Pregnancy: the potential for growth and vulnerability

Pregnancy is often a time of excitement and great joy and it is a time of tremendous change and stress. During pregnancy there are many changes in a woman’s life including changes in her body and hormones, but also changes in role, identity and feelings, to name a few. These changes also occur over a relatively short period of time. This time of her life is an opportunity for significant positive psychological development, as well as being a potentially vulnerable time when the woman is at risk for the development of particular mental health difficulties.

An opportunity for growth

For pregnant women and new mothers, there is the opportunity for the development of:

• caregiving and nurturing capacity and responsibilities
• tolerance of difficult feelings and ambivalence (which is a normal part of pregnancy, delivery and child rearing)
• a more stable self-identity

Pregnancy and new motherhood can also be a time when the woman

• reconciles difficult feelings she may have had about her own childhood,
• appreciates and understands her mother’s experience of motherhood, and
• experiences herself as more autonomous

A time of vulnerability

Just as adolescence represents a change from childhood to adulthood, pregnancy represents the change from being your mothers’ child, to being a mother to your future child. During this transition a woman is also vulnerable to developing mental health difficulties. Women are at a higher risk for both new and recurring mood and anxiety disorders. This is even true for women who have no prior history of mental health difficulties. The two most common perinatal mental health difficulties are depression and anxiety. In fact, 80 per cent of new mothers experience “baby blues.” And, while the lifetime rate of depression for women is around 20 per cent, the majority of these episodes occur during a woman’s reproductive years.

The perinatal period is clinically defined as the period covering pregnancy to one month postpartum. In practice, it is generally used to refer to the period of time including pregnancy to 12 months postpartum.

Baby blues

Baby blues, or postpartum blues, are very common and occur in up to 80 per cent of new mothers. Baby blues are mood swings due to the normal hormonal fluctuations during and following delivery. The onset is within a few days of giving birth. During baby blues, the woman often experiences feeling emotional, crying, being irritable, and having difficulty with sleep and concentration. These symptoms resolve within a few weeks after delivery.

Baby blues versus postpartum depression

While baby blues occur in up to 80 per cent of new mothers, postpartum depression is a more serious condition, and involves a major depressive episode that should be treated by a health-care professional. While 70 per cent of women report depressive symptoms, 10-16 per cent of women experience postpartum depression. A third of these represent women who experience their first depressive episode. The symptoms look very similar to depression at other points in a woman’s life cycle, although she may experience more anxiety. Postpartum depression is somewhat a misnomer, in that many women experience depressive symptoms starting during their pregnancy, not simply postpartum.

Description of postpartum depression

Women who are experiencing postpartum depression often experience the following:

• sadness
• crying for no reason
• lack of feeling pleasure for activities you once enjoyed
• irritability
• inability to sleep or nap – even when given the opportunity to sleep
• poor energy, concentration and appetite
• anxiety regarding the following:
  • baby’s health
  • breastfeeding issues
  • financial issues
  • your own appearance
• escape fantasies (for example, wanting to run away)
• thoughts of wishing you’d never had children
• thoughts of not wanting to live; thoughts of suicide
• thoughts of harming your baby

Thoughts of harming one’s baby can be very difficult for women to have. Our beliefs and image of what a mother should think and feel do not allow for the difficulties often experienced by women with postpartum depression. It is important to know that over 40 per cent of women with postpartum depression report thoughts of harming their baby.

If you are having any of these symptoms talk to your health-care provider immediately. Postpartum depression is a serious condition that can be treated very well with professional help.

Risk factors for perinatal depression

The following are risk factors for developing perinatal depression:

• history of depression or anxiety
• depressive or anxiety symptoms during pregnancy
• prior diagnosis of postpartum depression
• prior diagnosis of premenstrual dysphoric disorder
• ambivalent feelings about pregnancy
• limited social support
• marital conflict
• stressful life events
• living alone
• poor social supports
• child-care stress
• history of childhood sexual abuse
• infant irritability

Postpartum psychosis

A rare, but very serious, condition is postpartum psychosis. This occurs in one or two out of every 1,000 women, and usually develops within a few days or a couple of weeks following delivery. The symptoms usually develop quickly and they include:

• confusion
• disorganized behaviours and thoughts
• delusions, such as incorrect beliefs about the baby, self and the world (for example, beliefs about the safety of the baby, or thoughts of wanting to harm the baby)
• hallucinations (hearing or seeing things others do not hear or see)
• decreased sleep
• changes in mood – irritable/depressed/euphoric

Mothers who are experiencing postpartum psychosis should seek immediate attention from their nearest Emergency Room or nearest health-care professional.

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