Maternal Mental Health
Perinatal refers to the time period from conception to one year post birth. Maternal mental health services are specifically created to support the mental health of women and families during the period of transition into motherhood and family life.
Whilst this transition is a perfectly normal and common part of human life, we also know that it can be difficult for lots of mums with the added pressures of modern life.
Research from the World Health Organization (WHO) has shown that one in five mums struggle with their mental health during this time – whether it is whilst trying to get pregnant, during pregnancy or in the first year or so after having a baby. This is largely a biological process and so it is likely that these numbers are the same in UAE. Furthermore, many of the social and psychological factors, such as a history of mental health problems or social stressors such as financial pressure are global and therefore experienced by women and their families across the world.
These difficulties occur in a variety of different ways:
Unfortunately, not all attempts to have a baby are successful, or the journey to parenthood may have been long and complicated, whether this is due to fertility difficulties, recurrent miscarriages, traumatic pregnancies and births – all of which will have an impact upon your mental well-being as it can be linked to Trauma and Loss.
All of these experiences can feel overwhelming, and help is available. In some cases, these conditions can be preventable with early assessment and intervention. This does not always mean medication, and great relief can be found through talking therapies.
Maudsley Health have established the first highly specialized maternal mental health service for the UAE. Our multi-disciplinary team consists of experts from around the world, including nurses, psychologists and psychiatrists, who have been working in maternal mental health services for decades. We are very proud at Maudsley Health to have this collection of experts at your disposal! We have the privilege of offering evidence-based treatment and support in women’s perinatal experiences taking into account the local Emirati culture, and the diverse communities that we serve.
Come and talk to us and let us support you through this life-changing time – giving you the best start at motherhood and giving your baby a healthy beginning.
The Baby Blues are really common and are a real thing. The majority of mums (between 50-70%) will experience a change in mood at about day 3 after giving birth. This can range from feeling overly emotional, tearful for no apparent reason, to feeling really overwhelmed and wondering whether they can adjust to the parenting role. It is really important that this time is recognised and supported - not simply dismissed. Typically it improves by itself and by day 10 mums are feeling back to their normal self. However, when you are in the middle of this experience that may not feel very believable and so it important to have a supportive family around you who can help you through this difficult time.
It is also important to recognise that this is a self-limiting condition. So, if it is continuing beyond a week and it has gone on for more than 2 weeks then it is important to consider whether something else is causing it. Specifically we would be considering whether you are suffering from post-natal depression. We know that some physical illnesses can mimic depression and so a physical work up is needed with blood tests to make sure there isn’t another cause for your prolonged symptoms. For the majority of women however, a spontaneous, natural recovery from Baby Blues is the typical outcome - so if it is not resolving - seek help.
Although we commonly talk about PND or postnatal depression, for the majority of women who have postnatal depression, their symptoms actually started during pregnancy (or even before that for some women). In fact untreated ante-natal depression is the biggest predictor of postnatal depression.
Ante-natal depression is very similar to depression at any other time. The main symptoms of depression are low mood, loss of interest in things that you used to enjoy, loss of confidence or self-esteem, feelings of guilt, loss of concentration, feeling agitated or slowed up. There are other symptoms such as feeling tired, changes in appetite, sleep disturbance, which unfortunately can be normal parts of being pregnant, but maybe made even worse if you are depressed on top of being pregnant. It can also happen alongside a perinatal anxiety.
On top of these typical symptoms, you can also have specific symptoms because you are pregnant - such as not being able to prepare for the birth of your child, not being able to process the pregnancy and develop an ante-natal bond with your unborn child, struggle to look after yourself adequately - not able to attend to your self-care and also to the additional tasks you will have such as attending obstetric appointments etc. Unfortunately all of these generally compound to make you feel even more guilty and lower in mood.
For some women this can fit in with their experience of having suffered from a mood disorder before, but for others this could be the first time they have ever felt like this. The usual treatment for depression is psychological therapy and medication. The thought of medication during pregnancy can for many feel like a real barrier to accessing help - this is something that we at Maudsley Health understand and always respect.
