How to help new mums suffering from postnatal conditions

Niamh Delmar is a Chartered Registered Counselling Psychologist, mental health writer, and media contributor.

Counselling psychologist Niamh Delmar discusses the signs and symptoms of postnatal depression, and how new mums can be supported.

Approximately one in 10 women experience perinatal mental health problems, and over 70% hide or minimise symptoms.

After giving birth, 50-85% of mothers develop the baby blues, which do not impede daily function and resolve within two weeks of delivery.

Many women experience hormonal fluctuations, fatigue, physical challenges, stress and issues with breastfeeding. They may feel overwhelmed and isolated.

Gradually, with support and an adjustment period for the mother and baby, women ease into this new reality and identity. However, more significant conditions may arise for some, including postpartum depression, anxiety, OCD, PTSD or, more rarely, psychosis.

Screening may identify postpartum depression, but overlook anxiety or other mental health disorders.

Post-partum depression is characterised by a depressed mood, sadness, fatigue, a lack of concentration, reduced interest and enjoyment, difficulty bonding with the baby, changes in sleep and appetite and suicidal thoughts.

Mothers may feel negative about themselves, see themselves as failing and feel disconnected from the baby and others. Frequent crying and irritability may feature.

Postnatal anxiety persists beyond the first few weeks, and tends to be generalised, with panic attacks or health-focused concerns. Anxious mothers feel consumed with worry and fears, feeling constantly on edge.

Physical symptoms may arise, such as feeling lightheaded, heart palpitations or tummy upset. Obsessive and compulsive symptoms can also develop postpartum, such as excessive cleaning and checking or distressing, unwanted intrusive thoughts.

Postpartum post-traumatic stress disorder can arise following a complicated delivery and is characterised by stress, nightmares, flashbacks and hyper-arousal. Bipolar disorders feature mood episodes oscillating between manic/hypomanic or depressive states.

Postpartum psychosis occurs in approximately 1-2 per 1,000 women after childbirth. Signs include a shifting mood, disorientation, erratic behaviour alongside delusions and hallucinations.

Risk factors for women developing postnatal mental health problems are multifactorial. The biopsychosocial model explains the interplay of biological, psychological and environmental factors influencing psychological distress.

Studies have identified pre-existing mental health conditions, family history and previous trauma exposure as contributing factors.

A background of physical, sexual or psychological abuse can increase vulnerability in the perinatal and postnatal periods. Poverty, a lack of support, difficulties in a relationship, stressful life events and alcohol or drug abuse are all aggravating factors. Obstetrical and pediatric factors are also involved.

Experiencing a traumatic birth or not, having a positive parenting experience can also lead to mental health difficulties. There may be ongoing challenges with an unsettled baby constantly crying, not sleeping or feeding or with additional needs. The capacity to cope and the woman’s psychological battery become depleted.

With postnatal mental health conditions, the earlier the recognition and treatment, the quicker the recovery time will be. Care providers should explore a woman’s psychiatric history and carefully monitor her throughout the perinatal period.

Screening and early interventions are key aspects in alleviating psychological symptoms. All women should be screened for mental health issues before and after childbirth, according to the American College of Obstetricians and Gynaecologists.

After childbirth, the focus of attention shifts significantly from the mother to the baby, which can overshadow a thorough assessment. Family and friends are key people in spotting early warning signs.

Those supporting women with postpartum challenges can educate themselves on symptomatology. Monitor, ask open questions, and be present. Validate that it can be an overwhelming and stressful time.

Do not assume that mothers must be overjoyed, that it all comes naturally, or compare it to your own experience.

Offer practical help with lifts, cooking or shopping. Suggest a nap while you mind the baby, as sleep is a tonic for mothers. Express empathy with a caring, non-judgmental attitude. Fellow mothers can be alert and create space for those who may be struggling.

Women themselves need to be well informed about potential difficulties, and disclose any previous mental health conditions or traumas, family history of psychiatric diagnoses and other risk factors. Wrap-around services and a wellness plan can then be implemented.

Many maternity hospitals have a perinatal mental health multidisciplinary team that can work closely with women throughout pregnancy and after delivery. It is important not to plough through difficulties, operate on autopilot, or have unrealistic expectations of motherhood.

Thought processes can be distorted and disturbing, but there is help. Meet yourself where you’re at, be honest about all symptoms, and reach out for support. Avoid comparisons with other mothers and stay in your lane. Social media and celebrity mothering is not reality. Check in with your health professionals, GP, relevant organisations, and access psychological help.

Returning to work after maternity leave can be a further stressful and emotional transition for mothers. Mental health education in the workplace can help to identify and support vulnerable mothers. Studies have found that the majority of mothers reported that flexible working arrangements and a reintegration phase were most beneficial.

Paid parental leave, childcare facilities onsite or nearby, lactation support and other accommodations can help mothers return to work more smoothly. Wellness programmes, counselling and regular meetings create an inclusive and conducive culture. Acknowledging baby-related issues also fosters a positive work environment.

Government policy can address more extensive and prompt psychological and psychiatric resources for healthcare settings, families and workplaces in the provision of mental health support to mothers.

It is important to remember that maternal mental disorders are treatable.

If you are affected by any of the issues raised in this article, visit https://about.rte.ie/ie/helplines/