Are these numbers really confronting for you? That almost 1 in 4 mums-to-be report anxiety in pregnancy (and studies have shown that anxiety escalates/increases over time in pregnancy, peaking in the third trimester - leaving mums ripe for a postnatal anxiety/depression diagnosis). That over 1 in 10 mums experience depression in pregnancy? That it's not all about glowing in pregnancy or warm, snuggly newborns after birth?!

If you are thinking, why should you care about perinatal mood disorder? Well, if you’re a mum, or a mum-to-be, you will feel like absolute shit, emotionally (excuse my French, but need to emphasise it). If you’re a partner, or a health professional, it’s because mums will feel like absolute shit, if they have it. And unfortunately, there are studies showing that there can be an effect on the baby/child when their parents are not well. A really big concern is the effect on parent-infant attachment (i.e. bonding), but also a baby’s cognitive, behaviour, social and motor development[1]. So not only does a mum feel absolutely terrible at this time, but her baby is at risk. And we have all heard the awful news stories of when a parent’s mental health suffers to the point that they and/or their children are at risk of danger. This is the rare, but extreme reason to care about perinatal mood disorders.

Right, so we are getting really heavy in this article. To lighten it up a bit, let’s talk about that old saying of “prevention is better than cure”. Yes – what do we know about what helps to reduce the chance of developing perinatal mood disorder?

​

In a systematic review (a study that summarises the results of available healthcare studies and provides the highest level of evidence on the effectiveness of healthcare interventions) on interventions designed to prevent postnatal depression, the only one that showed a clear preventative effect was intensive support from a health professional in the postpartum period[2]. Here’s the problem: this (generally) doesn’t happen in Australia (and I’m not aware of anywhere that offers this as part of standard maternity care). In Australia, most women birth in the public system, usually by a team of health care professionals but without continuity of carer. Mums are discharged home within a few days of birth, they might get one or two home visits by a midwife and then a maternal and child health nurse (MCHN) will visit around 1-2 weeks after birth (and then it’s up to mum to visit her MCHN after that). No continuity, definitely not intensive, and debatable as to whether this can be called ‘support’! In the private sector (care by obstetrician), mums get continuity of carer in pregnancy, generally their hospital stay is a few days longer after birth, but the trade-off is there is no midwife home visiting service (although some private hospitals/obstetricians are beginning to offer this). Then the standard MCHN consults apply. Still no intensive support after birth! So how can you take advantage of the fact that intensive support from a health professional in the postpartum period is proven to prevent postnatal depression? Engage in a private midwife or doula, or even a student midwife, to provide this. It is worth noting that doulas and students are not registered qualified health professionals, but a good one is still worth her salt at this time. If you run into troubles, they can help recognise this (particularly if they can work with you during pregnancy) and will know how to get you good help. Whilst there are other preventative strategies, the research tends to show that they work for some women sometimes, and other women not at all – making it really hard to tailor to each individual mum based on her, where she lives, and her access to services and so on.

Another way to go about preventing perinatal mood disorders in a way is to reduce your risk factors, where you can. So, what is the biggest risk factor for developing anxiety/depression in pregnancy (bearing in mind that this is a precursor to the conditions being present in the postpartum period)?

​

Lack of support[3]. Not previous mental illness, not stress, not money, not relationship worries, not smoking (although these can be linked to perinatal mood disorders as well), but just a lack of support.

​

This almost shocked me in a way, because I thought “what if the whole of Australia knew that they only had to drop off a meal to a new mum, or check in via text to see how she’s going, or meet her for coffee, or hold the baby while she sleeps, or bring in her mail, or fold the washing”…or endless other things to reduce her mental load, and therefore her risk of psychological distress. Ask her what worries her during pregnancy. Ask her if her midwife/OB is listening to her, hearing her concerns. Talk to her partner about providing support to her. Ask what you can do to help! Creating a mama’s village for her (rather than making her do all the work to create her village) will no doubt go a long way to reducing her biggest risk factor – lack of support. Side note – if you are a partner or family member, READ THIS to understand what I mean about the mental load.

 

So that in mind, what IS perinatal mood disorder? How can you spot it, if you're a mama, partner, family member, health professional? This is important, because if I can illustrate with my own example after birth, I had many health professionals use the term 'postnatal depression' with me, but I felt anything but depressed. I felt wired, panicked and on edge the whole time, but not depressed. In retrospect I also developed some obsessive compulsive tendencies. With the help of hindsight, this is why I think perinatal mood disorder is a better suiting term to use (it's more generalised).

Well, instead of listing a whole heap of text, here's an infographic that contains common words and themes, and if you recognise these in yourself or someone you know, you need to follow the steps below to get help!