Maternal Mental Health

I’ve been a Specialist Mental Health Dietitian for a total of three years and a Mother for just over one year so writing this post seemed like a no-brainer (excuse the weak pun; pre-baby me would’ve Stephen Fry’d these throughout but post-baby me just points at things instead of going to the effort to find words for them) given my experience in the former and total lack of experience in the latter.

Background

Worldwide about 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression (WHO, 2017). We know that all women are at risk of developing disorders throughout preganancy and in the first year of Motherhood but why is this the case? Women go through an extreme amount of physical change pre and post-natally and we have historically accepted this as part of growing a human but we forget that these physical changes along with all the ‘new’ that comes with having a child can have an enormously overwheming and enduring effect on our mental health.

Information over and underload

So here we are pregnant, happy and eating for two. I jest, us poor Mums don’t even get the joy of eating an entire tub of Ben&Jerrys a day (I’ve banned that loaded type from the house, it was getting ridiculous). The extra increment doesn’t exist until the third trimester only and that’s only roughly the calorific equivalent of a medium banana and an apple a day or a Ripple (and a bite) if you’re going to go absolutely off the scale bonkers. We’ve eagerly signed up to Ante-Natal classes (I still laugh about the fact that when I was younger and my friend’s Mother was pregnant, I thought she was off to visit her old Auntie…. Natal. Weird name I thought but who am I to judge, I bet Natal is just lovely) and we are going to learn all about how to keep our new offspring alive and how to bathe and feed it. Wonderful. What we’re not told is how to care for ourselves. What about the new level of selflessness we’ve never experienced before when we’re breastfeeding on demand, starving, partner in work, we can’t reach the remote, badly need a wee and worst of all, the chocolate is out of reach at 5am? What about the irritability you feel after a paltry 2 hours sleep a night and colicky baby just will not go down for days on end? How about a super dose of mastitis and a cluster-feeding baby? Pain, frustration and the eventual tears spring to mind. Agreed you can’t prepare for this but being informed beforehand would be useful.

Mental Healthcare Vs Physical Healthcare

We’re referred instantly to Physiotherapy for example if we have any physical post-natal problems but services for our post-natal mental health are severely lacking. Specialist Mental Health Units do exist for the most severely ill women who need to be admitted to hospital but what about women who don’t need admission for specialist care. The Maternal Health Alliance (2017) suggest that Practitioners such as GPs and Midwives within primary care haven’t received specific and specialised training within mental health let alone maternal mental health so how do we assess need and signpost quicker? Much of NHS money is spent on curative measures rather than preventative and there must be a culture of change in the NHS towards proactive healthcare rather reactive.

New Mums may off-load onto Midwives and Health Visitors just for a shred of reassurance (and because they are probably the only people we have immediate post-natal access to) and for someone to tell you it’ll be ok but Mums need better and quicker access to talking therapies such as Cognitive Behavioural Therapy and Counselling. NHS Health Professionals are bound by time-constraints and can only do so much in a visit. Mums want to talk and especially in the weeks after giving birth. They want to know they’ve got something right and when we don’t talk, it can lead to feeling anxious (I don’t just mean a little bit of worry, I mean the sort of worry that is life-limiting with physical and mental consequences) about things and if this gets worse, it can lead to depression. Depression is so widely-used these days, it’s started to mean that we’re just a little down in mood because the weather’s rubbish or because you’ve been stuck in watching In the Night Garden all week when your child’s poorly. Depression is a serious condition with an apathy for life and potentially your new baby. Post-natal Depression (PND) is as worthy of immediate specialist treatment and the level of understanding as any physical post-natal problem. We are fixed immediately should we have any physical post-natal problem however what if our minds need fixing from PND or Adjustment Disorder? This is not to say that the NHS isn’t able to diagnose or treat in the same timeframe as physical health but more knowledge and awareness of mental health problems can sometimes be more poorly understood at a non-specialist level and this is likely a wider, political and cultural issue as a whole. The British Medical Journal (2017) supports this and recently described the account of a Mother who revealed opportunities to diagnose her Post-natal psychosis were missed, “When a mother divulges mental health problems to a GP, it’s a precious opportunity not only to improve the mental health of the patient but also the wellbeing of a whole family”. A report by MBRRACE-UK has published its latest Confidential Enquiry into Maternal Deaths and Morbidity today and findings and states that 1 in 9 women die during pregnancy or up to one year after pregnancy die by suicide.

