MATERNAL MENTAL HEALTH
“Remember, you are not alone. There is strength in seeking support.”
Maternal mental health conditions, such as depression, anxiety, and substance use disorder
are the most prominent complications of pregnancy, child birth, and postpartum; affecting 1
in 5 women. According to the CDC, 1 in 8 women experience postpartum depression, and
50% of them are untreated.
As part of World Mental Resilience Program's Better Health for Mothers and Babies
initiative, this page is designed to provide information, resources and best practices to better
support families and hospitals in addressing maternal mental health. Our efforts also
recognize the importance of promoting good mental health for children and adolescents.
Many females have psychological well-being issues during pregnancy or after giving birth. It
can happen to anybody. Depression and anxiety are the most widely recognized
psychological well-being issues during pregnancy. These affect a significant number of
pregnant females. Especially helpless are those females with histories of mental ailment who
stop psychotropic drugs during pregnancy. Mental health issues can also be associated with
abortions, broken homes, problems between the couple, unhealthy work-life balance, undue
stress, physiological disorders, and other associated comorbidities. Pregnancy is traditionally
considered a good time with good feelings, but it is not so. Until a few years ago, the only
importance given to mental health was after childbirth (preference was given to disorders
such as postpartum depression {PPD}).
Nowadays, mental health is given its due attention right from conception, to antenatal care, to labour, to the postpartum period. Patients are educated on the importance of mental health and its short-term and long-term effects on the mother and the baby. The baby father is educated because he can play a crucial role. Various researches show that children born to mothers who suffer from mental health ailments such as depression are low-birth- weight babies. Societal problems such as poverty, overpopulation, overcrowding, and poor hygiene can also adversely affect the mother mental health. Some valuable solutions can be medication such as antidepressants, talking to a therapist, exercising, talking to close friends and family, couple counseling, and de-stressing. A phenomenon called postpartum depression is also prevalent and is given its due importance.
Worldwide about 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression. In developing countries this is even higher, i.e. 15.6% during pregnancy and 19.8% after child birth. In severe cases mothers’ suffering might be so severe that they may even commit suicide. In addition, the affected mothers cannot function properly. As a result, the children’s growth and development may be negatively affected as well. Maternal mental disorders are treatable. Effective interventions can be delivered even by well-trained non-specialist health providers.
- To reinforce advocacy and provide global leadership for the mental health of the mothers;
- To provide support on evidence based, cost effective, and human rights oriented mental health and social care services in community-based settings for early identification and management of maternal mental disorders;
- To provide strategies for promotion of psychosocial well-being, prevention and promotion of mental disorders of mothers during pregnancy and after delivery;
- To support the integration of the programmes with maternal and child health initiatives, reproductive health programmes and mainstream them with gender sensitive, and equity and human rights-oriented strategies of WHO;
- To strengthen information systems, evidence and research relevant to mental health of mothers.
A recent meta-analysis by WHO showed that about 20 % of mothers in developing countries experience clinical depression after childbirth. This is much higher than the previous figures on prevalence coming mostly from high income countries. Suicide is an important cause of death among pregnant and post- partum women. Psychosis is much less common but may also lead to suicide and in some cases even harming the new-born. Depression causes enormous suffering and disability and reduced response to child’s need. Evidence indicates that treating the depression of mothers leads to improved growth and development of the new-born and reduces the likelihood of diarrhoea and malnutrition among them.
Globally maternal mental health problems are considered as a major public health challenge. Though maternal mortality still lies at the heart of maternal health indicators; for the post 2015 agenda for development goals, WHO is considering Universal Health Coverage (UHC) and proposing Healthy Life Expectancy (HLE) related indicators as well. This implies stronger focus on mental health conditions in the integrated delivery of services for maternal and child health. The need is not just felt in high income countries. In fact, some academic and public health institutions in low- and middle-income countries have already initiated integrated maternal mental health programmes. These have been low-cost interventions with the involvement of non-specialized or community health providers. Impact has been demonstrated not only on mothers but also on growth and development of children.
Virtually all women can develop mental disorders during pregnancy and in the first year after delivery, but poverty, migration, extreme stress, exposure to violence (domestic, sexual and gender-based), emergency and conflict situations, natural disasters, and low social support generally increase risks for specific disorders.
After the birth, the mother with depression suffers a lot and may fail to adequately eat, bathe or care for herself in other ways. This may increase the risks of ill health. The risk of suicide is also a consideration, and in psychotic illnesses, the risk of infanticide, though rare, must be taken into consideration.
Very young infants can be affected by and are highly sensitive to the environment and the quality of care, and are likely to be affected by mothers with mental disorders as well. Prolonged or severe mental illness hampers the mother-infant attachment, breastfeeding and infant care.
Maternal mental health can be integrated into general health care including women’s health, maternal and child health care, reproductive health care and other relevant services.
The mental health Gap Intervention Guide provides guidelines about identification and management of mental disorders by non-specialized mental health providers including in pregnant and postpartum mothers.
The terms “Perinatal Mental Health” and “Maternal Mental Health” both refer to mental health during the time of pregnancy and/or the postpartum period. In the U.S., the postpartum period is defined as the period from birth through one year. Clinicians often use the term perinatal. In Latin, “peri” means around, while “natal” refers to birth. The term perinatalis often confused with prenatal, which means “before” birth (or during pregnancy).
Postpartum depression and postpartum anxiety are the 2 most common perinatal mental health or maternal mental health disorders.
The following provides an overview of maternal mental health disorders (also referred to as perinatal mental health disorders), including postpartum depression. This summary includes maternal mental health statistics, symptoms, and support.
