Mental Health During Pregnancy and Postpartum

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Pregnancy is a life changing condition.  Physically and mentally, there are many changes that happen with new life growing within.  These changes during the perinatal and postnatal periods often put new mothers and mothers-to-be at high risk for developing anxiety and depression.  Less common but worse conditions may include bipolar disorder and postpartum psychosis.

Women may develop a mental health problem during pregnancy or may have a recurrence of such a problem if she had such issue before pregnancy.  Women on medication for some mental disorder may have to stop taking their prescriptions when they get pregnant.  Unfortunately, they form a high risk group for recurring symptoms.  Seven out of ten women who stop their antidepressant medication for instance fall back into depression or anxiety during their pregnancy.

In the U.K., about 10-15 out of 100 pregnant women become clinically depressed or anxious.  The cause is not singular but it is usually a mix of factors and it can happen to anyone.  These factors may depend on:

  • Degree of recent or ongoing stress in one’s life such as a death of a loved one, divorce or separation, etc.
  • Attitude toward pregnancy.  The thought of raising a child, for instance, may put undue worry on a person especially one with a difficult childhood.  Changes in weight and shape may take an emotional toll especially if the mother has an eating disorder.
  • Whether one is on treatment or medication.  Stopping treatment could make one fall ill again.
  • Type of mental illness one has experienced

Postpartum Depression and Anxiety

As pregnancy and post pregnancy are times of great changes, depression symptoms may not be so easy to identify.  Depression signals may come when there are big changes in everyday routines or habits such as short sleeping hours, increase in appetite, etc.

If you are experiencing some of these symptoms for more than two weeks, get some help:

  • Feelings of hopelessness, worthlessness, emptiness, sadness, and other feelings of inadequacy
  • Very low moods; extreme sadness
  • Feeling numb
  • Easily irritated, angry, or resentful
  • Unfounded fears for the baby or of motherhood
  • Loss of interest in things that were normally enjoyable
  • Withdrawal from social contact
  • Not taking care of self
  • Insomnia
  • Poor concentration and decision making
  • Harbouring thoughts of harming the baby or one’s self; thoughts of suicide
  • Decreased energy; extreme lethargy

Anxiety is a common partner of depression.  When experiencing these symptoms, you need to see your GP or health professional who may test your degree of depression and anxiety using the Edinburgh Postnatal Depression Scale (EPDS).  The EPDS is a questionnaire which assesses your feelings if these fall outside the normal range and into the depression/anxiety scope.  This test may be conducted twice during pregnancy and once after childbirth.

Seeking Help

A pregnant woman, who has had prior history of mental illness such as schizophrenia, bipolar disorder, anorexia, or severe depression, must make a wise decision to talk to her GP.  Consultation with a specialist, even if she feels very good about herself and her pregnancy at the moment, is important because there is a high enough risk for her mental illness to recur during pregnancy or after childbirth.  One needs a care plan drawn up by a GP in order to head off or at least lessen the effects of the illness.

Medication During Pregnancy

Since many pregnancies are usually unplanned, some women may be under medication at the time of conception.  If you are under medication but suspect a pregnancy, do not stop medication suddenly but go see your doctor immediately.  He will assess whether to change or gradually take you off your medicines.  Stopping medications suddenly can quickly cause a relapse of your symptoms or cause undesirable side-effects.  If the doctor sees no harm to the foetus with the drugs you were prescribed with, he may insist that you continue with your medicated treatment.

While many medications are unsafe for pregnancy, selected antidepressants such as a few serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are considered safe for pregnant women.  These few have not been associated with birth defects and pass at very low levels through breast milk.

The decision of your doctor on whether to continue or not to continue medication may rest on the ff. factors:

  • the likelihood that you may not be able to take care of yourself when off medication
  • your tendency to turn to drugs or alcohol because you feel unwell without medication.  This tendency is harmful for both you and the developing foetus.
  • your tendency to develop postpartum depression which will affect your nurture and care for your baby
  • you are at a high risk for a relapse.  A relapse may require more medication, usually a higher dose or a supplementary drug, both situations that can be very harmful to the baby.
  • if talking therapies are not enough to mitigate your mental health issues.  Mental health problems like depression must be addressed because these can cause a host of problems from low birth weight to infant development.

Talking Therapies

Talking therapies or psychological treatments may be imperative treatments for pregnant women afflicted with depression or anxiety.  Cognitive behavioural therapy (CBT) for one can help you cope with your feelings by changing the way you think and behave.  Talking therapies help people identify the problem and ways to change their thinking and behavioural patterns so that the effects of the triggers are significantly lessened.  Some people may do away with medication and get by very well with talking therapy alone.