Help is available. It is important to be seen by a perinatal mental health specialist who will have the latest information and knowledge about treatments during pregnancy. They will never insist that you have to take medication when you see them in an outpatient clinic. They will however, be able to give you the latest information and advice and together you can identify and develop a management plan which works for you. Whatever you decide to do, they will be there to offer support and advice. They will help you to weigh up the risks of taking medication, against the risks of being depressed and the impact that both can have on you, on your unborn child and on the rest of your family.
It is important to keep an eye on the future - having a baby is a very demanding role and so it is important that you are as well as you can be when the baby arrives. If it is possible to avoid postnatal depression, then this should be attempted.
Postnatal depression is common. For every 100 women who have a baby, between 10 and 15 of them will have postnatal depression. Postnatal depression has the same symptoms as depression at any other time - low mood, loss of pleasure in usually pleasurable activities, loss of confidence and self-esteem, feelings of guilt, loss of concentration, feeling agitated or slowed up. There are other symptoms such as feeling tired, changes in appetite, sleep disturbance, but unfortunately these are all common experiences for new mums, but may be made worse if you are also depressed. In postnatal depression these symptoms are classically seen during the first 6 months of having a baby, but can go on for much longer.
The reason so much emphasis is placed on postnatal depression is because it coincides with a time in a woman’s life when she has the biggest job in the world - getting to know her new baby and providing care and nurutre. Unfortunately when you are depressed it is really difficult to take on new tasks, learn new skills or to develop new relationships and attachments with people - including with your baby.
Support from the rest of the family is really important, but other help is available. It is important to get this help as soon as possible to help to protect the mother-infant relationship and to give all new mums the best opportunity to be the mother they want to be.
It is important to seek help from a perinatal mental health specialist as they will have a greater understanding of the impact of your mental health upon your developing relationship with your baby, as well as being aware of which treatment options are the most appropriate. It is essential that all treatment options consider the needs of the baby as well as of the mother. This means we will only consider medication that is safe for both mother and baby so that you can continue to breast feed for as long as you would like to or are able to. Psychological treatments will focus on the new skills that your are acquiring as a mother and help to support the developing relationship between you and the baby.
Many mothers worry about having a mental illness and the impact it can have on their baby and the relationship between them and their baby. This is made worse when The role of perinatal mental health clinicians is to support the mother-infant relationship. We have seen how all women are able to develop a link with their child, if this is something that they would like to do. Whilst being depressed or anxious can create a barrier to the development of this relationship initially, it is still possible for this to develop over time. Some mums will describe an overwhelming feeling of love for their baby as soon as their baby is born, but this is the exception rather than the rule. For most mums they simply feel exhausted, tired and relieved that the baby is here. There is no critical time by which you should have this feeling of a bond with your baby. For some mums it simply takes longer than it does for others. The key thing is to work on building that connection with your baby and providing the opportunity for your baby to develop a secure attachment to you.
The role of perinatal mental health clinicians is to support the mother-infant relationship. We have seen how all women are able to develop a link with their child, if this is something that they would like to do. Whilst being depressed or anxious can create a barrier to the development of this relationship initially, it is still possible for this to develop over time. Some mums will describe an overwhelming feeling of love for their baby as soon as their baby is born, but this is the exception rather than the rule. For most mums they simply feel exhausted, tired and relieved that the baby is here. There is no critical time by which you should have this feeling of a bond with your baby. For some mums it simply takes longer than it does for others. The key thing is to work on building that connection with your baby and providing the opportunity for your baby to develop a secure attachment to you.
All of our work and interventions at Maudsley Health are designed to be non-judgmental of the situation that our patients are in and to work with them to achieve the outcomes that are important to them. We are committed to working with mums with a maternal mental illness to achieve the best outcomes for them and their family.
If left untreated, Perinatal mental health disorders can have significant and far-reaching effects. Without support, negative effects are seen in the experience of motherhood, family dynamics, and the safety, health, and well-being of new moms, as well as of their newborn children.
At Maudsley Health, your Perinatal Mental Health Team (PMH) includes a mental health nurse, clinical psychologists, and consultant psychiatrists. We have the privilege of offering social support in women’s perinatal experiences founded on cultural ways of healing. We work closely to help families go through a personal yet collective period, a unique maybe lonely yet supported journey and a smooth healing experience.
Technology offers a virtual village of support 24/7, yet also adds pressure.
Social media, while offering a platform for support, also feeds into this myth of perfect motherhood, creating unrealistic expectations and increasing feelings of inadequacy.