Maternal Mental Health (MMH) disorders include a range of disorders and symptoms, including but not limited to depression, anxiety and psychosis. These disorders and symptoms can occur during pregnancy and/or the postpartum period (together often referred to as the perinatal period).
When left untreated these disorders can cause devastating consequences for the mother, her baby, her family and society.
These illnesses can be caused by a combination of biological, psychological and social stressors, such as lack of support, a family history, or a previous experience with these disorders.
Maternal anxiety and maternal depression are the most common complications of childbirth, impacting up to 1 in 5 women, yet they are not universally screened for, nor treated.
The good news is that risk for both depression and anxiety can be reduced and sometimes prevented, and with treatment women can recover.
Overview of Maternal Mental Health Conditions
The Baby Blues
Up to eighty percent (80%) of women will experience the “baby blues” after giving birth, tied to sudden shifts in hormones.
Women who experience the baby blues may feel sad, have mood swings and crying episodes. The Blues are not considered a disorder as the symptoms often resolve within a few days. If symptoms persist, beyond two weeks, it’s likely the mother is suffering from depression.
Pregnancy and Postpartum Depression
(Also referred to as maternal depression, peripartum depression or perinatal depression.) A Major Depressive Disorder with onset during pregnancy or within 4 weeks of birth though in practice it is applied to depression occurring within the first year from birth. Up to twenty percent (20%) of women experience clinical depression during and/or after pregnancy.
- Maternal depression is treatable during pregnancy and postpartum.
- Symptoms can range from mild to severe and, mothers with pre-existing depression prior to or during pregnancy are more likely to experience postpartum depression.
- Maternal depression is treatable and risk can also be mitigated.
- Symptoms generally include sadness, trouble concentrating, difficulty finding joy in activities once enjoyed, and difficulty bonding with the baby.
Research shows that the onset of depression occurs before delivery for the majority of women. Depression onset occurred prior to pregnancy among 27% of women, during pregnancy for 33%, and in the postpartum period for the remaining 40%. Therefore, it is important to screen for depression throughout the pregnancy and during the postpartum period.
Maternal Dysthymia
Dysthymia is defined as a low mood occurring for at least two years, along with at least two other symptoms of depression.
- Women with pre-existing dysthymia may be at a higher risk for severe symptoms/depression during the perinatal period.
Pregnancy and Postpartum Anxiety
Up to fifteen percent (15%) of women will develop anxiety during pregnancy or after childbirth.
- Anxiety is treatable during pregnancy and postpartum.
- Symptoms often include restlessness, racing heartbeat, inability to sleep, extreme worry about the “what if’s” - like what if my baby experiences SIDS, what if my baby falls, what if my baby has autism, etc.; extreme worry about not being a good parent/being able to provide for her family.
Pregnancy and Postpartum OCD
More studies are needed to identify a consistent rate of prevalence for perinatal OCD. One study found that perinatal OCD affects 2 in 100 women during pregnancy and 2-3 in every 100 women in the year after giving birth. Perinatal OCD is present in about 2-3% of all parents, though recent studies believe the number may actually be higher.
OCD includes obsessions (an unwanted thought or feeling) that a person has an urge to relieve through an action or a “compulsion.” OCD “obsessions” can include intrusive thoughts (see below for more information about intrusive thoughts). About 50% of women with OCD have intrusive/unwanted thoughts about intentionally harming their infant (e.g., throwing the baby).6 It is important to note that although obsessions often contain alarming content they do not represent a psychotic process, where mothers are at a higher risk of harming themselves or their infants/children.
Birth Related PTSD
The prevalence of postpartum PTSD is 3.1%.7 Most often, this illness is caused by a real or perceived trauma during delivery or the postpartum period.
- These women are plagued with intrusive memories and flashbacks of the event.
Birth Loss and Grief
Expectant mothers who experience miscarriage or stillbirth are also at risk for postpartum mental health disorders including PTSD in addition to grief or complicated grief. Globally 10-15 percent of known pregnancies, end in miscarriage and 1 percent of all pregnancies end in still birth (March of Dimes). According to the CDC Black mothers face double the stillbirth rate as White women in America. Native Americans face the second highest stillbirth rates.
Postpartum Mania
Women may suffer from an extreme inability to sleep, where a mother simply isn’t tired. She generally feels elated, and enthusiastic about completing tasks and motherhood. This is considered a state of hypomania or mania which may or may not be tied to an underlying bipolar disorder.
A state of mania is not in and of itself dangerous but because mania/severe lack of sleep may lead to impulsive and high-risk behaviour and can be a precursor to psychosis, it’s critically important that the mother receive clinical support from a psychiatric provider experienced in reproductive mental health.
Postpartum Psychosis
Postpartum psychosis is a rare/disorder symptom and occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately 0.1-0.2% of births.
The onset is usually sudden, most often within the first 2 weeks postpartum.
The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode. Postpartum Psychosis is considered a medical emergency due to the potential for a mom to harm herself or her baby.
Intrusive Thoughts
70-100% of women (and their partners) have “intrusive” thoughts surrounding childbirth/the postpartum period. These thoughts may include thoughts of infant harm (e.g., dropping the baby or a woman herself harming her baby). These thoughts are unwanted (ego-dystonic) and recognized by the woman as inappropriate and concerning, (which is why these thoughts alone are not cause for alarm). It is important to note that although obsessions often contain alarming content, they do not represent a psychotic process, where mothers are at a higher risk of harming themselves or their infants/children. Intrusive thoughts are not considered a “disorder.” When symptoms become persistent and are disabling, they are generally thought to be tied to OCD.