PND can have a serious impact on all areas of life, including relationships, well-being and especially a rather important part of life, appetite. If there is an apathy for life then eating isn’t a big priority and nutritional consequences can arise from a poor appetite including; weight loss, malnutrition and nutrient deficiencies. If Mum isn’t eating well or enough, Mum suffers. If Mum suffers, Baby suffers.

Mums need more information on how to care for themselves while access and availability to Mental Health Care Services and understanding of mental health at all levels improve.

How to master self-care:

– Eat right. I could bore you with the science but quite simply, if you can eat regularly and balanced (i.e. three meals a day and a few quick snacks) then your body and mind will thank you for it. You don’t need the extra frustration of preventable issues like dizziness and wind (it’s painful, it feels serious but it’s preventable by eating regularly) while your baby’s screaming at you. Don’t neglect yourselves. Yes baby must eat but you must too. No-one likes a sleep-deprived and hangry Mama. Yes, me. I’m talking about me. I’m usually hungry and largely unlikeable.

-Learn to accept your new body image. Learning to accept changes to your body while pregnant is one thing and usually acceptable to the majority as we’re not in control and that can be quite nice but I read and hear about so many women who try to get their ‘old body back’ and perhaps we should be accepting and embracing our new bodies. After all, it was amazing enough to give us our little ones.

-Be open and honest. Speak to family and friends about your needs and wants, for you and baby. New arrivals can change many dynamics and it’s important to nurture understanding to keep all of our relationships ticking over nicely.

– Boundary-set. It’s ok and in fact, necessary to set boundaries. We set them for our children and in the workplace but rarely set them for ourselves. If you don’t want visitors for a week or two when baby arrives then don’t. Boundary-setting is a huge part of self-care and just allowing yourself time to adjust to the new you with your new baby and new dynamics in your new world. I know, I’ve said ‘new’ an absurd amount but you get my drift; ‘new’ equals adjusting time in any area of life. Adjustment Disorders are very real, very common and you can hide them fairly well which does nothing for your well-being. Don’t hide it if you’re not coping. Even if you just tell someone you’re finding it hard and that’s enough for someone to empathise and support you (and probably say it back). We’re all different and have different limits with what we can manage and that’s perfectly acceptable. It’s also acceptable to not have to justify these boundaries to anyone as that doesn’t do anything for your well-being. Constantly putting yourself on trial for others to judge you is a recipe (appalling food pun #2) for disaster in terms of your mental well being. Having different limits to someone else or not doing something the way someone else is isn’t wrong, it’s just different.

-Stop comparing – opinions of others are just that. Too often we can become swayed by what ‘someone else’ is doing… who cares what ‘someone else’ is doing. You may not even like the way ‘someone else’ is doing something and their weird name. What works for you, works for you for a reason.

-Social Media. Many platforms are a breeding ground for assumptions on other’s lives which does nothing for your mental well-being. Used in a healthy way and following people who get ‘it’ (such as the superbly wonderful Unmumsy Mum, Hurrah for Gin and Selfish Mother -Instagram) will do wonders for your sanity and reassure you you haven’t failed if you give your children a fish finger sandwich. Heaven forbid.

Aaaand finally. Be nice to yourself. You would never say anything negative or critical about a friend and how they manage their new baby so why would you say it to yourself? You’re doing amazing, always. Repeat ad infinitum.

References

British Medical Journal (2017). Maternal Mental Health – Handle with Care. BMJ 2017;359:j4986

MBRRACE-UK (2017). Saving lives, improving Mother’s care. Available at: https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202017%20-%20Web.pdf

Maternal Mental Health Alliance, cited by BBC (2017) ‘Maternal Mental Health; how far have we come?’ at http://www.bbc.co.uk/news/health-42138868

World Health Organisation 2017. Available at – http://www.who.int/mental_health/maternal-child/maternal_mental_health/en/

 

 

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