Pregnancy and Your Mental Health: What to Expect, and When to Ask for Help

Pregnancy is often a very happy and exciting time. But not every woman feels this way.

You may have mixed, or even negative, feelings about being pregnant, especially when the pregnancy is perceived as unwanted, or if it is unplanned, or if you experienced a traumatic pregnancy in the past, or witnessed one in your family. You may find it more difficult than others to cope with the changes and uncertainties that pregnancy brings. Many things can affect how you feel in pregnancy, including physical symptoms (such as morning sickness), the support you have or don't have, and current and past stressful events in your life.

Make yourself familiar with the commonly used terms

• Perinatal means around the time of birth. It is a period that spans from your day of conception to a year after your delivery.
• Antenatal refers to the period of your pregnancy right from the day of conception.
• Postnatal refers to the period after the birth of your child, up to a year.

Women often worry about how they will cope with pregnancy or having a baby

It's normal to feel stressed or anxious at times. When you're pregnant, it's common to worry about:

• The changes in your role (becoming a mother, stopping work)
• Whether you will be a good parent
• The changes in your relationships
• Fear that there will be problems with the pregnancy or the baby
• Physical health problems and pregnancy complications
• Fear of childbirth
• Lack of support and being alone

As many as 1 in 5 women have mental health problems in pregnancy or after birth

It can happen to anyone. Depression and anxiety are the most common mental health problems in pregnancy. These affect about 10 to 15 out of every 100 pregnant women. Just like at other times in life, you can have many different types of mental illness, and the severity can vary. You may already have had a mental illness when you became pregnant.

Mental health problems you have had in the past can be worrying because they can increase the risk of becoming unwell, particularly after birth. However, with the right help this can often be prevented. You can also develop mental health problems for the first time in pregnancy or after birth.

What are the kinds of perinatal mental health problems we need to be aware of?

• Perinatal depression
• Perinatal anxiety
• Perinatal OCD
• Perinatal psychosis

How your mental health is affected during pregnancy depends on many things

These include:

• The type of mental illness you have had already
• Stopping medication for a mental health problem: you have a high risk of relapse if you do this when you become pregnant. This is more likely if you have had a severe illness, several episodes of illness, or a recent episode.
• Recent stressful events in your life (such as a death in the family or a relationship ending)
• How you feel about your pregnancy: you may or may not be happy about being pregnant

Symptoms of mental illness in pregnancy are similar to symptoms you have at other times, but predominantly, women can experience distressing thoughts and feelings revolving around their pregnancy.

What if I had mental health problems in the past, and I am well now?

You should be referred to a mental health service if you are pregnant and have ever had:

• A serious mental illness, like schizophrenia, bipolar disorder, obsessive-compulsive disorder, or severe depression
• Depression and anxiety exclusively during pregnancy or during postpartum periods

It is important to get specialist advice even if you are well during this pregnancy. Women who have had these illnesses have a high risk of becoming unwell after birth.

A perinatal mental health specialist's advice is beneficial to discuss care and treatment choices with you. They will help you make a plan for your care, together with your obstetrician, pediatrician, and other specialists involved.

What else can I do to keep my mental health well?

• Eat a healthy, balanced diet
• Reduce your alcohol intake. You should stop drinking if possible.
• Stop smoking (you may need to meet a de-addiction specialist to help you with this)
• Find some time each week to do something which you enjoy, improves your mood, or helps you relax
• Learn and practice meditation or mindfulness
• Let family and friends help you with housework, shopping, etc.
• Prenatal yoga can help you manage mild anxiety and fatigue
• Discuss any worries you may have with your family, your obstetrician, and psychiatrist
• Get regular sleep

What happens if I don't care for my mental wellbeing?

• You might not take good care of yourself
• You might not attend appointments with your doctor, so you don't get the care you need
• If you use drugs and alcohol, you may use more when unwell. This can harm your unborn baby.
• You may need a higher dose of medication if you become ill. Sometimes you may need two or more medications to treat a relapse. This might be riskier for your unborn baby than taking a standard dose of medication throughout pregnancy.
• You may need in-patient treatment
• You may still be unwell when your baby is born, which can make it more difficult to care for your baby and may affect your relationship with your baby

If your illness is not treated, this may be more harmful for your baby than the effect of medication. Untreated mental illness can cause a number of problems. For example, some research studies have found that babies are more likely to have low birth weight if their mother has depression in pregnancy. Untreated mental illness can also affect a baby's development later on.

Unfortunately, 2 to 3 in every 100 babies are born with an abnormality, even when the mother has not taken any medication.

Can your partners be affected with perinatal mental health problems?

Yes. Research states that one in 5 men can develop depression after they become parents, especially if:

• They are young parents with no perceived or actual social support
• They are struggling with financial or occupational stressors, or having marital stress
• They are finding it difficult to handle extra chores and responsibilities in the house, financial pressures, and coping with a partner who is having mental health issues

Partners can benefit by reporting their symptoms to perinatal mental health specialists, to seek further guidance.

What can your partner do to help himself cope with his perinatal mental health issues?

• Maintaining regular sleep and wake timings
• Taking good nutrition
• Managing work-life balance
• Having "me time" to help himself cope with regular stressors
• Meditation and mindfulness
• Enrolling in self-help, community-based fathers' parenthood groups