Gone are the days when women’s only domain was the home; many women now, navigate boardrooms and playdates with equal grace. The concept of the "working mom" has become normalized, challenging beliefs that identify motherhood solely with domestic duties. The constant juggle of career and family can leave one feeling like they are constantly running on empty, battling feelings of guilt and anxiety.
The pressure to excel both professionally and as a parent can lead to feelings of guilt, heightened stress levels and mental health concerns.
Despite these challenges, modern motherhood is characterized by resilience, adaptability and a complex interplay of societal expectations, individual aspirations, and emotional well-being. Mothers today are redefining what it means to raise children in an ever-changing world as they power through each day with love, laughter, and sometimes a caffeine boost. At the end of the day, it's their energy that fuels the next generation.
Whilst this transition is a perfectly normal and common part of human life, we also know that it can be difficult for lots of mums with the added pressures of modern life.
Research from the World Health Organization (WHO) has shown that one in five mums struggle with their mental health during this time - whether it is whilst trying to get pregnant, during pregnancy or in the first year or so after having a baby. This is largely a biological process and so it is likely that these numbers are the same in UAE. Furthermore, many of the social and psychological factors, such as a history of mental health problems or social stressors such as financial pressure are global and therefore experienced by women and their families across the world.
These difficulties occur in a variety of different ways:
- Depression can cover a range of conditions, from fluctuations in mood seen in ‘Baby Blues’ which affects most women and is considered normal, to major depression during pregnancy or post-natal depression
- Anxiety is extremely common during this time period, and when it impacts on your day-to-day function can be part of a generalized anxiety disorder, OCD, or health anxiety, or may prevent you from feeling able to get pregnant as seen with tokophobia.
- The most severe form of maternal mental illness is Postpartum Psychosis which affects 1 in 500 births each year around the world.
Unfortunately, not all attempts to have a baby are successful, or the journey to parenthood may have been long and complicated, whether this is due to fertility difficulties, recurrent miscarriages, traumatic pregnancies and births - all of which will have an impact upon your mental well-being as it can be linked to Trauma and Loss.
All of these experiences can feel overwhelming, and help is available. In some cases, these conditions can be preventable with early assessment and intervention. This does not always mean medication, and great relief can be found through talking therapies.
Maudsley Health have established the first highly specialized maternal mental health service for the UAE. Our multi-disciplinary team consists of experts from around the world, including nurses, psychologists and psychiatrists, who have been working in maternal mental health services for decades. We are very proud at Maudsley Health to have this collection of experts at your disposal! We have the privilege of offering evidence-based treatment and support in women’s perinatal experiences taking into
account the local Emirati culture, and the diverse communities that we serve.
Come and talk to us and let us support you through this life-changing time - giving you the best start at motherhood and giving your baby a healthy beginning.
When we consider a woman’s mood in the perinatal period then we think about antenatal depression (depression that occurs during the pregnancy), postnatal depression (depression occurring any time in the first year after having a baby) and we also think about the very common, but sometimes distressing Baby Blues. For all of these conditions, it is important to not just think about them as medical disorders, but to consider them in the context of adapting to motherhood, and therefore need to consider the impact on the mother-infant relationship.
At Maudsley Health we can support in all of these eventualities and it is something we are very familiar with. Let’s start the conversation and then we can develop a plan together to consider how we can best help you, your baby and the whole family.
Depression during pregnancy
Although we commonly talk about PND or postnatal depression, for the majority of women who have postnatal depression, their symptoms actually started during pregnancy (or even before that for some women). In fact, untreated ante-natal depression is the biggest predictor of postnatal depression.
Ante-natal depression is very similar to depression at any other time. The main symptoms of depression are low mood, loss of interest in things that you used to enjoy, loss of confidence or self-esteem, feelings of guilt, loss of concentration, feeling agitated or slowed up. There are other symptoms such as feeling tired, changes in appetite, sleep disturbance, which unfortunately can be normal parts of being pregnant, but maybe made even worse if you are depressed on top of being pregnant. It can also happen alongside perinatal anxiety.
