Prenatal (Antenatal) Depression
‘At any one time during pregnancy one in every ten women will be depressed and around one in every thirty will be depressed in pregnancy and the postnatal period.’
– Dr Vivette Glover, Director of the foetal and neonatal stress and research centre.
It is only within the last twenty years that prenatal (antenatal) depression has been associated with pregnancy. Prior to this, postnatal depression was the only ‘depression’ linked to pregnancy. Women who seek help for prenatal (antenatal) depression are often told that it is ‘just your hormones’. This is patronising and offers very little help to the sufferer.
Sufferers have often described prenatal (antenatal) depression as a nine month tunnel of doom, anxiety and despair, which makes for a stark contrast to the celebrated and expected joyful, happy time full of excitement and anticipation.
Common symptoms for prenatal/antenatal depression:
- Chronic anxiety
- Incessant crying
- Lack of energy
- Relationship worries: worrying their partner may leave once the baby is born
- Conflict with parents: pregnancy can often stir up emotions regarding their own up bringing
- Fear to seek help
The causes can often be broken down into three main areas; physical, emotional and social.
If you imagine waking up having gained two to three stone in weight, your breasts swollen to the size of two painful melons. You get up in a rush, leap out of bed, only to collapse to the floor overcome by dizziness and nausea. Your bladder feels like it is going to explode and after going to the bathroom, it feels the same. You look in your wardrobe for something to wear, only to be able to find a tatty old pair of leggings and an oversized jumper which you used for painting. Walking downstairs becomes exhausting and you get out of breath because your lungs, along with the rest of your internal organs, are now sat in your ribcage. Your heart is working 40% harder and this is all without mentioning your hormone levels, which, let’s face it, are through the ceiling. This may sound like a nightmare, but this is the biological reality of pregnancy.
During pregnancy the hormones oestrogen and progesterone rise in volume by 30-50 times. The immediate effects are the increased need to urinate, breasts swelling and ‘morning sickness’. In pregnancy this ideally creates a sense of wellbeing or maternal ‘bloom’. However, in some pregnancies the placenta doesn’t produce enough of the hormone progesterone. This does not have any effect on the baby but can lead to feelings of depression in the women.
A side effect of hormone imbalance is nausea. For a considerable amount of women it is more than ‘morning sickness’, it lasts all day and often for the full nine months. Permanently feeling sick can cause a lot of discomfort.
Iron and zinc
Deficiencies in minerals such as iron and zinc have both been linked to depression. As pregnancy can cause such deficiencies in these key minerals, it is crucial that the diet is full of iron and zinc rich foods. Vitamin C is also essential as this aids the absorption of iron into the body.
None of us like gaining weight and yet in pregnancy we are expected to put on at least 2 stone and feel radiant about it. Weight gain can have a severer effect on a women confidence, leading to feelings of worthlessness and low self-esteem. As well as psychological effects of weight gain, it can also be extremely uncomfortable.
By the last two months of the pregnancy simple tasks such as walking up stairs becomes a major challenge.
Often women who seek help during pregnancy querying they have prenatal (antenatal) depression as told that their mood swings are down to hormones and there is very little which can be done to help. Whether it is the first pregnancy or the fifth, there are still emotional implications of bringing a new life into the world.
The first time pregnancy involves a complete life change, whether this is social or psychological. They have gone from being someone’s sister or aunt to a mother. Problems with their partner and parents may be magnified, and the relationships with friends may change overnight, causing more stress on the women.
Even if you are already a parent, the fear of how they will cope with having another child, can cause feelings of depression.
If you have suffered a miscarriage or stillbirth previously it is inevitable that any further pregnancies will be met with anxiety and fear. It isn’t just anxiety which can lead to depression; the pregnancy can stir emotions of loss and grief. It is hard to imagine the level of fear and grief which any one goes through after a miscarriage or stillbirth. It is important when in this situation the feelings are discussed with your midwife or G.P. who may recommend counselling.
The majority of cases of prenatal (antenatal) depression include a degree of anxiety. These anxieties can be very different, leaving the sufferer frantic with worry and overcome with fear. Here are some common statements made by expectant mothers who are suffering with anxiety.
‘I’ll never make a good Mum’
‘My partner is going to leave me’
‘I’m terrified of the birth’
‘There is something wrong with my baby’
‘How will I cope with twins’
‘I feel like I am going mad’
The lack of publicity and support for prenatal (antenatal) depression makes it a terrifying experience, unaware that at least 10 per cent of women are going through exactly the same thing.
Older generation can have the attitude of ‘we didn’t have prenatal (antenatal) depression in my day, we just got on with it’ and with prenatal (antenatal) depression only beginning to be recognise in the 1990’s, we are not encouraged to express our emotions and feelings more than in previous years. This may mean that different generations of mothers were unable to express how they were feeling whilst pregnant.
In previous years there may have been four generations of one family living side by side, but now families are smaller and living further and further apart. The lack of support from family can be hard meaning the parents are unable to have a ‘break’.
Women are under more pressure to succeed in the world of work, it can be hard to juggle a full time job along with family. The important thing is for women to remember it isn’t impossible to have it all. Just becomes easier if you don’t try and have it all at once. There is nothing wrong with having a career break nor if you wanted to return to work straight after the birth of the baby. Every women has different needs, however, during pregnancy these are mostly the same of staying calm and relaxed.
More women have to face pregnancy and birth alone, without having a partner at their side. To cope with both can be a very daunting experience.
Financial problems are well known cause of distress and depression, so it isn’t surprising that it can be linked to prenatal (antenatal) depression. In any pregnancy magazine, there will be pictures of brightly coloured nurseries, with new toys, clothes and fancy furniture. This adds more pressure on the expectant mother. They may set an expectations that ‘everyone’ provides a brightly colours nursery for a new born. The worries of not having the finances to provide for a new born can cause depression.
Although the majority of cases of prenatal (antenatal) depression disappear with the birth of the baby, in one third of cases a mother goes on to suffer from postnatal depression. This highlights the importance a treating the depression during pregnancy for the sake of child and mother in the postnatal period.
Talk to your GP or midwife about how you are feeling, they will be able to assess whether you are suffering from prenatal depression. Your GP may recommend having counseling to help you come to terms with your emotions.
Prevention of antenatal depression is preferable to treatment and dealing with the depression will reduce the incidence of postnatal depression developing. Suggestions of preparation for motherhood:
- Are you psychologically prepared to take on motherhood? What kind of parent do you think you will be? What are you looking forward to?
- Explore your family history including your marital relationship and your relationship with your Mother. How do you want to Mother? Is this similar to the way you were Mothered or different? What are your fears?
- Take your own needs seriously. Take care of yourself by seeking support early and anticipating your needs with housework. What do you need in order to Mother a child? What will you be giving up? What will you gain?
- Share concerns as a couple. Discord and unwanted pregnancy will both contribute to stress and is a key factor in postnatal depression. Do you feel supported by your partner?
- Seek professional help early if needed especially if depression has been a long standing issue. Becoming a Mother is an underestimated life change.
- Talking through issues with your partner, family or friends is a good source of emotional support.
- Call Pandas Help Line for a confidential and friendly way to talk about your feeling and any concerns.
- Talk to your family and friends about how you are feeling, don’t be scared to admit that you are unhappy with the pregnancy.