Perinatal Mental Health Concerns Occur Exclusively in Early Postpartum: Myth

Let’s talk about: perinatal anxiety, pregnancy and postnatal depression and anxiety, worry and stress.

As a society, we correlate perinatal mental health concerns with early postpartum.

When we think of ‘postpartum depression’ we think of a mum with a newborn. A mum navigating the rapid skill acquisition and sleep deprivation of the newborn days. A mum in the fresh-from-birth whirring.

We certainly don’t think about a women whose babe is still tucked inside. Who is showing up to work every day, looking fine, smiling and saying she’s grateful.

We also don’t think of a mum that’s just packed her kindy kids lunchbox.

And yet. We need to.

We need to evolve our understanding of what’s really happening across these years so that we can meet women in their reality of this transition into motherhood. A transition that’s not just the blur of the first 6 weeks postpartum, but one that begins well before and continues well after this period.

What’s Happening in Pregnancy

Anxiety occurs at the same rate in pregnancy (1 in 5 mums) as it does in postpartum (1 in 5 mums).

Depression is common in pregnancy (1 in 10 mums) and in postpartum (1 in 6 mums).

According to COPE, it’s common for pregnant women to experience anxiety and depression at the same time too.

For many women who experience postnatal anxiety and/or depression, this is actually already occurring in pregnancy.

Underdiagnosis in Pregnancy

‘Are pregnant women at higher risk of depression underdiagnosis?’ from Journal of Affective Disorders shows depression underdiagnosis in pregnancy prevalence as 88%.

Underdiagnosis means we are missing this vital opportunity to fill women toolbox, build her skills, find her team and have supports in place early. Prior to postpartum.

But where is the space to open up truthful conversations about the reality of what it feels like to be pregnant? In our social circles and with our healthcare providers?

From my observation only I would say - there is huge stigma attached to feeling anything other than grateful in pregnancy. Many women silence their experience because it is so at odds with our societies expectations. There are only certain things we feel comfortable with seeing and hearing from a woman during pregnancy.

The gaslighting of ‘at least you’ve got a healthy baby’ starts with the gratitude we expect from pregnant women about their ability to conceive and carry a pregnancy.

We’ve enmeshed our feelings about the experience of pregnancy with the love we have for our growing babe. Our worth as a mother with our ability to smile over what we might feel internally.

When women don’t (or can’t) fit the mould of ‘only grateful’ in pregnancy there is shame. A silent question of: what does that mean about me?

It doesn’t feel like too much of a stretch to say: women may see their mental health as a reflection of their worthiness for the position of ‘Mother’.

Bottom line:

Antenatal depression and anxiety are common. This reflects nothing about the worth of a mother. What it does reflect is the need to envelop her with support, genuine care, resources and tools.

Instead of silencing pregnant women, we want to encourage towards gathering her healthcare team and supports. To find the people she can be honest with about her experience.

Note: Dads can experience all of these things too. For dads, see PANDA

Beyond the first year postpartum

Babe is walking, talking, and perhaps theres a bit more sleep occurring. First birthday candles blown out. If breastfeeding continues, it’s far less of a load. Periods have likely returned.

As a society, and even as healthcare providers, it’s common to barely differentiate a woman 1+yrs postpartum as distinct from any other adult.

But we must.

Maternal depression is more common at 4 years postpartum than at any time in the first 12 months postpartum. That was the conclusion from a Melbourne study ‘Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care’

Nearly one in three women reported depressive symptoms at least once in the first 4 years after birth.

Perinatal Mental Health is not only a situation of the early postpartum days

It’s more than something associated with having a newborn.

We need to break old stories and grow our understanding of when these things can (and do) occur.

And normalise having these conversations in our social circles and with care providers.

Women deserve to be heard and held. From their experience of trying to conceive, through pregnancy, birth, early postpartum and extending far into the years beyond.

Allowing women the space to say hard things can encourage help seeking. Which is only ever a great start.

Resources:

PANDA 1300 726 306

Centre For Perinatal Excellence

Gidget Foundation 1300 851 758

Lifeline (available 24hrs) 13 11 14

More about My Approach to Maternal Burnout & Maternal Mental Health

More about Perinatal Mental Health Consultations with Amy

Note:

I am not a psychologist or a counsellor. I’ve put this together from my experience treating women in perinatal period as an Acupuncturist and Chinese Medicine Practitioner. Use the helplines and resources above. See your GP. Find someone who’ll listen.

You deserve the best kind of care. Prevention, early intervention and genuine support, always.