On top of these typical symptoms, you can also have specific symptoms because you are pregnant - such as not being able to prepare for the birth of your child, not being able to process the pregnancy and develop an ante-natal bond with your unborn child, struggle to look after yourself adequately - not able to attend to your self-care and also to the additional tasks you will have such as attending obstetric appointments etc. Unfortunately, all of these generally compound to make you feel even more guilty and lower in mood.
For some women this can fit in with their experience of having suffered from a mood disorder before, but for others this could be the first time they have ever felt like this. The usual treatment for depression is psychological therapy and medication. The
thought of medication during pregnancy can for many feels like a real barrier to accessing help - this is something that we at Maudsley Health understand and always respect.
Help is available. It is important to be seen by a perinatal mental health specialist who will have the latest information and knowledge about treatments during pregnancy. They will never insist that you have to take medication when you see them in an outpatient clinic. They will, however, be able to give you the latest information and advice and together you can identify and develop a management plan which works for you. Whatever you decide to do, they will be there to offer support and advice. They will help you to weigh up the risks of taking medication against the risks of being depressed and the impact that both can have on you, on your unborn child and on the rest of your family.
It is important to keep an eye on the future - having a baby is a very demanding role and so it is important that you are as well as you can be when the baby arrives. If it is possible to avoid postnatal depression, then this should be attempted.
Depression after pregnancy (including baby blues)
The Baby Blues are really common and are a real thing. The majority of mums (between 50-70%) will experience a change in mood at about day 3 after giving birth. This can range from feeling overly emotional, tearful for no apparent reason, to feeling really overwhelmed and wondering whether they can adjust to the parenting role. It is really important that this time is recognised and supported - not simply dismissed. Typically, it improves by itself and by day 10 mums are feeling much more settled emotionally. However, when you are in the middle of this experience that may not feel very believable and so it important to have a supportive family around you who can help you through this difficult time.
It is also important to recognise that this is a self-limiting condition. So, if it is continuing beyond a week and it has gone on for more than 2 weeks then it is important to consider whether something else is causing it. Specifically, we would be considering whether you are suffering from post-natal depression. We know that some physical illnesses can mimic depression and so a physical work up is needed with blood tests to make sure there isn’t another cause for your prolonged symptoms. For the majority of women however, a spontaneous, natural recovery from Baby Blues is the typical outcome - so if it is not resolving - seek help.
Postnatal depression is common. For every 100 women who have a baby, between 10 and 15 of them will have postnatal depression. Postnatal depression has the same symptoms as depression at any other time - low mood, loss of pleasure in usually pleasurable activities, loss of confidence and self-esteem, feelings of guilt, loss of concentration, feeling agitated or slowed up. There are other symptoms such as feeling tired, changes in appetite, sleep disturbance, but unfortunately these are all common experiences for new mums but may be made worse if you are also depressed. In postnatal depression these symptoms are classically seen during the first 6 months of having a baby but can go on for much longer.
The reason so much emphasis is placed on postnatal depression is because it coincides with a time in a woman’s life when she has the biggest job in the world - getting to know her new baby and providing care and nurture. Unfortunately, when you are depressed, it can be really difficult to take on new tasks, learn new skills or to develop new relationships and attachments with people - including with your baby.
Support from the rest of the family is really important, but other help is available. It is important to get this help as soon as possible to help to protect the mother-infant relationship and to give all new mums the best opportunity to be the mother they want to be.
It is important to seek help from a perinatal mental health specialist as they will have a greater understanding of the impact of your mental health upon your developing relationship with your baby, as well as being aware of which treatment options are the most appropriate. It is essential that all treatment options consider the needs of the baby as well as of the mother. This means we will only consider medication that is safe for both mother and baby so that you can continue to breast feed for as long as you would like to or are able to. Psychological treatments will focus on the new skills that you are acquiring as a mother and help to support the developing relationship between you and the baby.
Impact on the relationship with baby
Many mothers worry about having a mental illness and the impact it can have on their baby and the relationship between them and their baby. This is made worse when mums are already depressed or anxious, as they already struggle with excessive feelings of guilt and a concern that they may be harming their child. As a result of these fears, many mums will feel that their baby is better off being looked after by others or may fear that if people knew the extent of how unwell they were feeling, then others may feel that their baby is better off being looked after by others.
