About Maudsley Health

Trying to conceive, being pregnant, giving birth and becoming a mum are all major life events. It is little wonder that this is the time in every woman’s life when they are most likely to struggle with their mental health and well-being. Specifically we know that a woman’s mood can be especially affected. But we also know that it be linked to perinatal anxiety and other trauma responses.
 
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 during the 6 months - 12 months 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.

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.