The sixth Maternal Mental Health Week will be celebrated in 2022. This week of awareness was inspired by the Perinatal Mental Health Partnership, which consisted of eleven individuals who have a lived experience of maternal mental illness.

What is perinatal mental health?

NHS England describes perinatal mental health (PMH) conditions as difficulties that occur ‘during pregnancy or in the first year following the birth of a child’.

The Royal College of General Practitioners (RCGP) estimates that ‘as many as one in five women develop a mental health problem during pregnancy or within the first year of giving birth’. To make matters worse, only 50% of these cases are currently diagnosed. It is imperative that the signs of perinatal mental illness are noticed early, and that support is put in place as soon as possible.

How does it manifest?

PMH conditions present differently in everyone. They may be induced through difficulties such as complicated childbirth, hormonal changes or lack of postpartum support. Disorders such as depression, anxiety, PTSD, maternal OCD and postpartum psychosis can all occur in the perinatal period.

The risk of severe mental illness postnatally is significantly high in women with a history of bipolar affective disorder, other psychotic disorders or severe depression.

The RCGP provides some ‘red flags’ as a guide for GPs, when treating women with PMH conditions. These include the following considerations:

Red flags:

  • Recent significant change in mental state or emergence of new symptoms
  • New thoughts or acts of violent self harm
  • New and persistent thoughts of incompetency as a mother or estrangement from the infant

Birth trauma – a lived experience

Suzy, a first-time mother, had a traumatic birth experience with her first child. She had been living in Spain, prior to returning home to the UK two months before the baby’s due date. Her Spanish midwife had told her that a caesarean section would be the best course of action as she had a narrow cervix, and a natural birth would be difficult and potentially life threatening.

However, once she was back in the UK, her new midwife said that she would be fine and that a natural birth would be the better option. Suzy went into a slow labour on a Sunday morning and seemed to be coping well. By the early hours of Monday morning, however, both she and her baby girl were showing signs of stress. Her husband took her to the hospital, and she was given gas and air to alleviate the pain.

Twelve hours later there was not much progress. Suzy’s midwife had arrived and said that the birth was still a long way off and she was given an epidural for the pain. At around 11pm Suzy was told that she would need to have a Neville Barnes Forceps delivery for her baby. Unfortunately, her ideal birthing pool experience was a long distant memory.

The next period of delivery was a blur, and the trauma still resonates with Suzy.

“I had wanted a natural birth but from the time that labour began to the moment that she was born it was the most horrific time of my life. I had pain and discomfort from the episiotomy and was bruised from my waist down to the top of my thighs. It was necessary for me to stay in hospital an extra five days due to heavy blood loss, which resulted in two transfusions. I had to attend daily infra-red therapy sessions at the local hospital and couldn’t sit down properly for months.”

The trauma of the delivery affected Suzy and her husband for years to come. Their sex life became non-existent, stemming primarily from the pain but also from the fear of becoming pregnant again. Suzy became very depressed and struggled to function.

She was, however, fortunate to have a supportive family, who recognised her need for substantial support during this period in her life:

“It wasn’t an easy road to travel,” says Suzy, “but I’m so grateful to have an understanding husband and wonderful family who were with me on this journey. They gave me guidance and their unconditional love, without which I would have struggled even more.”

There are established NHS perinatal mental health teams throughout England and those presenting with PMH difficulties can be referred by their GP, midwife or health visitor.

The Pre and Postnatal Depression Advice Support (PaNDAS) Foundation, who are also members of the Maternal Mental Health Alliance (MMHA), provide peer-to-peer community support for people affected by perinatal mental illness. They offer the following:

  • Free helpline open from 11am until 10pm.
  • Text support – text PANDAS to 85258.
  • Email information service – 365 days a year.
  • Support groups throughout the country.
  • Social media groups – seven days a week. 

Perinatal mental health conditions affect men too!

The PaNDA website has a plethora of lived experience traumatic birth stories, all of which are unique in the way the perinatal experience differs in everyone. One of the stories, however, is particularly poignant. Louis struggled with post-natal depression after his daughter was born and his wife suffered a postpartum haemorrhage following a caesarean section.

Louis says:

“I think it is important to share my story so other fathers see that it is also possible for them to suffer from perinatal mental health issues. I want to bring awareness to this and show other men that there are places they can turn to for support if they have any of these symptoms or conditions.”

Fathers and partners can access help for mental health issues via their GP or local IAPT (talk therapy) service. 

Smile!

It is clear to see that support is essential when navigating the challenges of perinatal mental health. Another charity that works to develop services for people affected by PMH conditions is The Smile Group, which offers peer support groups, home visits, talking therapy, family sessions and a virtual community.

It was established by two mums, Natalie and Ruth, who both had first-hand experience of PMH challenges. They now have an established team, some of whom have been recipients of support from the charity during their own PMH difficulties.

Ruth, one of the charity’s founders, offers these words of comfort:

“You’re not alone, you can and will get better. There’ll be bad days and good days, but the good days will increase.”

It is predictable and understandable that everyone will want to hold and cuddle a new-born baby, but who holds the mother – and father?  So, during Maternal Mental Health Week, try to practise self-care, acknowledge the hurdles you have jumped and the mountains you may still climb on your journey with maternal mental health.

Reviewed by Dr Emma Fisher, Consultant Psychiatrist MBBS, MRCPsych, PGCert MEd

April 2022