The role of perinatal mental health clinicians is to support the mother-infant relationship. We have seen how all women are able to develop a relationship with their child, if this were something that they would like to do. Whilst being depressed or anxious can create a barrier to the development of this relationship initially, it is still possible for this to develop over time. Some mums will describe an overwhelming feeling of love for their baby as soon as their baby is born, but this is the exception rather than the rule. For most mums they simply feel exhausted, tired and relieved that the baby is here. There is no critical time by which you should have this feeling of a bond with your baby. For some mums it simply takes longer than it does for others. The key thing, which we can support you with, is to work on building that connection with your baby and providing the opportunity for your baby to develop a secure relationship with you.
All our work and interventions at Maudsley Health are designed to be non-judgmental of the situation that our patients are in, and strengths-based, we work with you to draw on your strengths and achieve the outcomes that are important to you. We are committed to working with mums with a maternal
mental illness to achieve the best outcomes for them and their family.
Trying to conceive, being pregnant, giving birth and becoming a mum are all extremely anxiety provoking stages to go through. Not only is this a huge social change - resetting your relationships with your own family, your partner, your baby, your work life and social group; it is also a time of huge psychological change as you re-define your role as a mother in the context of your own earlier experiences; and a huge biological change as your body is exposed to enormous hormonal changes and physical processes which only happen during pregnancy and childbirth.
It is a lot!
And it is normal to think about all of these changes and to feel anxious about them. However, for some women it can feel overwhelming, and they cannot think about anything else. They can become consumed by these worries and anxieties, and it prevents them from enjoying their pregnancy or from being present in those early months for their baby after giving birth.
For some women they feel anxious all the time and just cannot “switch off” and we see this with Generalised Anxiety Disorder.
For others they have repeated intrusive thoughts or worries which prevent them from making decisions or moving forward until they have completed tasks to ensure their baby is safe. These worries are obsessional in nature and happen with Perinatal Obsessional Compulsive Disorder.
For some the worry focuses on their own health and the health of their baby and they find themselves constantly seeking reassurance for both which can be seen in Health Anxiety.
For others it starts even before they get pregnant where the worry and the fear of a pregnancy is so great, they cannot go through with conception - this is called Tokophobia (morbid fear of childbirth).
Sometimes the phobia is about a specific intervention - such as having to have a blood test - this is known as a Simple Phobia but can be extremely distressing and it does not feel very simple when you have it.
Help is available for all of these conditions. And the starting point is seeking help and meeting with a mental health clinician to talk through your current symptoms, where they fit in the context of the rest of your life and what ‘better’ would look like for you. This way we can develop shared goals to ensure we deliver the treatment which is right for you and meets your needs at this very special, but stressful time in your life, overcoming any impact on the relationship with your baby.
Generalised Anxiety Disorder
Generalised anxiety, as its name suggests, is a feeling of anxiety and anxiousness which is present for much of the time. There is no clear reason for it, but there is a feeling of being on edge, waiting for something bad to happen and a general sense of doom. It’s difficult to switch off from this feeling, reassurance may help for a period, but this is short lived and the feeling of worry quickly comes back again.
It can prevent women from going out of the house, mixing with others or doing their normal day to day activities with their baby. Gradually the world becomes much smaller as there are more and more people, activities or places that are avoided in an attempt to prevent the feeling of anxiousness. This avoidance can even include their own baby. Sometimes parents and parents-to-be experience panic attacks which can be terrifying and reinforce the need to reduce interactions and activities. This can make the adaptation to being a mum incredibly hard and impact on mum’s confidence as a mother with their new baby.
Help is available. This starts by a full assessment to make sure we understand exactly what the difficulties are, how you feel things could be improved and developing a treatment plan which feels comfortable to you. We can be by your side throughout this journey. Medication is not the only answer. Talking Therapies have lots of evidence to say that they are helpful, and we can guide you through these options. If you or a loved one is struggling, please be aware that help is available, and we will work together to make things better and manageable.
Obsessive Compulsive Disorder
For some women during pregnancy and after having a baby, their anxiety presents in a very specific way. This is characterised by lots of intrusive worries, thoughts and images about what could possibly go wrong. To some extent this is normal - most mums will experience having an intrusive thought or image of dropping their baby for example, but for most mums they are able to knock the thought away and it has very little impact on the rest of their day. For some mums though, these thoughts become very “sticky” - no matter how hard they try, they cannot shake the thought. In fact, the harder they try, the more intrusive and stickier the thought becomes. They start taking extreme steps to protect their baby and sometimes these steps do not make sense to them nor to anyone else, but they cannot stop themselves from doing it ‘just in case’ something bad should happen.