Talking therapy may be done as a one-on-one consultation or as a group event.  This type of therapy may also be conducted online as e-therapy through e-mail or video sessions.

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Parenting With a Mental Health Problem

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Being a parent is no easy task and definitely not for the fainthearted.  Parenting becomes even more difficult if the parent himself or herself is disadvantaged with the added liability of having a mental health problem.

How does Mental Illness Affect Parenting?

Many children live with a parent who may have had a short-term mental illness or is currently suffering an ongoing one in which alcoholism, drug dependency, or depression is a fact of life.  U.K. statistics show that about 50% to 66% of parents with severe, long-term illnesses such as schizophrenia, bipolar, and personality disorder live with one or more kids under the age of 18.  These estimates intimate that about 17,000 children and adolescents are subject to living conditions under a mentally ill parent.

With a mental illness to deal with, many parents are under tremendous pressure to carry out their daily roles as nurturers, not to mention other roles such as workers, partners, friends, and the like that they struggle to fulfill.  Their troubling mental health, if not treated and supported, will often disrupt the stability of their children’s lives and their relationship with them.  Since parents with a mental problem can be unpredictable, their children may not know how to deal with sudden emotional crisis or how to come to terms with the emotional issues that come along with it.

A parent with mental disorder may feel that they have to put the needs of their children first which is exactly what any parent is compelled to do, whether they have or do not have any mental disabilities.  For mentally disadvantaged parents, doing so however may entail curtailed hospital stays and putting the brakes on medication expenses and intake.  As this may seem like a good thing to do in the short run, skipping or avoiding treatments may backfire on your capability as a parent, upending the balance of your relationship with your children.  Untreated depression, for instance, may make it very difficult or almost impossible for a parent to be emotionally engaged in their children’s lives  so much so that parent-child communication can become impaired.

How Does a Parent’s Mental Health Problems Affect Their Children?

Because the effects of mental illnesses are varied and sometimes unpredictable in individuals, so are the effects these have on the children under an afflicted parent.  Although genetics and home life pose high risks for mental illness on children with mentally unhealthy parents, not all children grow up to inherit the problem or be so negatively affected.  Just because a child’s parent has mental illness, it is not enough to conclude that the child will become mentally affected as well.

A child’s mental health under a mentally unwell parent will hinge on the following factors:

  • severity and length of time of the parent’s mental illness
  • age of the child during the onset of the parent’s illness
  • how the parent’s mental condition affects his behaviour and how this behaviour affects the child
  • degree of stress arising from the parent’s behaviour
  • degree to which the parent’s symptoms interfere with positive parenting such as parental interest and participation in the child’s daily life

With the above factors in mind, it is correct to surmise that a parent’s negative behaviour as a result of mental illness, however, can have many troublesome effects on a child.  Some kids withdraw emotionally, become anxious, and find focusing on schoolwork next to impossible.  Most of them are ashamed of their parent’s illness, consequently finding it distressing to talk about their problems and get the help they need.  Children also may become excessively worried about “getting infected” by the illness and may start to develop emotional problems.  The risk of these children acquiring mental illness is further escalated when poverty, bad living conditions, and chronic instability form the framework of their lives.

What Can a Mentally Ill Parent Do?

When a parent is mentally unwell, it is tough to make children, particularly very young children, understand and make sense of their parent’s behaviour.  Why does Mommy seem so happy for a whole week and then so despondent the next?

parenting with mental illnessOne of the best things a mentally ill parent can do is provide clear facts and information of their condition.  Children need to know what to expect from their ill parent’s conduct.  This will help mitigate the anxiety and confusion children often feel when faced with an adult’s bewildering behaviour.

The sick parent may also educate their kids on what they may find helpful and unhelpful in times when their illness strikes.  Kids can feel like they are contributing to their parent’s attempts to get well.  Bringing in another adult to take on the major part of the caregiving burden is a necessity to avoid placing a huge burden of caregiving on the children.

Parents may draw up a plan for childcare before a situation arises where they need to be hospitalized or are unable to do their responsibilities.  This plan should detail the child’s daily routine, likes, and dislikes and entrusted to a responsible child caregiver.  This way, the child can have a sense of continuity, security, and stability when the care giving is simply continued as is.

Above all, a mentally unwell parent must seek the proper professional treatment.  This way, the right decisions and support may be received, important factors that will greatly help both parent and child cope well with living problems from mental health issues.