prenatal depression] or after the baby is born [postpartum depression]. Most people have heard of perinatal depression, but what’s equally common for mums to experience is perinatal anxiety either separately, or with depression,” explains Canadian therapist Kate Borsato. Perinatal depression does not discriminate. “Some people are surprised when I tell them that I experienced postpartum anxiety, because of my job as a therapist for mums. But mental illness doesn’t really care who you are or what you know.”
While anyone can experience it, there are some known risk factors that increase women’s chances of developing mental health difficulties in the perinatal period. According to Australia-based social worker and founder of Mama Matters, Fiona Weaver, these include a “previous history of depression or anxiety, those who have limited support networks, have experienced birth or pregnancy trauma, infertility or who may be genetically predisposed to it.”
What are the signs and symptoms to look out for?
Symptoms differ for everyone, and may include feelings of anger, anxiety, fatigue, neglecting personal hygiene, health or surroundings, fear and/or guilt, lack of interest in the baby, change in appetite and sleep disturbance, difficulty concentrating/making decisions, loss of enjoyment or enthusiasm for anything, and possible thoughts of harming the baby or oneself.
Dr Cornelia Chee, head and senior consultant of Singapore’s National University Hospital’s Department of Psychological Medicine and programme director of the NUH Women’s Emotional Health Service shares: “Apart from the usual symptoms including persistent low mood, inability to enjoy things, negative thoughts and excessive guilt, perinatal depression can usually be mixed with anxiety symptoms, or irritability.”
Lesser-known signs include “difficulty sleeping when the baby sleeps, thoughts of ‘escaping’ from the baby, and interpersonal sensitivity especially with family members,” says Dr Chee.
Jen Schwartz, US-based mental health advocate and CEO of Motherhood Understood, first experienced perinatal depression a day after giving birth. “The biggest red flag was that I was having scary thoughts about wanting to get hurt or sick so I could go back to the hospital and not have to take care of my baby,” she says. “I had no interest in my son. I thought I had made a huge mistake becoming a mother and I couldn’t understand why I was failing at something that I believed was supposed to come naturally and that all other women were so good at.”
It’s not just perinatal depression and anxiety that you need to look out for: women can also develop postpartum obsessive-compulsive disorder, and postpartum psychosis. Copenhagen-based content creator Clara Aatoft was diagnosed with severe postpartum depression and psychosis months after becoming a new mum. “For the first three months, I didn’t sleep at all. I was constantly aware of my daughter’s needs. She was later diagnosed with colic. When I gave up breastfeeding and switched to the bottle, my depression and psychosis went full-blown.” She continues, “I started thinking that my daughter was a robot that someone placed a chip inside at the hospital. I attempted suicide and ended up in the psychiatric ward. I’m very well now, still medicated on antidepressants. But my daughter and I have the best relationship.”
How can you manage your maternal health during and after pregnancy?
There are various ways to manage perinatal depression. “Identifying that there is a problem is the first thing,” says HH Sayyida Basma Al Said, Omani royal, mental health consultant, psychotherapist and mum of four. “Acting upon it is next—you just have to filter what works for you.”
One way is preventative. Abbie Mitchell, the author behind Abbie’s Mind and UK-based maternal mental health advocate, says that recognising symptoms and early intervention prevented her from having perinatal depression. “When I was pregnant, I had a consultation with my midwife and we decided it might be best with my history [clinical depression] that as a preventative measure, I signed up with the perinatal mental health team. We both believed that early intervention, if I were to suffer with perinatal illness, would be best.”
According to Borsato, there was no simple ingredient that could resolve her perinatal anxiety. Instead, she puts it down to “my willingness to accept support, learning to be self-compassionate, and finding ways to finally care for myself. Meeting with a mental health professional was also paramount in my recovery”.
Schwartz had a similar experience: “I accepted help from families, friends, and a part-time nanny that we were able to hire,” she says. “Finding a supportive group of mum friends was also helpful. These women never judged, but rather supported and cheered for me the whole time I was fighting the depression.”
Elsewhere, India-based yoga teacher Nidhi Khurana, who experienced perinatal depression at the same time as contracting COVID-19, turned to journalling and meditation as a way of managing her fears and emotions. “I practised deep breathing exercises while trying my best to only think positively about the whole situation—just by opening up brought a huge change in my mental state.”
It’s also a balance between keeping informed and overwhelming yourself with too much information, according to Dr Chee in Singapore. “It can help to read a reliable book on what to expect for the pregnancy and for one’s baby such as What to expect when you’re expecting. However, information overload is also confusing. Bear in mind that social media and internet spaces can be very skewed. For example, many websites about infant parenting come from English-speaking Western countries, and may not take into account local practices and contexts.”
While conversations about mental health have finally entered the mainstream, maternal health is still being somewhat overlooked. Quite simply, we need to talk about it more, whether that’s to friends, partners, family members, support groups such as Postpartum Support International, communities such as Weaver’s Mama Matters or Schwartz’s Motherhood Understood, therapists, midwives and other medical professionals. Whatever happens, it’s important to realise that you are not alone and that help is available.
How can you better support the mental health of other mums in your life?
Let’s be clear, maternity leave is no walk in the park. “Don’t assume that she is ‘on holiday’ during her maternity leave: it’s hard work,” says Dr Chee. “Don’t assume that the mum is enjoying herself. There can be a lot of anxiety especially if there are health concerns for mum and baby, or financial worries.”
Be a source of strength to your mum friends by asking how you can best support them by “offering a listening ear. Don’t rush in with problem-solving either.”
You are not alone. If you think that you are experiencing poor maternal mental health, contact NUH’s Women’s Emotional Health Service, which offers education on parenting, emotional assessment and support during and after pregnancy, support for gynaecological cancer patients, fetal loss support, and individual and couple’s counselling. Support is also available at KK Women’s and Children’s Hospital or your doctor. Your GP can recommend you to a therapist or counsellor.