Many mums find it hard to disclose their thoughts as they fear others will think that they would want to harm their baby in some way - in reality for mums with OCD, these thoughts are the very last thing that they want to do, and they go to extraordinary lengths to protect their child. It’s okay to tell others what you are experiencing, and help is available.
If you are struggling with unwanted thoughts or images, then please come and talk to us. This has an impact on many new mums, and we can help and support you through this. Things can and do get better. Normally a combination of medication and talking therapy in the form of Cognitive Behavioural Therapy is life changing - enabling you to be in control of your thoughts again and allowing you to carry on focussing on being a mum again.
Health Anxiety
For some, the anxiety focuses specifically on their own physical health, or that of their baby. This can be seen by repeated presentations to see the obstetrician, gynaecologist, paediatrician, etc. Their concerns grow and it is impossible to feel satisfied with the advice that has been given. There is a general feeling of “what if they have missed something,” ‘what if I am really unwell” and many other “what ifs…” This can happen both for women who do have a physical health condition and for those who don’t but are instead extremely worried about developing one.
These situations can be extremely complicated, and it is important not to dismiss the worry, but simply to work through it to make the worry feel more manageable. This will often require co-working with the physical health specialists to make sure any physical health problem is being managed adequately whilst simultaneously working with our team to develop strategies to manage what is an anxiety provoking situation.
Tokophobia
Childbirth is an amazing process, but this does not prevent it from being scary. For first time mums it is an unknown, potentially life-threatening event and as a result anxiety is normal when anticipating it. For mothers who already have children, then previous traumatic births can make the prospect of having another birthing experience very anxiety provoking.
For both groups of women, these feelings can be so extreme that they will go to any lengths to avoid being pregnant or having to go through a vaginal birth. Not only can these feelings be associated with extreme anxiety, they can also be accompanied by feelings of shame or inadequacy as a woman. It is important therefore, that these feelings are listened to and validated and that any birth plan takes these feelings into account.
Members of our maternal mental health team can help mums to develop strategies to manage their anxiety. We can also liaise with other health care providers to contextualise the anxiety to ensure that a safe birth plan is offered for both mother and the baby.
Simple Phobia
Some people have lifelong fears which can get in the way of doing things. During pregnancy this can be particularly debilitating when they are linked to medical interventions. For example - needle phobia or fear of blood is common and can make having the appropriate assessments and intervention during pregnancy really difficult to tolerate. The fear of vomiting is another common example which can be particularly overwhelming during pregnancy. When this is on top of all the other anxieties that can occur at this time, it can feel even more overwhelming. Psychological treatments for these phobias are extremely successful and so it is worth identifying these potential barriers early, so that treatment can be given in a timely way to make the rest of the pregnancy and the birth go as smoothly as possible.
What is it?
Postpartum psychosis is a rare but serious mental health problem. It is sometimes called puerperal or postnatal psychosis. Symptoms usually start within a few weeks after giving birth. For some women, symptoms start suddenly but for others it can come on more gradually. It can be an extremely overwhelming and frightening experience. Most people recover quickly with the right care and treatment, so it is important to seek help as soon as possible if you experience symptoms. Symptoms of postpartum psychosis
include:
- Feeling excited, elated or like your thoughts are racing
- Feeling severely depressed
- Feeling like your mood is changing rapidly
- Feeling anxious, irritable or restless
- Having paranoid thoughts or being suspicious of other people
- Experiencing hallucinations or delusions
- Feeling confused or disorientated
- Behaving differently or out of character
You may not realize that you are ill. Your partner, family or friends may recognise something is wrong and need to ask for help.
You can develop postpartum psychosis even if you have no history of mental health problems. But you may be more likely to develop it if you have:
- A family history of mental health problems, particularly a family history of postpartum psychosis or bipolar disorder
- A diagnosis of bipolar disorder or schizophrenia
- A traumatic birth or pregnancy
- If you have experienced postpartum psychosis before
If you are at a higher risk of developing postpartum psychosis and are pregnant or planning a pregnancy, it's important to talk to your doctor. You should do this even if you have no symptoms.
