Chapter 26 Perinatal Mental Health
Stress/anxiety and domestic abuse
Women are affected emotionally and socially on many levels. Women in abusive relationships are particularly vulnerable. Approximately 30% of domestic violence and abuse begins or escalates during pregnancy or following childbirth.
The transition to motherhood
Postnatally, parents may find coping with the demands of a new baby, infant feeding, financial constraints and adjusting to changes in roles and relationships particularly testing emotionally. Disturbed sleep is inevitable. Soreness and pain from perineal trauma will affect libido; so too will the feelings of exhaustion, despair and unhappiness that may be associated with the round-the-clock demands of caring for a new baby.
Normal emotional changes during pregnancy, labour and the puerperium
It is perfectly normal for women to have periods of self-doubt and crises of confidence. They may experience fluctuations between positive and negative emotions, as described below.
Labour
For many women, labour will be greeted with varied emotional responses such as:
great excitement and anticipation to utter dread
fear of technology, intervention
fear of hospitals, illness and death
tension, fear and anxiety about pain and lack of control
concerns about the baby and ability of their partner to support/cope
Women’s perceptions of control during labour are influenced by:
The puerperium
Normal emotional changes are complex and may encompass the following:
Relief labour is over – others may convey a cool detachment from events.
Contradictory and conflicting feelings from joy and elation to exhaustion and helplessness.
Closeness to partner and/or baby or disinterest.
Desire for prolonged skin-to-skin contact and early breastfeeding.
Fear of the unknown and realisation of overwhelming responsibility.
Exhaustion and increased emotionality.
Pain (e.g. perineal, nipples).
Increased vulnerability and indecisiveness.
Postnatal ‘blues’
This normal and transient phase is experienced by 50–80%, of women depending on parity. The onset typically occurs between 3 and 4 days postpartum, but may last up to a week or more, though rarely persisting for longer than a few days. The features of this state are mild and transitory and may include a state in which women usually experience labile emotions. The actual aetiology is unclear but hormonal influences seem to be implicated, as the period of increased emotionality appears to coincide with the production of milk. Although the condition is self-limiting, the midwife must be vigilant as persistent features could be indicative of depressive illness.
Emotional distress associated with traumatic birth events
Over recent years the label ‘post-traumatic stress disorder’ (PTSD) has emerged in midwifery practice. Many women will eventually overcome the stress, pain and trauma that might have been their birth experience. However, others may find their birth experience blights their life and affects relationships with their partner and baby.
Perinatal psychiatric disorders
Perinatal psychiatric disorders encompass those that develop during the perinatal period as well as pre-existing disorders. Midwives are recommended to routinely ask at early pregnancy assessment about previous mental health problems, their severity and care. For example:
During the past months, have you often been bothered by feeling down, depressed or hopeless?
During the past months, have you often been bothered by having little interest or pleasure in doing things?
A third question should be considerd if the woman answers ‘yes’ to initial question.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
