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Mental health during and after pregnancy

It was sad to read last week’s Mmegi story that a 25 year old mother committed suicide five days after giving birth.

Often, clinic/hospital check-ups during and after pregnancy focus mostly on the physical changes of the mother and child. The mental health of the mothers is rarely actively investigated. This neglect has dire consequences for the mother because pregnancy can trigger episodes of mental illness, and childbirth can lead to postnatal mental illnesses. Also, active episodes of mental illness impact the child’s physical and mental development.

The physiological changes during pregnancy can compromise the mental health women. For example, hormonal changes and disruptions in the normal sleep-wake cycle are associated with an occurrence of an episode of mental illness. Women with severe mental illnesses especially bipolar disorder find themselves at increased risk for such a re-occurrence. Furthermore, changes during pregnancy may interfere with the effectiveness of mental health medication, thus leaving the women vulnerable to a re-occurrence of an episode of mental illness if their medication doses are not adjusted. There are also cases were some women stop taking their medication (especially valproate which is commonly used in bipolar disorder and epilepsy) because such medication has been associated with an increased likelihood of children born with birth defects and disorders like autism spectrum disorder. By stopping the medication, these women have been found to be two or three times more likely to have a re-occurrence of a manic episode.

Psychosocial stressors that come with pregnancy can also be overwhelming for women. Limited support from partner or family, financial demands, changes in a sense of identity, and lifestyle adjustments are some of the stressors that can lead to a occurrence of an episode of mental illness. Society often views pregnancy as a blessing and a gift from God that needs to be celebrated. However, pregnancy can be a very stressful time for some women. Often when some women complain of being overwhelmed they are ignored or rebuked for being ungrateful for the ‘blessing’. Their inability to find a safe space to speak about their stressors adds to their existing stressors. Unfortunately, stressors trigger and exacerbate episodes of mental illness.

Childbirth can also come with its own mental health complications. Up to 75% of women experience ‘baby blues’ after birth. Baby blues are flitting periods of low mood, and a sudden shift in mood. Baby blues are not

an illness, but are a common psychological experience which may start a few days after delivery but generally does not last longer than two weeks. Baby blues are different to postpartum depression, which affects about 10% of women after child birth. Postpartum depression starts later on after delivery compared to baby blues (often with three months of delivery), and it lasts longer (up to a year) than baby blues if it is untreated. Postpartum depression requires treatment (psychotherapy and medication).

Furthermore, a significant number of women experience postpartum psychosis which starts earlier (within two weeks) than postpartum depression and is characterised by delusions and hallucinations. Postpartum psychosis mostly affects women with an existing bipolar disorder. Women experiencing postpartum psychosis may initially be restless, agitated and have difficulties sleeping. As time goes on, they become suspicious, hold irrational beliefs, and start hearing voices or seeing people that others can not hear or see. About 5 % of women experiencing postpartum psychosis commit suicide or murder their children.

The above mental health complications can be reduced significantly. Firstly, mental health information needs to be provided to pregnant women and their partners.  Increased information will allow for the early detection and treatment of mental health problems. Secondly, we need to establish Perinatal Mental Health Services in hospitals and clinics across the country. These treating teams comprise of psychologists, psychiatrists, obstetricians, midwives, and mental health nurses. The focus of these multidisciplinary teams will be to screen, monitor and treat mental health problems during and post pregnancy. While we wait for such an increase in information and the establishment of Perinatal Mental Health Services, the public is encouraged to look out for the mental health changes in pregnancy and seek treatment from a nearby clinic or hospital or private GPs, psychologists and psychiatrists.


(insert) Risk factors for Mental Health Problems:

First time mothers

Women with existing mental health problems

Women with limited support and or women who are abused during pregnancy

Anxiety during pregnancy

*Maphisa Maphisa (B.Psych., UB; M.A .Clin.Psych., Rhodes) is a clinical psychologist and lecturer in the Department of Psychology, University of Botswana. The ideas expressed here are solely his and not of his employer. The article is not intended to be a substitute for professional psychological and medical advice.

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