More information on Postpartum psychosis can be found via Action on Postpartum Psychosis (APP) (https://www.app-network.org/)
This can be because it can be extremely challenging to conceive in the first place and many couples will experience conception difficulties, with the agony of repeated negative pregnancy tests every month, followed by the trials of various forms of IVF to assist conception.
For some, conception may occur so that the highs of being pregnant are experienced only to be cruelly dashed by a pregnancy loss – either with a miscarriage or a later stillbirth or even an infant death.
For some, the experience of pregnancy can be extremely traumatic, with multiple interventions due to physical complications and for others it can be the actual birth which is extremely traumatic.
For between 2 and 4 babies born out of every 100, they will have some sort of physical difficulty. Adjusting to the needs of a new baby is hard, but adjusting to the needs of a new baby with specific challenges can be even harder. This requires an adjustment from what was expected to what the reality of the situation is.
All these traumatic experiences are challenging. And many mothers feel as though they just must cope and carry on regardless, and that to complain would be a sign of ingratitude for what they do have. It is okay to be kind to yourself. If your experience has been different from what you had expected, it is okay to feel disappointed and to take some time to process this. For others, it is far more than just a sense of disappointment but is a Post-Traumatic Stress response as seen in PTSD, with persistent heightened anxiety, avoidance of certain triggering situations and experiences, recurrent nightmares and flashbacks to the extreme event.
Help is available for all these outcomes – to help you to adjust to your new reality and to overcome some of the typical trauma responses that you have experienced which are a biological response to the trauma you have endured. An assessment of your difficulties is the starting point and will help to ensure you are guided to the right treatment options for you.
Birth trauma
Giving birth is a major physical event, with the human body going through extreme changes in a relatively short period of time. The miracle of childbirth does not always go smoothly and at times events can feel out of control and it can feel terrifying. For some this can lead to them experiencing anxiety which can be ongoing and can require additional intervention. For other women and families present, there can be a genuine fear that they, or their baby, may not survive the birthing experience.
These types of experiences can leave a psychological mark on those experiencing it and also for those witnessing it. This can be characterised by an inability to stop thinking about the event. Even when they are distracted from these thoughts, they will suddenly come back to their mind when triggered by something that reminds them of the event. This can interfere even with their sleep and so they will have nightmares and repeated dreams of the event. It is difficult to switch off from the experience and they are constantly on the lookout for something else to happen which is equally catastrophic, placing them on high alert and in a constant state of anxiety and panic. These feelings will make the adaptation to parenthood even more difficult and often the baby themselves can be a source of the trigger to re-living the event and increasing anxiety.
All of this can feel like a bad dream, and it can feel difficult to conceive of a way out of it. The common response is to try to avoid anything which is triggering and to simply avoid talking about it or letting people know what is happening. Unfortunately, this does not make the feelings go away and simply restricts your day-to-day experiences.
Seeking help can be extremely hard. It is important to seek help from clinicians who are aware of what you are going through and have the expertise to deliver interventions that can help you, your baby and the family. Gradually talking about your difficulties in a supportive environment is the first step. There are a range of evidence based psychological therapies for birth trauma. A specific plan can be put into place which feels acceptable to you and will allow you to progress forward.
Conception difficulties
Trying to have a baby isn't always straight forward. The journey can be plagued by monthly disappointments and setbacks. For some this means that after much trying, additional help is required. Assisted conception comes in various forms and is commonly termed IVF. However, IVF is just one form of assisted conception or fertility treatment. This again is a stressful situation as you embark upon the medicalisation of an otherwise natural event. Again, it can be characterised by setbacks and disappointments, made all the worse as so many people are now involved and aware of the difficulties you have been facing.
A much-wanted pregnancy which has followed several unsuccessful attempts, often acquires an even greater significance than other pregnancies. There is the added pressure to ensure the baby is okay and safe. This is often associated with an increased anxiety and sometimes an over-protectiveness of the unborn child which then persists once the baby has arrived. We also often see, women placing high levels of pressure and expectations on themselves as a mother, with an unrealistic expectation that they should cherish and be grateful for every moment of motherhood. This can make it feel very difficult for them to talk openly about the ups and downs, and challenges that every mother experiences.
