The Importance of Maternal Mental Health: A Guide for Healthcare Practitioners

The Importance of Maternal Mental Health: A Guide for Healthcare Practitioners

Pregnancy and childbirth can be challenging and stressful times for women, and mental health disorders during these periods are common. Research suggests that approximately 1 in 5 women will experience a mental health disorder during pregnancy or in the first year postpartum.1 These disorders can have a significant impact on a mother's health and wellbeing, and if left untreated, can also have negative consequences for the baby's development. As healthcare practitioners, it is crucial to understand the importance of maternal mental health and to take steps to support women who may be struggling. Here we explore the impact of maternal mental health disorders, the signs and symptoms to look out for, and the importance of taking a proactive and collaborative approach to supporting women during pregnancy and postpartum. The Impact of Maternal Mental Health Disorders Maternal mental health disorders can have a significant impact on a mother's health and wellbeing. These disorders can manifest in a range of ways, including anxiety, depression, and post-traumatic stress disorder (PTSD). Women who experience maternal mental health disorders are at risk of experiencing a range of negative outcomes, including: - Difficulties with bonding and attachment to the baby - Reduced breastfeeding rates - Poor infant health outcomes - Increased risk of suicide - Reduced quality of life for the mother Given the potential consequences of untreated maternal mental health disorders, it is essential that healthcare practitioners are aware of the signs and symptoms to look out for and take a proactive approach to supporting women during pregnancy and postpartum. Signs and Symptoms of Maternal Mental Health Disorders There are many signs and symptoms that healthcare practitioners should be aware of when it comes to maternal mental health disorders. These can include: - Excessive worry or fear - Feeling sad or hopeless - Lack of interest in activities that were previously enjoyed - Difficulty sleeping or changes in appetite - Difficulty concentrating - Feeling irritable or angry - Thoughts of harming oneself or the baby It is essential that healthcare practitioners are aware of these signs and symptoms and take them seriously when they are presented by women during pregnancy or postpartum. Beyond post-partum depression Postpartum mental health disorders encompass a range of conditions that can affect women following childbirth. While postpartum depression (PPD) is the most well-known, there are other lesser-known disorders that can also have significant impact on the lives of new mothers. Postpartum Anxiety (PPA) Postpartum anxiety affects approximately 10% of new mothers, but it often goes undiagnosed due to the focus on postpartum depression.2 Symptoms of PPA include constant worry, racing thoughts, and feelings of dread. It can also manifest as physical symptoms such as dizziness, rapid heartbeat, and difficulty breathing. Postpartum Obsessive-Compulsive Disorder (PPOCD) PPOCD affects approximately 3-5% of new mothers, and it is characterized by intrusive and obsessive thoughts about the baby, often involving harm. 3 Women with PPOCD may experience compulsive behaviours such as excessive cleaning or repeatedly checking on the baby, which can interfere with daily functioning and bonding. Postpartum Psychosis (PPP) Postpartum psychosis is a rare but severe condition, affecting 1-2 out of every 1,000 new mothers. 4Symptoms of PPP can include hallucinations, delusions, and extreme mood swings, and it typically requires immediate medical intervention to protect both the mother and the baby. Postpartum Post-Traumatic Stress Disorder (P-PTSD) P-PTSD can develop after a traumatic childbirth experience, such as an emergency C-section, a difficult labour, or the baby needing to be admitted to the neonatal intensive care unit.5 Symptoms of P-PTSD include flashbacks, nightmares, and avoidance of reminders of the traumatic event. It is estimated to affect 1-6% of women following childbirth.6 Postpartum Bipolar Disorder Postpartum bipolar disorder is characterized by extreme mood swings, including episodes of mania and depression.7 The onset of bipolar disorder can be triggered by hormonal changes and sleep deprivation during the postpartum period. This condition may be underdiagnosed, as its symptoms can overlap with those of postpartum depression and psychosis.8 Proactive and Collaborative Approach to Supporting Women To support women effectively during pregnancy and postpartum, healthcare practitioners should consider a proactive and collaborative approach. Screening for maternal mental health disorders Healthcare practitioners should use validated screening tools to identify women who may be at risk of maternal mental health disorders. Screening should take place during pregnancy and at regular intervals throughout the first year postpartum. Providing education and support Healthcare practitioners should provide education and support to women to help them understand the changes that they may be experiencing during pregnancy and postpartum. This education should include information about the signs and symptoms of maternal mental health disorders and the importance of seeking support if they are experiencing these symptoms. Referring women for specialist support If a woman is identified as being at risk of maternal mental health disorders, healthcare practitioners should refer them to specialist support services. These services may include psychological therapies, medication, or support groups. Working collaboratively Healthcare practitioners should work collaboratively with other professionals involved in the care of the woman, including obstetricians, midwives, and mental health professionals. This collaboration ensures that the woman receives coordinated care that is tailored to her individual needs. Encouraging self-care Healthcare practitioners should encourage women to prioritise self-care during pregnancy and postpartum. This may include activities such as exercise, eating a healthy diet, getting enough sleep, and taking time for themselves. Summary Maternal mental health disorders are common, and there is no shame in mothers seeking support. As healthcare practitioners, it is crucial to create a safe and non-judgmental environment in which women feel comfortable discussing their mental health concerns. By taking a proactive and collaborative approach, healthcare practitioners can ensure that women receive the care and support that they need to promote positive mental health outcomes for themselves and their babies. Useful resources https://maternalmentalhealthalliance.org/about/perinatal-mental-health/
References
  1. https://www.rcog.org.uk/for-the-public/rcog-engagement-listening-to-patients/maternal-mental-health-womens-voices
  2. Goodman, J. H., & Watson, G. R. (2019). Anxiety disorders in postpartum women: a systematic review and meta-analysis. Journal of Affective Disorders, 253, 69-84
  3. Miller, E. S., Chu, C., Gollan, J., & Gossett, D. R. (2013). Obsessions and compulsions in postpartum women without obsessive-compulsive disorder. Journal of Women's Health, 22(10), 825-830
  4. VanderKruik, R., Barreix, M., Chou, D., Allen, T., Say, L., & Cohen, L. S. (2017). The global prevalence of postpartum psychosis: a systematic review. BMC Psychiatry, 17(1), 272.
  5. (NICU) (Ayers, S., Bond, R., Bertullies, S., & Wijma, K. (2016). The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychological Medicine, 46(6), 1121-1134.
  6. Beck, C. T., Driscoll, J., & Watson, S. (2013). Traumatic childbirth. Routledge
  7. Meltzer-Brody, S., & Jones, I. (2015). Optimizing the treatment of mood disorders in the perinatal period. Dialogues in Clinical Neuroscience, 17(2), 207-218.
  8. Sharma, V., & Burt, V. K. (2017). Bipolar and related disorders in the postpartum period. In Psychiatric Disorders during the Postpartum Period in Light of Current Advances (pp. 121-146).
   
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