Why pregnant mama's mental health should be the top priority

Maternal mental health statistics don’t make for easy reading. Experienced midwife Barbara Wear shares her thoughts on why mum’s wellbeing needs to be top priority.

It is my belief that mental health still holds a degree of stigma within our society. Maternal mental health can be perceived as a weakness, a lack of strength and fortitude. Or even more puzzling, a 'woman’s problem'. Surely, all women are excited and full of happiness to be pregnant? It must be a dream come true to be bringing a baby into our world? Planning a future with the responsibility and care of another human being, what could be more rewarding? These are the words that many pregnant women will hear throughout their pregnancy journey. 

But for many, being pregnant may be the beginning of feelings not previously experienced. Feelings of anxiety, depression, anger and sadness. Having no control of your changing body, your changing hormonal surges and exhaustion.

The sad truth is, suicide is the leading cause of death during pregnancy and the 42 days after the baby’s birth. This tragic and shocking statistic is hard to read, understand and accept. The mental health of our pregnant mothers is of concern to all carers within the maternity service. My message to mothers is, you are not alone. Please, reach out to your family, friends and community. If you are receiving care from a Lead Maternity Carer (LMC), they or their midwifery practice will be on call for you 24 hours a day, so please contact them for initial support. They may reach out to your GP or other health professionals if required as there are many and varied signs of depression and anxiety that also need to be discussed.

Historically, it has been thought that the days and weeks following a baby’s birth was the time to be vigilant and watch mothers for signs of anxiety and/or depression. We now understand that during her pregnancy, and weeks following the birth, there may be times and situations that can lead to a mother having feelings of sadness, guilt, anger and not being good enough.

These times, when shared with health professionals, can lead to timely intervention, guidance and support. Some triggers for maternal mental health could be:

+  Isolation

+  Financial insecurity

+  Single parenting

+  Family harm/violence

+  An unplanned pregnancy

+  Society’s pressure of needing to be the very best in everything you do

We live in a world of continuous availability to information on every subject possible, including pregnancy, labour, birth and the weeks beyond. Social media tells us how to be the best, how to look the best, how to achieve the perfect pregnancy and birth, be the perfect mother and perfect partner. Added to this pressure is the exhaustion, sleep deprivation and anxiety that modern motherhood brings.

Here are a few ways to support your physical and emotional wellbeing in pregnancy and the postnatal period:

 + If you have feelings of anxiety, depression or being overwhelmed, be open and honest with those who love you, care for you and are supporting you through these months. This allows an early discussion about mental wellness, alongside physical and emotional wellness, so any concerns can be addressed and extra support may be put in place.

+  Be kind to yourself when time and energy allow. Go for a walk, a swim, listen to music, read a book or watch a movie. Or sleep! Spending 30-40 minutes on whatever you choose to do will allow your body time to relax, recover and re-group. Please, do not use this quiet time to Google your concerns or worries. Speak to your lead maternity carer at your next appointment (hint...write your questions down as they come to you). Your care provider will take all your questions seriously and give you information that is current and relevant to your situation and area of New Zealand.

+  During your pregnancy, talk to your employer or colleagues if you feel you're struggling at work. They may be making assumptions about your wellbeing based on your energy level, production, availability and outward appearances. If you need to reduce your days or hours at work, ask to meet and have this discussion. You might be surprised by the level of support that can be offered, leading to your continued presence at your workplace.

+  Eat well and sleep well (these are big asks I know!). As your baby takes up more room in your belly, your ability to eat large meals is difficult so eating little and often might be a better way to go at meal times. Try and have healthy snacks throughout the day and drink plenty of water too. And sleep... again tricky. As your baby grows their kicks become stronger and really uncomfortable, indigestion can be a problem, especially at night and keep you awake. Prioritise unwinding in the evening and preparing your mind and body for as optimal sleep as you can manage.

+  Take all offers of support in those first few weeks after baby is born. People popping in to meet the baby are not overly helpful. However, having a meal dropped off is a definite winner or anyone who offers to help with housework or hold baby while you take a nap.

Travelling alongside some of our mothers are their significant others. Not necessarily the biological father but the person who loves them unconditionally, providing them with love, care and support. One in ten fathers will also experience postnatal depression. As with maternal mental health, there are triggers to watch out for:

+  If they have experienced depression or anxiety in the past

+  Their partner/family/friend is also experiencing depression

+  Baby is sick or in the neonatal unit

+  Being at a traumatic birth of this baby

+  Money or relationship problems

There are many and varied signs of depression that need to be watched for also:

+  Physical: tired, lack of appetite, trouble sleeping, weight loss

+  Emotional: sad, feelings of guilt or shame, disconnection, fear of looking after baby

+  Thoughts: forgetful, difficulty in making decisions, overwhelmed, unable to concentrate

+  Behaviour: withdrawing from family and friends, spending more time at work, turning to alcohol or drugs to manage day by day, no longer interested in sex.

Your significant other may feel like they need to be strong, emotionally and mentally, to best support you and baby. In reality, the strongest thing they can do for themselves is ask for help as soon as these feelings begin.

I have been looking after new mums for 25 years, and in recent times I’ve noticed society is a lot more generous in their thinking, kinder in their actions and quieter with their negativity around mental health. Maternal mental health is in all our communities regardless of ethnicity, socio-economic standing, age and culture. If you know someone who is struggling, make contact with them and show compassion, kindness and patience.

WHERE TO GET HELP

Below is a list of useful resources for readers. Do not forget, if you have immediate concerns about yourself, or someone close to you, dial 111

Plunket Line: (inc perinatal adjustment programme) 0800 933 922

Health Line: 0800 611 116 Text 1737 "need to talk"

Parent Helpline: 0800 568 856 

Lifeline: 0800 543 354 

Anxiety NZ: 0800 269 4389

Barbara Wear is a midwife based in Canterbury with post graduate study in maternal mental health. With three grown children and nine grandchildren, life is busy but when there’s time, she loves reading, walking and interior design.