It can be hard to come to terms with these struggles, and often it can be hard to share with others in your family as you do not wish to burden them or worry them. In fact, talking to friends and family is a very good thing to do. It can help to relieve some of the worries that you may have. Sometimes this is not sufficient and the worries and anxieties that you hold are more in-keeping with a perinatal anxiety. In which case further professional help may be indicated.
Talking to us at Maudsley Health will help you to process what you are currently experiencing and to decide on the right way forward.
Conception difficulties
Not all pregnancies end with the birth of a baby. Pregnancy loss is extremely common. Between 10 and 20% of pregnancies will end in a miscarriage depending upon your age and other factors. A miscarriage is the loss of the
baby at any stage up until 24 weeks, but most frequently happens in the first 12 weeks of pregnancy.
Miscarriages are not something which are commonly talked about – even though so many women will have experienced them. We invest a lot in our pregnancies from the very beginning and so their loss, even just a few days or weeks after finding out about the pregnancy, can be severely felt. These feelings are compounded if we do not feel that we can talk about the loss or share it with others. It is exacerbated further if these shared feelings are not validated or are minimized in some way.
Everyone will respond to these losses in different ways. There is no right or wrong way to respond and often we have no choice as we automatically respond to these experiences without consciously thinking about it. It is important to take time and to look after yourself. If the feelings of grief or sadness about the loss do not pass, then it could have triggered a perinatal depression. Sometimes the loss can result in heightened anxiety. Either way additional help is available at Maudsley Health.
The loss of a baby after 24 weeks into the pregnancy is called a still birth. There are a whole range of medical reasons why this may have occurred, but sometimes the reason for this remains unknown, which can be incredibly difficult for families to manage. This is much less common than a miscarriage. A stillbirth is often hugely shocking and distressing, as the plans and expectations for a birth and a baby are well underway. This can hit like any other bereavement, and it is important to allow time to grieve and to process what has happened. Again, sometimes this natural bereavement process can feel "stuck" and if so, professional help may be required. For others this bereavement process can coincide with another subsequent pregnancy, and this can create conflicted emotions, as you grieve the first baby, but try to prepare for the next. Professional help can help to process these conflicted emotions.
Adjustment to a sick baby
Not all pregnancies result in a healthy baby. In fact, between 2 and 4 babies in every 100 babies will have some sort of congenital anomaly which has an impact on the health of the baby. This could be a heart defect, cerebral palsy or a genetic disorder such as Down's Syndrome for example. None of these difficulties are anticipated at the point of conception and so for many parents it will feel like a shock and at odds with their expectations of being a parent. Therefore, it can sometimes feel like a loss, they may feel like they lost their opportunity to have a healthy baby.
It can take time to adjust to the new situation. It is important to acknowledge these feelings and to be kind to yourself as you adapt to your new baby. For some people the emotions and feelings that they have can feel confusing and make them feel guilty or ashamed. These responses are automatic responses, and we have little control over them. The key aspect of this is to simply acknowledge that this is how you feel and then to consider how you
would like the feelings to be different. Working with members of our specialist team can help you to process these feelings and to come to terms with the changes that have happened.
Interpersonal trauma
Interpersonal traumatic events are defined as traumatic experiences that either included the perinatal woman or someone close to them, and they can happen before, during, or after the perinatal period. These interpersonally traumatic experiences can have a substantial negative impact on women and could be connected to pregnancy-related issues (like pregnancy loss) or unrelated issues (like childhood trauma, conjugal violence, sexual assault and others).
Interpersonal traumas can be prevalent among expectant and new mothers and have been shown to significantly affect women's mental health. These experiences could distort mothers' views of the parent-child bonding, their parenting behaviors, and the behavioral and emotional development of children.
Research has linked traumatic experiences to a host of unfavourable consequences for pregnant and postpartum women. These include physical health issues like vaginal bleeding and elevated blood pressure, psychological issues like anxiety, depression, posttraumatic stress disorder (PTSD), and postpartum depression, as well as complications during birth.
Using a trauma informed approach based on emotional and social support, our perinatal team can offer early detection of at-risk families and help put in place preventative measures to help caregivers receive the therapy needed to stop the pattern of intergenerational transmission of maltreatment and psychiatric vulnerability for the infant.