The Perfect Storm: Understanding Perinatal Mental Illness
This is the first blog of our Maternal Mental Health series. For the next six weeks, dear reader, you will read about the often misrepresented, largely misunderstood world of maternal mental illness. We will publish stories from lived experience perspectives and give you the researcher or clinician's perspective on the topics of perinatal OCD, postpartum psychosis, clinical and community mental health support, and childbirth-related post-traumatic stress disorder, and we will close with a final interview led by Dr Jodi Pawluski. We hope that this series brings you a greater insight into maternal mental illness and demystifies its prevalence, symptoms, experiences and outcomes for mothers and their families.
There are many misconceptions about pregnancy and motherhood. Perhaps the biggest one is the idea that becoming a mother is an inherently happy time for a woman. It isn’t.
I’m a neuroscientist, therapist and author who focuses on understanding how the brain changes with the transition to motherhood and perinatal mental illness. I also like to talk about all things Mommy Brain.
I recently sat down with Prof Carmine Pariante, Editor in Chief of InSPIre the Mind, Professor and perinatal psychiatrist, to talk about mental illness during the perinatal period — beyond postnatal depression — to bring our awareness to the range of illnesses that a mother (and father) can be faced with. (You can find a recording of our conversation on my podcast Mommy Brain Revisited episode #33.)
Perinatal Mental Illnesses
We talk about postnatal depression quite a bit these days, which is a significant improvement compared to even 5 years ago, but what about other significant mental illnesses that mothers struggle with?
As it turns out, there are a number of mental illnesses that occur during the transition to motherhood — either during pregnancy or the postnatal period — that often occur together and may have started prior to pregnancy.
These illnesses include “depression, anxiety, eating disorders, substance abuse, bipolar disorder, and OCD,” says Pariante. There are also two less common mental illnesses that occur only during the postpartum period — Postpartum Psychosis and Childbirth-related PTSD.
Over the course of this Perinatal Mental Health series, we will focus on anxiety and OCD, Postpartum Psychosis and Childbirth-related PTSD.
Many Moms Have Scary Thoughts
Recent research states that clinical levels of anxiety exist in 13–21% of pregnant women and 11–17% of postpartum women in the western world. That’s nearly 1 in every 5 moms, and we believe these numbers are underreported, with the actual figure being considerably higher.
This perinatal anxiety can take the form of constant worry about the well-being of the baby or doubting one’s ability to be a mother. It can be coupled with physical symptoms such as heart palpitations, sweaty palms, or feelings of panic.
Other moms will struggle with obsessions which take “the form of unpleasant distressful images” says Prof Pariante, and are part of what we call OCD (and can occur without any compulsions). Obsessions in mothers are often thoughts of harming the baby — which are incredibly distressing and can result in a mother not wanting to be near her baby.
It’s important to know that obsessive thoughts are not related to actions. The thoughts are about things that could happen, but never will.
Unfortunately, mothers struggling with obsessive thoughts are unlikely to share how they are feeling with those around them or a health care provider, for fear of the reaction of others. Dr Pariante urges moms to talk about these thoughts with health care specialists in perinatal mental health, to learn how to manage them.
Beyond Scary Thoughts
The most severe mental illness occurring with motherhood is Postpartum Psychosis. It occurs in 1–2 of every 1000 women, “usually occurring quite predictably within about 2 weeks postpartum, and most often in women with a history of bipolar disorder,” says Prof Pariante.
Often not feeling the need to sleep is an early sign that something could be wrong. This coupled with other symptoms such as racing thoughts, paranoid feelings, feeling very energetic, and believing in ‘signs’ from the world around you, are indications that it is time to talk to a health care professional.
This illness requires immediate medical and psychiatric intervention, and is treatable.
The Impact of Birth
The experience of birth itself can contribute to perinatal mental illness and in certain cases results in childbirth-related PTSD — affecting 1–2 of every 100 women.
We know that many women do not have the birth experience they thought they would — perhaps due to unrealistic expectations, lack of education about the process, or being the victims of medical procedures or neglect.
When I spoke with Prof Pariante about the impact of the birth experience on perinatal mental illness, he talked about how important it is to acknowledge that trauma at birth can contribute to mental health outcomes, but there are often additional contributing factors involved in a diagnosis of perinatal mental illness.
The Perfect Storm
What are the causes of perinatal mental illness? “Every woman has a slightly different story,” says Prof Pariante, but there are common threads in these stories that can provide us with answers. First of all, there is no denying that maternal mental illness is “largely driven by psychosocial circumstances,” Pariante states, “Women in the perinatal period are the most vulnerable members of our society.” I couldn’t agree more, yet what are we doing about it?
Second, there is always a biological component, and if you know me, I’m always looking for a neurobiological component. Pregnancy and the postpartum period involve a number of changes throughout our body and brain, over the backdrop of genetics. These changes, coupled with life experiences, can contribute to perinatal mental illness — we just have yet to understand these biological factors completely.
Third, we have moved away from extensive family and community support for moms. “It’s only been the last 50 years or so where western culture has focused on individualization — doing it alone. This is not how mothering should be,” says Pariante.
I know I’ve probably said this too many times, but it does take a village to raise a child. It must.
It’s Not a Mother’s Fault
Often our narrative around perinatal mental illness isn’t about how it impacts the mother but how it impacts that developing child. But we need to remember that the majority of children born from mothers with a perinatal mental illness are perfectly fine. There is a strong element of resilience in children — even in severe cases [of perinatal mental illness],” says Prof Pariante.
The impact of the mother’s health on the child is important, of course, but mothers deserve support too.
“It’s not a mother’s fault she is struggling,” says Pariante. It is our society’s inability to value motherhood and maternal health — the people that give birth to the next generation.
To learn more about maternal mental illness check out the Maternal Mental Illness Series at InSPIre the Mind every Wednesday and Thursday until the 9th of November.