In recent years years, a slow stream of dialogue concerning postnatal depression has opened up. Celebrity mums including Chrissy Teigen, Serena Williams and Sarah Michelle Gellarhave all spoken candidly about the effects the condition during a time period widely assumed to be one of the most joyful in life.
While it's encouraging that the conversation has opened up, perinatal mental health is often not talked about. The term refers to the changes in mental health during pregnancy and it's more common than many of us might think.
Perinatal depression is just as important to recognise
Earlier this year, a study by King's College, London found that one in four pregnant women experience mental health problems, a figure higher than was previously presumed. Conditions detected in the study ranged from depression (11%), anxiety (15%), eating disorders and obsessive-compulsive disorder (both at 2%) and PTSD and bipolar in less than one per cent.
More recently, a new short documentary film, Perinatal Positivity, was launched to educate women about the importance of talking about any mental health challenges they feel during pregnancy. Filmmaker Emma Lazenby told us that, during her research, it became apparent that the education pregnant women receive often lacks in the realm of mental health.
'Ante-natal classes often concentrate on physical health and the physiology of birth, but until recently, haven't spoken a lot about mental health,' she says. 'Many people were taken by surprise and didn't know what was happening to them, thinking something awful was happening to brain and they could never "get back to normal."'
When luxury cake company owner Michelle Shulman, 40, fell pregnant with her first child back in 2000, she was shocked that as someone who had always considered herself a 'happy-go-lucky person' and 'eternal optimist', she found herself getting tearful and snappy.
'Those around me just put it down to pregnancy hormones and gave me a wide berth if I was in one of 'those' moods,' she told Harper's Bazaar. 'It wasn’t until after the birth of my daughter that I was actually diagnosed with pre and postnatal depression when my health visitor picked up on it during her visits. I was immediately referred to a doctor for treatment and given a course of anti depressants for six months which really helped.'
The symptoms are often confused with pregnancy in general
This antiquated notion of 'mood swings' can often get in the way of genuine mental health issues being diagnosed during pregnancy.
'It's predominantly women that people refer to as having mood swings rather than looking at the fact that something is wrong with these women, mentally,' says Janet Fyle - a midwife and a policy advisor at the Royal College of Midwives. 'We, as clinicians and society, need to help those women out. It is no longer the case to be saying that women have mood swings because they say it about women who are not even pregnant. Studies have demonstrated that women who are pregnant can get depressed.'
According to the NHS, it is 'common for women to experience mental ill health for the first time in pregnancy', potentially because they're feeling more vulnerable or anxious. The cause is still largely unknown - as is the case with many mental health conditions. Fyle says triggers range from 'changes in hormones to changes in the woman's life or just generally some women are susceptible to mental ill health to a certain degree'.
What support is available?
When Shulman - who has since been diagnosed with bipolar disorder - fell pregnant again two years later, she was monitored much more closely by both care professionals and her family. She found her second pregnancy much more smooth-sailing in comparison to her first.
Her bipolar is treated with anti-depressants, which Shulman has found to really work for her. 'I still have the odd bad day where I feel like I am wading through treacle but I very much know how to deal with it now and those episodes are much shorter than ever before.'
The key to accessing the right support and treatment comes down to women being comfortable enough to feel able to talk about any concerns they have during their pregnancy - whether it be mental or physical - with their midwife or healthcare professional. Taking that first step by acknowledging what feels different is crucial to receiving help, support and advice.
'By speaking to women, we're then able to identify what's going on and even if we don't have the solution, having identified an issue, there are pathways [like specialist mental health support] which we can refer women on to,' Fyle adds.
There's a stigma to overcome
One reason why women often don't feel comfortable approaching their midwife comes down to the ever-pervading stigma surrounding mental health. As Fyle says, expectant mothers often believe that admitting they are struggling is equated with 'being a bad mother' or 'not able to cope', which of course is not the case.
'We need to talk about it and remove the stigma attached to it because no one asks to be unwell mentally, it's not something people plan to do,' says Fyle. 'We need to look at the parity across mental and physical ill heath. No matter what is affecting somebody physically, we have to talk to people about if they’re upset, worried or stressed because pregnancy [too], brings with it it's own stresses.'
Fyle adds that this stigma is often combined with a general lack of understanding around how significant the changes are in pregnancy.
'Pregnancy is one of the monumental changes in a woman's life,' she says. 'As a society, we do not understand how impactful pregnancy can be on a woman’s life. If you have that huge impact on your life, [it's understandable] there could be some psychological or mental impact.'
Her underlying advice is that even if you feel slightly different, teary, stressed, anxious or just 'not right' while pregnant, talk about it. It might be something which requires further medical intervention or it might not. 'If more women are disclosing how they feel mentally, and us as midwives and GPs are helping them, other women will come forward because they’ll know they can be helped.'
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As Lazenby points out: 'People came through this [mental illness in pregnancy] and said that they knew themselves better, were stronger than they’d ever been and were better able to cope with life after having this experience.'
Can mental health improve during pregnancy?
In a short answer, yes. Other women have noted improvements with their mental health while they were expecting. For 30-year-old Michelle Frewin, her depression and anxiety virtually disappeared during her pregnancy, which led her to come off her anti-depressant medication.
'My mental health improved drastically,' she told Bazaar. "'I thought I would struggle but I actually felt "normal" and felt I was back to how I was both before I was ever prescribed anti-depressants and how I felt when the anti- depressants worked in my day to day routine. I was happy, full of energy, positive and I could get up out of bed in the mornings and feel each day was going to be a great one. I was productive, rarely had mood swings and my mind was peaceful and balanced. I loved my body and wore anything without a second thought.'
After giving birth, Frewin noticed her mental health deteriorating again, feeling highly anxious with low moods, like 'all the strain I hadn't had for nine months just came crashing back'. She turned to her health visitor who scheduled extra visits, reassured the new mum she was doing a great job and encouraged her to see her GP who advised going back on medication.
'I decided to use my energy in a totally positive way and poured all my energy into setting up my own little vintage boutique business,' Frewin says of her mental health now. 'I love what I do and how far I’ve come since the days after giving birth. I still rely on my medication to stay balanced and lessen the bad mental health days but with my little girl, support of my husband and seeing how my work has made other women feel more confident I’m definitely in a better mental head space.'
The NHS adds that some women with a history of severe mental illness remain well during pregnancy and that it's important to remember that everyone is different. Fyle agrees and encourages other healthcare professionals 'not undermine a woman's own experience of pregnancy'.
Some women have wonderful pregnancies and notice improvements in their health and wellbeing, others don't. It's an individual experience and women should be completely trusted to relay how they personally felt during the, often, life-altering experience.
If you are pregnant and struggling with your mental health, speak to your midwife, GP or health visitor. You can also find further information and advice via the NHS website and the charity, Bluebell.